Evaluation of mobile digital light-emitting diode fluorescence microscopy in Hanoi, Viet Nam

L H Chaisson; C Reber; H Phan; N Switz; L M Nilsson; F Myers; N V Nhung; L Luu; T Pham; C Vu; H Nguyen; A Nguyen; T Dinh; P Nahid; D A Fletcher; A Cattamanchi

doi:10.5588/ijtld.15.0018

Evaluation of mobile digital light-emitting diode fluorescence microscopy in Hanoi, Viet Nam

Int J Tuberc Lung Dis. 2015 Sep;19(9):1068-72. doi: 10.5588/ijtld.15.0018.

Authors

L H Chaisson¹, C Reber², H Phan¹, N Switz³, L M Nilsson², F Myers², N V Nhung⁴, L Luu⁵, T Pham⁶, C Vu⁶, H Nguyen⁶, A Nguyen⁶, T Dinh⁶, P Nahid⁷, D A Fletcher⁸, A Cattamanchi⁷

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, USA.
² Bioengineering Department, University of California Berkeley, Berkeley, USA.
³ Bioengineering Department, University of California Berkeley, Berkeley, USA; Biophysics Graduate Group, University of California Berkeley, Berkeley, California, USA.
⁴ National Lung Hospital, Ba Dinh, Hanoi.
⁵ Hanoi Health Services Department, Ba Dinh, Hanoi.
⁶ Hanoi Lung Hospital, Hai Ba Trung, Hanoi, Viet Nam.
⁷ Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, USA; Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA.
⁸ Biophysics Graduate Group, University of California Berkeley, Berkeley, California, USA.

PMID: 26260826
DOI: 10.5588/ijtld.15.0018

Abstract

Setting: Hanoi Lung Hospital, Hanoi, Viet Nam.

Objective: To compare the accuracy of CellScopeTB, a manually operated mobile digital fluorescence microscope, with conventional microscopy techniques.

Design: Patients referred for sputum smear microscopy to the Hanoi Lung Hospital from May to September 2013 were included. Ziehl-Neelsen (ZN) smear microscopy, conventional light-emitting diode (LED) fluorescence microscopy (FM), CellScopeTB-based LED FM and Xpert(®) MTB/RIF were performed on sputum samples. The sensitivity and specificity of microscopy techniques were determined in reference to Xpert results, and differences were compared using McNemar's paired test of proportions.

Results: Of 326 patients enrolled, 93 (28.5%) were Xpert-positive for TB. The sensitivity of ZN microscopy, conventional LED FM, and CellScopeTB-based LED FM was respectively 37.6% (95%CI 27.8-48.3), 41.9% (95%CI 31.8-52.6), and 35.5% (95%CI 25.8-46.1). The sensitivity of CellScopeTB was similar to that of conventional LED FM (difference -6.5%, 95%CI -18.2 to 5.3, P = 0.33) and ZN microscopy (difference -2.2%, 95%CI -9.2 to 4.9, P = 0.73). The specificity was >99% for all three techniques.

Discussion: CellScopeTB performed similarly to conventional microscopy techniques in the hands of experienced TB microscopists. However, the sensitivity of all sputum microscopy techniques was low. Options enabled by digital microscopy, such as automated imaging with real-time computerized analysis, should be explored to increase sensitivity.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bacteriological Techniques / instrumentation*
Female
Humans
Male
Microscopy, Fluorescence / instrumentation*
Middle Aged
Mycobacterium tuberculosis
Sensitivity and Specificity
Sputum / microbiology*
Tuberculosis, Pulmonary / diagnosis*
Vietnam