TAILIEUCHUNG - LABORATORY DIAGNOSIS OF PULMONARY TUBERCULOSIS : CONVENTIONAL AND NEWER APPROACHES+

The diagnosis of pulmonary tuberculosis can be made by the detection of acid fast bacilli by direct microscopy, using carbol fuchsin stain and/or fluorochrome stain. Microscopy is a rapid method but lacks sufficient sensitivity and does not distinguish between different species of mycobacteria. The sensitivity of microscopy is often not more than 25-40% as compared to culture, but under ideal conditions, it is possible to achieve a rate of 60-70%. The average rate obtained in India is 12-15%, but microscopy is still the mainstay of the tuberculosis control programme of the developing countries, including India. The fluorochrome stain technique is. | CONTINUING MEDICAL EDUCATION Ind. J. Tub. 1996 43 107 LABORATORY DIAGNOSIS OF PULMONARY TUBERCULOSIS CONVENTIONAL AND NEWER APPROACHES4 . Jain I Inspite of the discovery of the causative agent more than a century back the bacteriological diagnosis of tuberculosis has been a major hurdle in the treatment and control of the disease. Due to its global prevalence the methods available for diagnosis are under rapid development. Briefly reviewed below are the present and the possible future laboratory tools for die diagnosis of pulmonary tubercolosis. MICROSCOPY The diagnosis of pulmonary tuberculosis can be made by the detection of acid fast bacilli by direct microscopy using carbol fuchsin stain and or fluorochrome stain. Microscopy is a rapid method but lacks sufficient sensitivity and does not distinguish between different species of mycobacteria. The sensitivity of microscopy is often not more than 25-40 as compared to culture but under ideal conditions it is possible to achieve a rate of 60-70 . The average rate obtained in India is 12-15 but microscopy is still the mainstay of the tuberculosis control programme of the developing countries including India. The fluorochrome stain technique is better then carbol fuchsin stain method but is very expensive and less specific and is not suitable for adoption as a routine method in our country. CULTURE Culture is considered as the reference method for the detection of tubercle bacilli but mycobacterial culture is laborious expensive and slow. It is worth noting however that not more than 50 of clinically diagnosed patients are confirmed by culture. Traditional culture on Lowenstein Jensen egg medium takes 2-6 weeks. The introduction of other media for culture of tubercle bacilli such as 7H10 and 7H11 agar have resulted in a faster higher rate of detection. These media an commonly used in developed countries and are costly. The radiometric respirometry technique BACTEC is more sensitive and can drastically reduce the .

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