Comparison of Diagnostic Tools; Ziehl Neelsen Staining, Fluorescence Microscopy with Gen-expert for the Diagnosis of Pulmonary Tuberculosis in Resource-Limited Settings Research Article
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Abstract
In resource-limited nations such as Pakistan, pulmonary tuberculosis represents a predominant contributor to disease burden and fatalities. Conventional diagnostic techniques such as Ziehl-Neelsen (ZN) staining, Fluorescence Microscopy (FM), and GeneXpert each have distinct advantages and limitations. This cross-sectional study aimed to assess the diagnostic efficiency of ZN staining, FM, and GeneXpert for the detection of MTB in resource-limited, high-burden settings.
The current study was carried out at the Department of Pathology, Khalifa Gul Nawaz Medical Teaching Hospital, Bannu, Pakistan. A total of n=400 respiratory samples were collected and analyzed through Ziehl Neelsen staining, fluorescence microscopy, and GeneXpert; reference standard. Diagnostic performance metrics were determined for each diagnostic approach. The socioeconomic status of the participants was categorized according to the revised Kuppuswamy scale. Statistical analysis was performed using SPSS v 26.
The GeneXpert identified 19.3% (n=77/400) of the patients positive for Mycobacterium tuberculosis, followed by FM 15.5% (n=62/400) and ZN staining 12%(n=48/400). The GeneXpert emerged as the superior diagnostic method, achieving 95% sensitivity, 98% specificity, 96% positive predictive value, and 97% negative predictive value. The sensitivity and specificity of FM vs. ZN 88% vs.92% and 85% vs.90% respectively. The highest percentages of MTB positive cases were observed in the upper lower 31.2%(n=24/77) and lower 37.6% (n=29/77) socioeconomic groups and decreased consistently among higher socioeconomic tiers. GeneXpert remained a reliable tool for the diagnosis of MTB, with the limitation of infrastructure and associated costs.
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