Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
PLoS One. 2011;6(11):e27125. doi: 10.1371/journal.pone.0027125. Epub 2011 Nov 4.
The World Health Organization recommends the roll-out of light-emitting diode (LED) fluorescent microscopes (FM) as an alternative to light microscopes in resource-limited settings. We evaluated the acceptability and performance of three LED FMs after a short orientation among laboratory technicians from government health centers in Zambia. Sixteen technicians with varied light microscopy experience were oriented to FMs and divided into groups; each group read a different set of 40 slides on each LED FM (Primo Star iLED™, Lumin™, FluoLED™) and on a reference mercury-vapor FM (Olympus BX41TF). Slide reading times were recorded. An experienced FM technician examined each slide on the Olympus BX41TF. Sensitivity and specificity compared to TB culture were calculated. Misclassification compared to the experienced technician and inter-rater reliability between trainees was assessed. Trainees rated microscopes on technical aspects. Primo Star iLED™, FluoLED™ and Olympus BX41TF had comparable sensitivities (67%, 65% and 65% respectively), with the Lumin™ significantly worse (56%; p<0.05). Specificity was low for trainees on all microscopes (75.9%) compared to the experienced technician on Olympus BX41TF (100%). Primo Star iLED™ had significantly less misclassification (21.1% p<0.05) than FluoLED™ (26.5%) and Lumin™ (26.8%) and significantly higher inter-rater reliability (0.611; p<0.05), compared to FluoLED™ (0.523) and Lumin™ (0.492). Slide reading times for LED FMs were slower than the reference, but not significantly different from each other. Primo Star iLED™ rated highest in acceptability measures, followed by FluoLED™ then Lumin™. Primo Star iLED™ was consistently better than FluoLED™ and Lumin™, and performed comparably to the Olympus BX41TF in all analyses, except reading times. The Lumin™ compared least favorably and was thought unacceptable for use. Specificity and inter-rater reliability were low for all microscopes suggesting that a brief orientation was insufficient in this setting. These results provide important data for resource-limited settings to consider as they scale-up LED FMs.
世界卫生组织建议在资源有限的环境中推广使用发光二极管（LED）荧光显微镜（FM）来替代光学显微镜。我们在赞比亚政府卫生中心的实验室技术员中进行了简短的培训后，评估了三种 LED FM 的可接受性和性能。16 名具有不同光学显微镜经验的技术人员接受了 FM 培训，并分为小组；每个小组在每种 LED FM（Primo Star iLED™、Lumin™、FluoLED™）和参考汞蒸气 FM（Olympus BX41TF）上阅读了不同的 40 张幻灯片。记录了幻灯片阅读时间。一位经验丰富的 FM 技术人员检查了 Olympus BX41TF 上的每张幻灯片。计算了与 TB 培养物的敏感性和特异性。与经验丰富的技术人员相比，评估了分类错误，并评估了受训人员之间的组内一致性。受训人员对显微镜的技术方面进行了评分。Primo Star iLED™、FluoLED™和 Olympus BX41TF 的敏感性相当（分别为 67%、65%和 65%），而 Lumin™ 明显较差（56%；p<0.05）。与经验丰富的技术人员在 Olympus BX41TF 上（100%）相比，所有显微镜的受训人员的特异性都较低（75.9%）。与 FluoLED™（26.5%）和 Lumin™（26.8%）相比，Primo Star iLED™的分类错误明显较少（21.1%，p<0.05），与 FluoLED™（0.523）和 Lumin™（0.492）相比，组内一致性更高（0.611；p<0.05）。LED FM 的幻灯片阅读时间比参考值慢，但彼此之间没有显著差异。在可接受性测量方面，Primo Star iLED™的评分最高，其次是 FluoLED™，然后是 Lumin™。除了阅读时间外，Primo Star iLED™在所有分析中均优于 FluoLED™和 Lumin™，并且与 Olympus BX41TF 性能相当。在所有显微镜中，特异性和组内一致性都较低，这表明在这种环境下，简短的培训是不够的。由于这些结果，在资源有限的环境中考虑扩大 LED FM 时，Lumin™的表现最差，被认为不可接受。
