Added value of bleach for tuberculosis microscopy diagnostic in limited resources setting

Indonesia is one of the high burden tuberculosis (TB) countries. The utilization of molecular diagnostic has been setting over the country, however there are still a lot of remote areas that only depend on microscopic smear. Bleach might be used to increase the value of microscopy diagnostic. The study aimed to evaluate the added value of 1% bleach to increase the positivity rate of TB compared to conventional stain. This study was conducted on 70 subjects who were suspected as TB from various primary care centers in West Java and Banten, Indonesia. The sputum was 2-3 mL, and divided into two parts, both of them were stained using Ziehl-Neelsen (ZN), however the first was only stained and the second added 1% bleach. Bleach was added in same volume with sputum and incubated for 10 minutes. After 10 minutes, the sputum was stained with ZN. The positivity rate for ZN only was 39 (55.7%) compared to 1% bleach was 63 (90%), and significantly different (P=0.000) using Mann-Whitney U test. Bleach can be used as an alternative agent to improve the TB smear in setting that only depends on microscopy diagnostic.