Conventional light microscopy of Ziehl-Neelsen-stained smears prepared directly from sputum specimens is the most widely available test for diagnosis of tuberculosis (TB) in resource-limited settings. Ziehl-Neelsen microscopy is highly specific, but its sensitivity is variable (20-80%) and is significantly reduced in patients with extrapulmonary TB and in HIV-infected TB patients. Conventional fluorescence microscopy is more sensitive than Ziehl-Neelsen and takes less time, but its use has been limited by the high cost of mercury vapour light sources, the need for regular maintenance and the requirement for a dark room.
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