{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:19:04Z","timestamp":1783430344239,"version":"3.54.6"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Ziehl\u2013Neelsen (ZN) staining is routinely used for tuberculosis (TB) diagnosis, but cannot differentiate viable from nonviable bacilli. This limitation is particularly relevant in smear-positive pulmonary TB patients, where assessment of treatment response is essential. Fluorescein diacetate\/ethidium bromide (FDA\/EtBr) viability microscopy detects live\n                      <jats:italic toggle=\"yes\">Mycobacterium tuberculosis<\/jats:italic>\n                      based on metabolic activity. This study compared the diagnostic performance of FDA\/EtBr microscopy with ZN staining, using culture and drug susceptibility testing (DST) as the reference standard.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A cross-sectional study was conducted on 300 smear-positive pulmonary TB patients at Santosh Medical College, Ghaziabad, and National Institute of TB and Respiratory Diseases, New Delhi. After n-acetyl-l-cysteine-sodium hydroxide decontamination, sputum samples were examined using ZN staining, FDA\/EtBr viability microscopy, and mycobacteria growth indicator tube 960 culture\/DST. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy were calculated, and paired statistical comparision were performed and statistical significance (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05) was assessed for diagnostic outcomes. Inter-test agreement was evaluated using Cohen\u2019s \u03ba-statistic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      FDA\/EtBr microscopy demonstrated significantly higher sensitivity (94.4% vs. 88.9%; absolute increase 5.5%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.018) and higher diagnostic accuracy (91.0% vs. 86.7%; absolute increase 4.3%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.04) compared to ZN staining. While ZN staining showed marginally higher specificity (66.7% vs. 60.0%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.42), FDA\/EtBr provided a significantly improved NPV (54.5% vs. 40.0%; absolute increase 14.5%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.03). Agreement with culture\/DST was almost perfect for FDA\/EtBr (\u03ba = 0.85) and substantial for ZN staining (\u03ba = 0.72).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>FDA\/EtBr viability microscopy offers statistically significant improvements in sensitivity, NPV, and diagnostic accuracy over ZN staining in smear-positive pulmonary TB patients, supporting its prioritized use for treatment monitoring and programmatic decision-making in resource-limited, high-burden settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijmy.ijmy_243_25","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T22:17:18Z","timestamp":1782857838000},"page":"95-103","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Evaluation of Fluorescein 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