Microscopy applications for your laboratory

Microscopy Solutions for Primary Health Care

Health Problems that Occur Mainly in Resource-limited Regions

Primary health care deals with health problems that occur mainly in resource-limited regions in developing and emerging countries. HIV/AIDS, malaria and tuberculosis still devastate individuals, families, and even entire communities. Primary health care requires instruments that are used directly to deliver help to where it is needed most, focusing on patients in remote areas and far from large cities who cannot be reached by existing health services.

Conventional light microscopy of Ziehl-Neelsen-stained smears prepared directly from sputum specimens is the most widely available test for detecting tuberculosis (TB) in resource-limited settings. Ziehl-Neelsen microscopy is highly specific, but its sensitivity is variable (20 to 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 vapor light sources, the need for regular maintenance and the requirement for a dark room.

Light-emitting diodes (LED) have been developed to offer the benefits of fluorescence microscopy without the associated costs. In 2009, the evidence for the efficacy of LED microscopy was assessed by the World Health Organization (WHO), based on standards appropriate for evaluating both the accuracy and the effect of new TB diagnostics on patients and public health. The results showed that the accuracy of LED microscopy with Auramine O staining was equivalent to that of international reference standards, it was more sensitive than conventional Ziehl-Neelsen microscopy, and it had qualitative, operational and cost advantages over both conventional fluorescence and Ziehl-Neelsen microscopy.

Malaria as well as African trypanosomiasis, also known as sleeping sickness, are insect-borne parasitic diseases that are widespread in developing and emerging countries. Both of these diseases cause hundreds of thousands of deaths per year when untreated. The parasites are usually identified in a patient’s blood film using a compact, upright microscope with brightfield contrast. The most common staining methods are the Giemsa, Romanowski or the Leishman stain of the blood smear.

Microscopy Solutions for Primary Health Care

Microscope Requirements

Lightweight, compact, portable and easy-to-use microscopes with an independent power supply, a robust light source and climate-protected optics are requirements for reliable help wherever it is needed.

  
      Tutorial
      
    Diagnosis of Tuberculosis with Fluorescence Microscopy

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Application Examples

counterstaining Methylene blue, fluorescence imaging, acquired with ZEISS Primostar iLED. Courtesy of Dr. med. H. Hoffmann, WHO - Supranationales Referenzlabor IML Gauting, Germany

Auramine staining of Mycobacterium tuberculosis, counterstaining Methylene blue, fluorescence imaging, acquired with ZEISS Primostar iLED.

Acquired with ZEISS Axiolab.A1. Courtesy of Dr. G.-D. Burchard, Specialist for Internal Medicine – Tropical Medicine, Infectiology, Bernhard Nocht Institute for Tropical Medicine, Germany

Plamodium falsiparum. Acquired with ZEISS Axiolab.A1

Acquired with ZEISS Axio Lab.A1. Courtesy of A. Michelsen, Managing Director of the Deutscher Verband Technischer Assistentinnen/Assistenten in der Medizin e.V., Head of the Central Laboratory of Ortenau Klinikum Lahr-Ettenheim, German