٥٠
ﺷور ﻪﺴﻳﺎﻘﻣ و ﺖﻨﺳرﻮﻠﻓ ﻲﭘﻮﻜﺳوﺮﻜﻴﻣ يﺎﻬ
ﻞﻳز - ﻦﺴﻠﻧ
ﻞﻜﻟا و ﺪﻴﺳا ﻪﺑ موﺎﻘﻣ ﻞﻴﺳﺎﺑ ﺺﻴﺨﺸﺗ رد
ﻲﺋﺎﻴﺿ دﻮﻌﺴﻣ ﺮﺘﻛد -1
رﺎﻛرذآ ﻪﻴﺳﺪﻗ ﺮﺘﻛد -2
ﻲﻜﻟﺎﻣ نﺎﻤﻴﭘ
3داﮋﻧ
هﺪﻴﻜﭼ
فﺪﻫ و ﻪﻨﻴﻣز زا هزوﺮﻣا :
يروﺎﻨﻓ ﻪﺘﻓﺮﺸﻴﭘ يرﺎﻤﻴﺑ ﺺﻴﺨﺸﺗ ياﺮﺑ يا ﻞﺳ
ﻲﻣ هدﺎﻔﺘﺳا دﻮﺷ
ﻲﻟو مﺪﻋ ﻞﻴﻟد ﻪﺑ
ﻪﻨﻳﺰﻫ و ﻲﺳﺮﺘﺳد رد نآ يﻻﺎﺑ
ﺮﺘﺸﻴﺑ ﺰﻛاﺮﻣ
، ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ شزرا ﻦﻴﻴﻌﺗ فﺪﻫ ﺎﺑ
ﻪﺴﻳﺎﻘﻣ و ﻲﻤﻳﺪﻗ شور ود
ﮓﻧر يﺰﻴﻣآ
Ziehl-Neelsen (ZN) Fluorescence Microscopy (FM) و
يرﺎﻤﻴﺑ ﺺﻴﺨﺸﺗ رد ﻞﺳ
مﺎﺠﻧا ﺪﺷ .
شور ﻲﺳرﺮﺑ ﻦﻳا: ﻲﻔﻴﺻﻮﺗ ﻪﻌﻟﺎﻄﻣ -
ﻲﻠﻴﻠﺤﺗ ﺪﺷ مﺎﺠﻧا ﻪﻠﺣﺮﻣ ود رد .
رد لوا ﻪﻠﺣﺮﻣ 3125
زا ﻪﻧﻮﻤﻧ 1430 رﺎﻤﻴﺑ
ﻲﻨﻴﻟﺎﺑ ﻢﺋﻼﻋ ﺎﺑ ﻞﺳ ﻪﺑ كﻮﻜﺸﻣ )
هﺪﺷ عﺎﺟرا ﺪﻨﺟﺮﻴﺑ ﺮﻬﺷ ﻞﺳ يﺰﻛﺮﻣ هﺎﮕﺸﻳﺎﻣزآ ﻪﺑ
( ﻦﻳدروﺮﻓ زا 1374
ﺎﺗ ﻦﻳدروﺮﻓ
1381 دﻮﺟو ﺮﻈﻧ زا
Acid-Fast Bacilli (AFB)
ﮓﻧر ﻪﻠﻴﺳو ﻪﺑ يﺰﻴﻣآ
وZN
ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ درﻮﻣFM
. رد
ﻪﻠﺣﺮﻣ مود 500 زا رﺎﻤﻴﺑ 1430 شور ود ﺮﻫ ﺎﺑ رﺎﻤﻴﺑ وZN
ﺪﻧﺪﺷ ﻲﺳرﺮﺑFM
. ﻊﻤﺟ تﺎﻋﻼﻃا هﺪﺷ يروآ
ﺎﺑ هدﺎﻔﺘﺳا
ﺎﭘﺎﻛ ﻖﻓاﻮﺗ ﺐﻳﺮﺿ يرﺎﻣآ يﺎﻬﻧﻮﻣزآ زا ﻲﻨﻌﻣ ﺢﻄﺳ رد
يراد 05 /
P≤0 ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﻞﻴﻠﺤﺗ درﻮﻣ .
ﻪﺘﻓﺎﻳ ﺎﻫ ﻲﺳرﺮﺑ ﻦﻳا رد: 116
) 1 / 8
% ( شور ﺎﺑ رﺎﻤﻴﺑ ﺪﻧداد نﺎﺸﻧ ار ﺖﺒﺜﻣ ﺮﻴﻤﺳا ،FM
؛ ﻦﻳا زا داﺪﻌﺗ 41 ﺮﻔﻧ ) 9 / 2
% (
شور ﺎﺑ ﺖﺒﺜﻣ ﺮﻴﻤﺳا ﻢﻫ ZN
ﺪﻧدﻮﺑ . ﮓﻧر يﺰﻴﻣآ ﺖﻴﺳﺎﺴﺣZN
35 ﻪﻧﻮﻤﻧ رد ار يﺪﺻرد يﺎﻫ
ﺎﺑ ﺖﺒﺜﻣ نﺎﺸﻧ FM
داد . ﻲﻧﺎﻣز ﻪﻧﻮﻤﻧ ﻪﻛ يﺎﻫ ﺪﻧﺪﺷ ﻲﺳرﺮﺑ ﻢﻫ ﺎﺑ ود ﺮﻫ مود و لوا
، ﺖﻴﺳﺎﺴﺣ زاZN
35
% ﻪﺑ 42
% دﺮﻛ اﺪﻴﭘ ﺶﻳاﺰﻓا .
500 شور ود ﺮﻫ ﺎﺑ رﺎﻤﻴﺑ وZN
ﻪﻛ ﺪﻧﺪﺷ ﻲﺳرﺮﺑFM
30 ﺎﺑ ﻪﻧﻮﻤﻧ وFM
26 ﺎﺑ ﻪﻧﻮﻤﻧ ر ﺖﺒﺜﻣ ﺮﻴﻤﺳاZN
نﺎﺸﻧ ا
ﺪﻧداد
؛ ﻞﻛ رد 37 ﺪﻧدﻮﺑ ﺖﺒﺜﻣ شور ود ﺮﻫ ﺎﺑ ﻪﻧﻮﻤﻧ .
ﻲﺼﻴﺨﺸﺗ شور ود ياﺮﺑ ﺎﭘﺎﻛ ﻲﻘﻓاﻮﺗ ﺐﻳﺮﺿ و ZN
FM
660 / 0 ﺑ ﻪ ﺪﻣآ ﺖﺳد ) 001 /
P<0 ( . ﺮﺑ ﻲﺳرﺮﺑ ﻦﻳا رد ﻦﺘﻓﺮﮔراﺮﻗ رﺎﻴﻌﻣ سﺎﺳا
،FM
شور ﮓﻧر يﺰﻴﻣآ ﺖﻴﺳﺎﺴﺣZN
3 / 77
%
، ﻲﮔﮋﻳو 5 / 98 ﺖﺒﺜﻣ يرﺎﺒﺧا شزرا ، 85
% ﻲﻔﻨﻣ يرﺎﺒﺧا شزرا و 6
/ 97 ر داد نﺎﺸﻧ ا .
ﻪﺠﻴﺘﻧ يﺮﻴﮔ يﻻﺎﺑ ﻖﻓاﻮﺗ ﺐﻳﺮﺿ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ: وFM
ﺮﻫZN
شور ود ﻲﺼﻴﺨﺸﺗ ﻞﺳ يرﺎﻤﻴﺑ ياﺮﺑ
؛ﺖﺳا ﻲﻧﺎﻣز ﺎﻣا
ﺪﺷﺎﺑ سﺮﺘﺳد رد ﻪﻧﻮﻤﻧ ﻚﻳ ﻪﻛ
FM، ﺖﺳا ﺢﺟرا
؛ دﺎﻬﻨﺸﻴﭘ ﻦﻳاﺮﺑﺎﻨﺑ ﻲﻣ
دﻮﺷ ﮓﻧر مﺎﺠﻧا نﺎﻜﻣا ﻪﻛ يﺰﻛاﺮﻣ رد يﺰﻴﻣآ
دراد دﻮﺟوFM
، ﺸﻳﺎﻣزآ ﺖﻴﺳﺎﺴﺣ و ﺖﻋﺮﺳ ﺶﻳاﺰﻓا ﺖﻬﺟ
،ﺎﻬ ﺑا ﻪﻧﻮﻤﻧ اﺪﺘ ﺎﺑ ﺎﻫ ﻪﻧﻮﻤﻧ ﺲﭙﺳ و ﻲﺳرﺮﺑFM
ﺖﺒﺜﻣ يﺎﻫ
ZN ﺎﺑ ﺪﻴﻳﺄﺗ ﻮﺷ ﺪﻧ .
هژاو يﺪﻴﻠﻛ يﺎﻫ ﻞﺳ:
؛ پﻮﻜﺳوﺮﻜﻴﻣ ﺖﻨﺳرﻮﻠﻓ
؛ ﻞﻳز ﻦﺴﻠﻧ
؛ ﻞﻴﺳﺎﺑ ﺪﻴﺳا ﺖﺴﻓ
ﻣ ﺪﻨﺟﺮﻴﺑ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻲﻤﻠﻋ ﻪﻠﺠ )
هرود 11 هرﺎﻤﺷ ، 4 لﺎﺳ ، 1383 (
) 1
لوﺆﺴﻣ هﺪﻨﺴﻳﻮﻧ (
ﺺﺼﺨﺘﻣ
؛ﻲﻧﻮﻔﻋ يﺎﻬﻳرﺎﻤﻴﺑ رﺎﻳدﺎﺘﺳا
ﻲﺷزﻮﻣآ هوﺮﮔ ﻲﻠﺧاد
،ﻲﻜﺷﺰﭘ هﺪﻜﺸﻧاد ، ﺪﻨﺟﺮﻴﺑ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد
سردآ : ﺪﻨﺟﺮﻴﺑ - يرﺎﻔﻏ نﺎﺑﺎﻴﺧ -
ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﺪﻨﺟﺮﻴﺑ
- ﻲﻜﺷﺰﭘ هﺪﻜﺸﻧاد
ﻦﻔﻠﺗ : 9 - 4443041 - 0561 رﺎﮕﻧرود : 4443001 - 0561 ﻲﻜﻴﻧوﺮﺘﻜﻟا ﺖﺴﭘ [email protected] :
ﻲﻣﻮﻤﻋ ﻚﺷﺰﭘ2
ﻲﻜﺷﺰﭘ يﻮﺠﺸﻧاد3
٥١
ﻪﻣﺪﻘﻣ ﻲﻤﻳﺪﻗ زا ﻲﻜﻳ ﻞﺳ يرﺎﻤﻴﺑ ﻪﻛ ﺖﺳا ﺎﻬﻳرﺎﻤﻴﺑ ﻦﻳﺮﺗ
ﺑ ﺮﻴﮕﻧﺎﺒﻳﺮﮔ ﺮﺸ
ﻲﻣ ﺪﺷﺎﺑ . ﻪﻧﻻﺎﺳ دﻮﺟﻮﻣ يﺎﻫرﺎﻣآ سﺎﺳا ﺮﺑ
دوﺪﺣ 8 ﻲﻳﺎﺳﺎﻨﺷ ﺎﻴﻧد رد ﺪﻳﺪﺟ لﻮﻠﺴﻣ رﺎﻤﻴﺑ نﻮﻴﻠﻴﻣ ﻲﻣ
ﺪﻧﻮﺷ
؛
نآ ﻦﻤﺿ دوﺪﺣ ﻪﻟﺎﺳ ﻪﻤﻫ ﻪﻛ
3 ﻞﻴﻟد ﻪﺑ ﺎﻴﻧد رد ﺮﻔﻧ نﻮﻴﻠﻴﻣ
ﺖﺳد زا ار دﻮﺧ نﺎﺟ يرﺎﻤﻴﺑ ﻦﻳا ﻪﺑ ﻼﺘﺑا ﻲﻣ
ﺪﻨﻫد ) 1 .(
لﺎﺳ ياﺪﺘﺑا رد 1990
ﻪﻧﺎﻴﻟﺎﺳ 8 / 3 ﺪﻳﺪﺟ ﻞﺳ درﻮﻣ نﻮﻴﻠﻴﻣ
ﻪﻛ 90
% دﻮﺑ ﻪﻌﺳﻮﺗ لﺎﺣ رد يﺎﻫرﻮﺸﻛ رد نآ
، نﺎﻣزﺎﺳ ﻪﺑ
ﺪﺷ شراﺰﮔ ﻲﻧﺎﻬﺟ ﺖﺷاﺪﻬﺑ .
ﻪﺑ لﺎﺣ ﻦﻳا ﺎﺑ ﻞﻴﻟد
دوﺪﺤﻣ ﺢﻄﺳ
ﺑﺎﻳرﺎﻤﻴﺑ ﻲ شراﺰﮔ و ﻪﻣﺎﻧﺮﺑ زا يرﺎﻴﺴﺑ رد ﻲﻓﺎﻛﺎﻧ ﻲﻫد
ﺎﻫ ي ،ﻲﻠﻣ
راوﺮﺧ زا ﻲﺘﺸﻣ ﺎﻬﻨﺗ ﻢﻗر ﻦﻳا ﺖﺳا
. د ر لﺎﺳ 1995 ﻢﻗر ﻦﻳا ،
8 / 8 ﻪﻛ ﺪﺷ هدز ﻦﻴﻤﺨﺗ ﺮﻔﻧ نﻮﻴﻠﻴﻣ 95
% رﻮﺸﻛ رد ﺎﻬﻧآ رد يﺎﻫ
دﻮﺑ ﻪﻌﺳﻮﺗ لﺎﺣ )
2 .(
رد ﻞﻴﺳﺎﺑ ﻦﻳا ﻪﺑ ﺪﻳﺪﺟ ﻲﮔدﻮﻟآ ناﺰﻴﻣ
لﺎﺳ 2004 يﺮﻴﮕﺸﻴﭘ تﺎﻣاﺪﻗا ﻲﻣﺎﻤﺗ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﺎﻜﻳﺮﻣآ رد
هﺪﺷ مﺎﺠﻧا
، 14511 ﺮﺑ ﺮﻔﻧ آ ﺪﺷ درو ) 3 (.
لﺎﺳ ﺎﺗ 1984
، يﺎﻫرﻮﺸﻛ و ﺎﻜﻳﺮﻣآ رد ﻞﺳ يرﺎﻤﻴﺑ
ﺶﻳاﺰﻓا ﻪﺑ ور نآ زا ﺲﭘ و ﺶﻫﺎﻛ ﻪﺑ ور ﻲﻳﺎﭘورا دﺎﻬﻧ
ﺑ ﻪﻛ ﻪ
ﻪﺑ هﺪﻤﻋ رﻮﻃ ﻞﻴﻟد
ﺶﻳاﺰﻓا ﻞﺜﻣ يﺮﮕﻳد ﻞﻣاﻮﻋ و زﺪﻳا عﻮﻴﺷ
ﻲﺑ داﺪﻌﺗ نﺎﻤﻧﺎﺧ ﺎﻫ ي ﺖﻴﻤﻫا و ﻲﻘﻳرﺰﺗ نادﺎﺘﻌﻣ ،يﺮﻬﺷ ﻧ
نداﺪ
ﻪﻣﺎﻧﺮﺑ ﻪﺑ ﺑ ﻞﺳ لﺮﺘﻨﻛ يﺎﻫ ﻮ
د ) 4 (.
هﺪﻳﺪﻋ تﻼﻜﺸﻣ ﻪﻠﻤﺟ زا يا
ﻪﻌﻣﺎﺟ ﻲﻫﺎﮔآ دﻮﺒﻤﻛ هرﺎﺑرد
ﺗ ﺎﺑ ﺺﻴﺨﺸﺗ ،يرﺎﻤﻴﺑ ﻦﻳا ﺄ
ﻦﻳا ﺮﻴﺧ
،ﺐﺳﺎﻨﻣﺎﻧ نﺎﻣز رد نﺎﻣرد ﻊﻄﻗ ﺎﻳ ﻂﻠﻏ نﺎﻣرد ،يرﺎﻤﻴﺑ ﺖﻣوﺎﻘﻣ
مﻮﻳﺮﺘﻛﺎﺑﻮﻜﻳﺎﻣ رد ﻲﻳوراد و ﺎﻫ
رد زﺪﻳا يرﺎﻤﻴﺑ شﺮﺘﺴﮔ ﺖﻳﺎﻬﻧ
ﺪﻳﺎﻤﻧ ﻪﺒﻠﻏ ﻚﻠﻬﻣ يرﺎﻤﻴﺑ ﻦﻳا ﺮﺑ ﺪﻧاﻮﺘﻧ ﺮﺸﺑ زﻮﻨﻫ ﺎﺗ هﺪﺷ ﺐﺒﺳ ) 2 .(
نﺎﻤﻫ ﺮﺑ دﻮﺟﻮﻣ هﺪﻤﻋ تﻼﻜﺸﻣ زا ﻲﻜﻳ ﺪﺷ ﺮﻛذ ﻪﻛ رﻮﻃ
يرﺎﻤﻴﺑ ﻦﻳا ﺎﺑ هزرﺎﺒﻣ هار ﺮﺳ
، ﻊﻗﻮﻤﺑ و ﺢﻴﺤﺻ ﺺﻴﺨﺸﺗ مﺪﻋ
ﻲﻣ ﺪﺷﺎﺑ . ﺷ ﺮﻛذ دراﻮﻣ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ يﺎﻬﺷور ﻪﺑ زﺎﻴﻧ ،هﺪ
ياراد ﻲﺼﻴﺨﺸﺗ و
ﻴﮔﮋﻳ يﺎﻬ ﺮﻳز
، ﻲﻣ سﺎﺴﺣا تﺪﺸﺑ دﻮﺷ
:
1 - ﺪﻨﺷﺎﺑ رادرﻮﺧﺮﺑ ﻲﻳﻻﺎﺑ ندﻮﺑ ﻲﺻﺎﺼﺘﺧا و ﺖﻴﺳﺎﺴﺣ زا .
2 - ﺪﻨﺷﺎﺑ ﻪﺘﺷاد ﺞﻳﺎﺘﻧ ﺐﺴﻛ رد ﻲﻳﻻﺎﺑ ﺖﻋﺮﺳ .
3 - ﺪﺷﺎﺒﻧ زﺎﻴﻧ ﺎﻬﻧآ مﺎﺠﻧا ياﺮﺑ ﻲﻳﻻﺎﺑ ﻪﻨﻳﺰﻫ .
ﻪﻧﻮﻤﻧ ﻲﭘﻮﻜﺳوﺮﻜﻴﻣ ﻲﺳرﺮﺑ
ﻠﻛ يﺎﻫ ﻴ دﻮﺟو ﺮﻈﻧ زا ﻲﻜﻴﻨ
ﻣ ﻞﻴﺳﺎﺑ ﺖﺣار ،ﻦﻳﺮﺘﻌﻳﺮﺳ ،ﻞﻜﻟا و ﺪﻴﺳا ﻪﺑ موﺎﻘ
و ﻦﻳﺮﺗ
نازرا ﻲﺘﻴﻌﻤﺟ رد صﻮﺼﺨﺑ ﻞﺳ يرﺎﻤﻴﺑ ﺺﻴﺨﺸﺗ شور ﻦﻳﺮﺗ
ﻲﻣ ﻞﻘﺘﻨﻣ ناﺮﮕﻳد ﻪﺑ ار يرﺎﻤﻴﺑ ﻪﻛ نارﺎﻤﻴﺑ زا ﺪﻨﻳﺎﻤﻧ
، ﻲﻣ ﺪﺷﺎﺑ
) 5 .(
ﺺﻴﺨﺸﺗ هﻮﻴﺷ ﺎﻬﻨﺗ ،هﻮﻴﺷ ﻦﻳا ﻪﻛ ﺮﻈﻧ ﻦﻳا زا عﻮﺿﻮﻣ ﺮﻴﻘﻓ يﺎﻫرﻮﺸﻛ زا يرﺎﻴﺴﺑ رد يرﺎﻤﻴﺑ ﻲﻣ
ﺖﻴﻤﻫا ،ﺪﺷﺎﺑ هﮋﻳو
يا
ﻲﻣ ﺪﺑﺎﻳ
؛ ﻪﻧﻮﻤﻧ ﻲﭘﻮﻜﺳوﺮﻜﻴﻣ ﻲﺳرﺮﺑ ﻪﭼﺮﮔ ﺮﻈﻧ زا ﺎﻫ
ﻞﻴﺳﺎﺑ
ﺖﺴﻓ ﺪﻴﺳا (AFB)
ﻲﺑ و بﻮﺧ ﺖﻴﺻﺎﺼﺘﺧا زا ﺮﻴﻈﻧ
ي ياﺮﺑ
مﻮﻳﺮﺘﻛﺎﺑﻮﻜﻳﺎﻣ ﻲﻳﺎﺳﺎﻨﺷ ﻦﻳا ﺖﻴﺳﺎﺴﺣ ﺎﻣا ﺖﺳا رادرﻮﺧﺮﺑ ﺎﻫ
ﻲﻤﻧ بﻮﻠﻄﻣ شور ﺪﺷﺎﺑ
) 5 (.
ﺗ ﺖﺤﺗ ﻲﭘﻮﻜﺳوﺮﻜﻴﻣ ﻲﺳرﺮﺑ ﺖﻴﺳﺎﺴﺣ ﺄ
ﻞﻣاﻮﻋ ﺮﻴﺛ
ﻪﻧﻮﻤﻧ عﻮﻧ ،يرﺎﻤﻴﺑ تﺪﺷ ﺪﻨﻧﺎﻣ يدﺪﻌﺘﻣ
، ﻛ ﻊﻤﺟ ﺖﻴﻔﻴ آ
يرو
مﻮﻳﺮﺘﻛﺎﺑﻮﻜﻳﺎﻣ داﺪﻌﺗ ،ﻪﻧﻮﻤﻧ ﺎﻫ
ي شور ،ﻪﻧﻮﻤﻧ رد دﻮﺟﻮﻣ
ﺮﻓ آ ﮓﻧر شور ،ﻪﻧﻮﻤﻧ يرو ﺖﻴﻔﻴﻛ ﺖﻳﺎﻬﻧ رد و ﻪﻧﻮﻤﻧ يﺰﻴﻣآ
ﻪﻧﻮﻤﻧ ﻲﺳرﺮﺑ ﻲﻣ
ﺪﺷﺎﺑ ) 6 - 12 (.
ﮓﻧر شور ود ﺮﺿﺎﺣ لﺎﺣ رد يﺰﻴﻣآ
رد AFB
ﻲﻣ راﺮﻗ هدﺎﻔﺘﺳا درﻮﻣ يژﻮﻟﻮﻳﺮﺘﻛﺎﺑﻮﻜﻳﺎﻣ يﺎﻬﻫﺎﮕﺸﻳﺎﻣزآ ﺪﻧﺮﻴﮔ
.
شور ﺎﻬﻨﻳا زا ﻲﻜﻳ ﮓﻧر
ﻦﻴﺷﻮﻓ لﻮﺑﺮﻛ زا هدﺎﻔﺘﺳا ﺎﺑ يﺰﻴﻣآ
**
) ﻦﺴﻠﻧ ﻞﻳز نﻮﻴﻨﻳﺎﻛ ﺎﻳ
( زا هدﺎﻔﺘﺳا شور يﺮﮕﻳد و
موﺮﻛورﻮﺌﻠﻓ يﺎﻬﮕﻧر )
ﻦﻴﻣاروا ﺎﻳ ﻦﻴﻣاروا -
ﻦﻴﻣادر (***
ﻲﻣ ﺪﺷﺎﺑ . ﻦﻳا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ رد ﻪﻛ
ﺖﺷاﺪﻬﺑ ﺰﻛﺮﻣ ﻞﺳ هﺎﮕﺸﻳﺎﻣزآ
ﺪﻨﺟﺮﻴﺑ نﺎﺘﺳﺮﻬﺷ زا
ﮓﻧر شور ود ﺮﻫ ﻲﺳرﺮﺑ ياﺮﺑ يﺰﻴﻣآ
ﻪﻧﻮﻤﻧ ﻣ نارﺎﻤﻴﺑ يﺎﻫ هدﺎﻔﺘﺳا ﻞﺳ ﻪﺑ كﻮﻜﺸ
ﻲﻣ دﻮﺷ
، ﻦﻳا رد
زا هﺪﻣآ ﻞﻤﻋ ﻪﺑ يﺎﻬﻴﺳرﺮﺑ ﺞﻳﺎﺘﻧ ﻪﻌﻟﺎﻄﻣ 1430
كﻮﻜﺸﻣ رﺎﻤﻴﺑ
ﻞﺳ ﻪﺑ و ﻪﺴﻳﺎﻘﻣ ﻢﻫ ﺎﺑ شور ود ﻦﻳا ﺖﻴﺳﺎﺴﺣ ناﺰﻴﻣ ﺪﺷ
.
هﺪﺷ مﺎﺠﻧا ﻲﺳرﺮﺑ ﻖﺒﻃ ﺖﺳا ﺮﻛذ ﻪﺑ مزﻻ
، ﺎﺗ مﺎﺠﻧا نﺎﻣز
،ﻖﻴﻘﺤﺗ ﻦﻳا ﺑﺎﺸﻣ
ﻪ ﻦﻳا ﻪﻌﻟﺎﻄﻣ رد هﺪﺸﻧ مﺎﺠﻧا ناﺮﻳا دﻮﺑ
.
§ Acid-Fast Bacilli (AFB)
** Carbol-Fucin
†† Ziehl-Neelsen (ZN)
‡‡ Kinyoun
§§ Fluorochorom
*** Auramin-Rhodamin
٥٢ ﻲﺳرﺮﺑ شور
ﻦﻳا رد ﻲﺳرﺮﺑ ﻪﺘﺷﺬﮔ ترﻮﺻ ﻪﺑ و ﺖﻤﺴﻗ ود
مﺎﺠﻧا ﺮﮕﻧ
ﺪﺷ . ﻲﻔﻴﺻﻮﺗ ﻪﻌﻟﺎﻄﻣ ﻚﻳ رد -
ﻲﻠﻴﻠﺤﺗ ﻪﻧﻮﻤﻧ ﻲﻣﺎﻤﺗ اﺪﺘﺑا يﺎﻫ
شﺮﻳﺬﭘ ﻲﻜﻴﻨﻴﻠﻛ زا ﺪﻨﺟﺮﻴﺑ ﺖﺷاﺪﻬﺑ ﺰﻛﺮﻣ ﻞﺳ هﺎﮕﺸﻳﺎﻣزآ هﺪﺷ
لﺎﺳ ياﺪﺘﺑا 1374
ﺎﺗ لﺎﺳ نﺎﻳﺎﭘ 1381
ﺮﻈﻧ زا ﻪﻛ ﻪﺑ AFB
ﮓﻧر شور ود ﺮﻫ يﺰﻴﻣآ
ﻦﻴﻣاروا و ZN -
درﻮﻣ ﻦﻴﻣادور
ﺮﻗ ﻲﺳرﺮﺑ ﻪﺘﻓﺮﮔ را
ﺪﻧدﻮﺑ شور ﺎﺑ ﺎﻬﻧآ ﺮﻴﻤﺳا ﺞﻳﺎﺘﻧ و
ﮓﻧر ﻦﻴﻣاروا يﺰﻴﻣآ -
ﺮﻈﻧ زا ﻦﻴﻣادور
،AFB شراﺰﮔ ﺖﺒﺜﻣ
هﺪﺷ دﻮﺑ
، ﺘﻓﺮﮔ راﺮﻗ ﻪﻌﻟﺎﻄﻣ درﻮﻣ ﺪﻨ
. د ﻪﻧﻮﻤﻧ زا هوﺮﮔ ﻦﻳا ر ﺎﻫ
ﮓﻧر زا ﻞﺻﺎﺣ ﺞﻳﺎﺘﻧ يﺰﻴﻣآ
ﮓﻧر زا ﻞﺻﺎﺣ ﻪﺠﻴﺘﻧ ﺎﺑZN يﺰﻴﻣآ
ﻦﻴﻣاروا - ﺪﺷ ﻪﺴﻳﺎﻘﻣ ﻦﻴﻣادور ﺪﻧ
.
ﻪﻌﻟﺎﻄﻣ ﻦﻳا مود ﺶﺨﺑ رد 500
ﻲﻜﻴﻨﻴﻠﻛ ﻪﻧﻮﻤﻧ
ﻪﺘﻓﺮﻳﺬﭘ ياﺪﺘﺑا زا ﺪﻨﺟﺮﻴﺑ ﺖﺷاﺪﻬﺑ ﺰﻛﺮﻣ ﻞﺳ هﺎﮕﺸﻳﺎﻣزآ رد هﺪﺷ
لﺎﺳ 1374 ﺮﻈﻧ زا ﻪﻛ ﮓﻧر شور ود ﺮﻫ ﻪﺑAFB
يﺰﻴﻣآ ZN
ﻦﻴﻣاروا و -
ﻪﺘﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ درﻮﻣ ﻦﻴﻣادور ﺪﻧدﻮﺑ
، رد نوﺪﺑ
راﺮﻗ ﻪﻌﻟﺎﻄﻣ درﻮﻣ ﺮﻴﻤﺳا ﻲﺳرﺮﺑ زا ﻞﺻﺎﺣ ﻪﺠﻴﺘﻧ ﻦﺘﻓﺮﮔ ﺮﻈﻧ ﺘﻓﺮﮔ ﺪﻨ . رد زا هوﺮﮔ ﻦﻳا ﻪﻧﻮﻤﻧ
ﺎﻫ
، ﻪﻧﻮﻤﻧ ﻲﺳرﺮﺑ زا ﻞﺻﺎﺣ ﺞﻳﺎﺘﻧ
ﺮﻈﻧ زا ﮓﻧر يﺎﻬﺷور زا ﻚﻳ ﺮﻫ ﺎﺑ AFB
قﻮﻓ يﺰﻴﻣآ ﺎﺑ ﺮﻛﺬﻟا
ﺪﺷ ﻪﺴﻳﺎﻘﻣ ﻢﻫ ﺪﻧ
. هداد ﻞﻴﻠﺤﺗ و ﻪﻳﺰﺠﺗ ياﺮﺑ رﺎﻣآ ﺶﺨﺑ رد ﺎﻫ
و ﻲﻠﻴﻠﺤﺗ رﺎﻣآ ﺶﺨﺑ رد و ﻲﻧاواﺮﻓ ﻊﻳزﻮﺗ لواﺪﺟ زا ﻲﻔﻴﺻﻮﺗ ﺎﭘﺎﻛ ﻖﻓاﻮﺗ ﺐﻳﺮﺿ نﻮﻣزآ زا ﻞﺻﺎﺣ ﺞﻳﺎﺘﻧ ﻪﺴﻳﺎﻘﻣ هدﺎﻔﺘﺳا
ﺪﻳدﺮﮔ
؛ 05 / P≤0 ﺑ ﻪ ﻲﻨﻌﻣ ﺢﻄﺳ ناﻮﻨﻋ ﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد يراد
.
ﻪﺘﻓﺎﻳ ﺎﻫ رد ﻲﺳرﺮﺑ ﻦﻳا رد لوا ﻪﻠﺣﺮﻣ
1430 زا ﻪﻧﻮﻤﻧ نارﺎﻤﻴﺑ
ﻞﺳ ﻪﺑ كﻮﻜﺸﻣ ﺘﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ درﻮﻣ
ﺪﻨ ﻪﻛ 116 ) 1 / 8 (%
شور ﺎﺑ رﺎﻤﻴﺑ هﺪﻋ ﻦﻳا زا و ﺪﻧداد نﺎﺸﻧ ار ﺖﺒﺜﻣ ﺮﻴﻤﺳا ،FM
41 ﺮﻔﻧ ) 9 / 2 % نارﺎﻤﻴﺑ ﻞﻛ (
شور ﺎﺑ ﺖﺒﺜﻣ ﺮﻴﻤﺳا ﻢﻫ ZN
ﺪﻧدﻮﺑ . ﮓﻧر يﺰﻴﻣآ ﺖﻴﺳﺎﺴﺣ ZN
35 ﻪﻧﻮﻤﻧ رد ار يﺪﺻرد يﺎﻫ
ﺎﺑ ﺖﺒﺜﻣ ﻲﻧﺎﻣز و داد نﺎﺸﻧFM
لوا ﺖﺑﻮﻧ ﻂﻠﺧ يﺎﻫﺮﻴﻤﺳا ﻪﻛ
و ﺮﻫ نارﺎﻤﻴﺑ مود ود
ﺪﻧﺪﺷ ﻲﺳرﺮﺑ ﻢﻫ ﺎﺑ
، ﺖﻴﺳﺎﺴﺣ ﮓﻧر
يﺰﻴﻣآ زاZN
35 % ﻪﺑ 42 % دﺮﻛ اﺪﻴﭘ ﺶﻳاﺰﻓا .
ﻪﻛ ﺪﻳدﺮﮔ مﺎﺠﻧا ﻪﺴﻳﺎﻘﻣ ﻦﻳا ﺰﻴﻧ ﻲﮔدﻮﻟآ تﺪﺷ سﺎﺳا ﺮﺑ ﻪﻧﻮﻤﻧ رد ﺎﻫ ﮓﻧر ﺎﺑ ﺖﺒﺜﻣ ﻚﻳ ي يﺰﻴﻣآ
،FM ﺖﻴﺳﺎﺴﺣ ZN
28 % ﺖﺒﺜﻣ ود و 43
% ﺖﺒﺜﻣ ﻪﺳ ، 50
% ﺖﺒﺜﻣ رﺎﻬﭼ و 80
% ار
داد نﺎﺸﻧ .
500 زا رﺎﻤﻴﺑ 1430 شور ود ﺮﻫ ﺎﺑ رﺎﻤﻴﺑ و ZN
FM
ﻪﻛ ﺪﻧﺪﺷ ﻲﺳرﺮﺑ 30
ﺎﺑ ﻪﻧﻮﻤﻧ وFM
26 ﺎﺑ ﻪﻧﻮﻤﻧ ﺮﻴﻤﺳاZN
ﺪﻧداد نﺎﺸﻧ ار ﺖﺒﺜﻣ .
ﻞﻛ رد 37 ﺎﺑ ﻪﻧﻮﻤﻧ شور ود ﺮﻫ زا ﻲﻜﻳ
ﺑ ﺖﺒﺜﻣ ﺪﻧدﻮ ) رادﻮﻤﻧ 1 .(
شور ود ﺮﻫ ياﺮﺑ ﺎﭘﺎﻛ ﻲﻘﻓاﻮﺗ ﺐﻳﺮﺿ
ﻲﺼﻴﺨﺸﺗ وZN
660FM / 0 ﺑ ﻪ ﺪﻣآ ﺖﺳد )
001 / P<0 .(
ﻦﺘﻓﺮﮔ راﺮﻗ رﺎﻴﻌﻣ سﺎﺳا ﺮﺑ ﻲﺳرﺮﺑ ﻦﻳا رد
،FM شور
ﮓﻧر يﺰﻴﻣآ ﺖﻴﺳﺎﺴﺣ ZN
3 / 77
% ﻲﮔﮋﻳو ، 5
/ 98 شزرا ،
ﺖﺒﺜﻣ يرﺎﺒﺧا 85
% ﻲﻔﻨﻣ يرﺎﺒﺧا شزرا و 6
/ 97 % داد نﺎﺸﻧ ار .
ﻪﺠﻴﺘﻧ و ﺚﺤﺑ يﺮﻴﮔ
ر ﮓﻧر يﺎﻬﺷو يﺰﻴﻣآ
پﻮﻜﺳوﺮﻜﻴﻣ ﺖﻨﺳرﻮﻠﻓ و ZN
ﺺﻴﺨﺸﺗ ياﺮﺑ لﻮﻤﻌﻣ يﺎﻬﺷور ناﻮﻨﻋ ﻪﺑ (FM)
ﻲﻣ رﺎﻛ ﻪﺑ ﻞﺳ ﻲﻫﺎﮕﺸﻳﺎﻣزآ ﺪﻧور
. ياراد ماﺪﻛ ﺮﻫ ﺎﻬﺷور ﻦﻳا
ﻲﻣ دﻮﺧ صﺎﺧ ﺐﻳﺎﻌﻣ و ﺎﻳاﺰﻣ ﺪﻨﺷﺎﺑ
. نﻮﻨﻛﺎﺗ يدﺪﻌﺘﻣ تﺎﻌﻟﺎﻄﻣ
ﻪﻧﻮﻤﻧ ﻲﭘﻮﻜﺳوﺮﻜﻴﻣ ﻲﺳرﺮﺑ شور ﺖﻴﺳﺎﺴﺣ دﻮﺒﻬﺑ ﺖﻬﺟ ﺎﻫ
ﺖﺳا ﻪﺘﻓﺮﮔ ترﻮﺻ .
زا ﻲﺸﺨﺑ ﻪﺴﻳﺎﻘﻣ ﺖﻬﺟ رد تﺎﻌﻟﺎﻄﻣ ﻦﻳا
ﮓﻧر شور ود ﺖﻴﺳﺎﺴﺣ يﺰﻴﻣآ
ﺖﺳا هدﻮﺑ موﺮﻛورﻮﺌﻠﻓ وZN .
رادﻮﻤﻧ 1 - شور ود ﺎﺑ ﺖﺒﺜﻣ ﺮﻴﻤﺳا نارﺎﻤﻴﺑ عﻮﻴﺷ ناﺰﻴﻣ
ﮓﻧر ﻞﻳز يﺰﻴﻣآ -
ﻦﻴﻣاروا و ﻦﺴﻠﻧ -
ﻦﻴﻣادور
††† Fluorescence Microscopy (FM)
30
26
37
0 5 10 15 20 25 30 35 40
FM+ ZN+ FM+ or ZN+
٥٣
ﻪﻌﻟﺎﻄﻣ رد Habeenzu
نارﺎﻜﻤﻫ و
، زا 488 درﻮﻣ ﻪﻧﻮﻤﻧ
ﻲﺳرﺮﺑ 66 ﻞﻴﺳﺎﺑ ﺮﻈﻧ زا ﻪﻧﻮﻤﻧ ﺎﺑAFB
ﮓﻧر يﺰﻴﻣآ ﺖﺒﺜﻣZN
ﺪﺷ شراﺰﮔ ﺪﻧ
؛ ﮓﻧر شور ﺎﺑ ناﺰﻴﻣ ﻦﻳا ﻪﻛ ﻲﻟﺎﺣ رد يﺰﻴﻣآ
ﻦﻴﻣاروا - ﻞﻨﻓ ) ﮓﻧر يﺎﻬﺷور زا ﻲﻜﻳ يﺎﻬﮕﻧر ﺎﺑ يﺰﻴﻣآ
موﺮﻛورﻮﺌﻠﻓ (
152 زا ﺖﺒﺜﻣ ﻪﻧﻮﻤﻧ 488
ﻪﻧﻮﻤﻧ ﺪﻣآ ﺖﺳد ﻪﺑ
) 13 .(
ﮓﻧر شور ﺖﻴﺳﺎﺴﺣ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد يﺰﻴﻣآ
3 FM / 2
ﮓﻧر شور ﺖﻴﺳﺎﺴﺣ ﺮﺑاﺮﺑ يﺰﻴﻣآ
دﻮﺑ ZN
؛ ﻄﻣ رد ﻪﻌﻟﺎ ﺮﺿﺎﺣ
ﮓﻧر شور ﺖﻴﺳﺎﺴﺣ يﺰﻴﻣآ
8 FM / 2 دﻮﺑ ﺮﺑاﺮﺑ
؛ ﻪﻌﻟﺎﻄﻣ
Murray ﻲﻨﻌﻣ فﻼﺘﺧا ﺰﻴﻧ نارﺎﻜﻤﻫ و
ود ﻦﻳا ﺖﻴﺳﺎﺴﺣ راد
ﮓﻧر هﻮﻴﺷ داد نﺎﺸﻧ ار يﺰﻴﻣآ
) 14 .(
ﻂﺳﻮﺗ ﻪﻛ يﺮﮕﻳد ﻲﺳرﺮﺑ رد Ulukanligil
نارﺎﻜﻤﻫ و
يور ﺮﺑ 465 ﺪﻳدﺮﮔ ﺺﺨﺸﻣ ،ﺪﺷ مﺎﺠﻧا ﻞﺳ ﻪﺑ كﻮﻜﺸﻣ رﺎﻤﻴﺑ
ﻚﻳ ﻂﻘﻓ ﻪﻛ يدراﻮﻣ رد شور ،ﺖﺳا سﺮﺘﺳد رد ﻪﻧﻮﻤﻧ
FM
ﺖﻴﺳﺎﺴﺣ زا 2
/ 85 % شور و ﺖﻴﺳﺎﺴﺣ زا ZN
1 / 67 %
ﺖﺳا رادرﻮﺧﺮﺑ .
ﻪﻧﻮﻤﻧ راﺮﻜﺗ ﺎﺑ ﺖﻴﺳﺎﺴﺣ ،ﺖﺑﻮﻧ ﻪﺳ رد ﺎﻫ
ZN
80 % ﺖﻴﺳﺎﺴﺣ و 92FM
% ﻲﻣ ؛ددﺮﮔ نﺎﻘﻘﺤﻣ ﻦﻳا دﺎﻬﻨﺸﻴﭘ ﻪﺑ
ﻞﺳ ﺮﻈﻧ زا ﻲﺼﻴﺨﺸﺗ ﻲﺑﺎﻳزرا ياﺮﺑ ﻪﻧﻮﻤﻧ ﺪﻨﭼ ﻪﻛ يدراﻮﻣ رد شور ود ﺮﻫ ،ﺖﺳا سﺮﺘﺳد رد و ZN
ﻞﺑﺎﻗ ﺖﻴﺳﺎﺴﺣ FM
،ﺖﺳا سﺮﺘﺳد رد ﻪﻧﻮﻤﻧ ﻚﻳ ﻪﻛ يدراﻮﻣ رد ﻲﻟو ﺪﻧراد ﻲﻬﺟﻮﺗ FM شور ﺖﺳا ﺢﺟرا )
15 .(
Kivihya Ndugga van Cleeff و
ﻪﻌﻟﺎﻄﻣ رد يا
ﺮﺑ
يور 1398
،ﻞﺳ ﻪﺑ كﻮﻜﺸﻣ رﺎﻤﻴﺑ ﻪﻛ ﺪﻨﺘﻓﺎﻳرد
ﺺﻴﺨﺸﺗ رد
شور ،ﻞﺳ شور ﻪﺑ ﺖﺒﺴﻧ FM
يﺮﺘﺸﻴﺑ ﺖﻴﺳﺎﺴﺣ زا ZN
ﻴﻧ يدﺎﺼﺘﻗا ﺮﻈﻧ زا و ﺖﺳا رادرﻮﺧﺮﺑ ﺖﻋﺮﺳ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﺰ
ﻪﻓﺮﺻ ﻪﺑ نوﺮﻘﻣ ،ﺮﺗﻻﺎﺑ ﺖﻴﺳﺎﺴﺣ و ﺮﺘﺸﻴﺑ ﺺﻴﺨﺸﺗ ﺮﺗ
ﻲﻣ ﺪﺷﺎﺑ
؛ ﻦﻴﻨﭽﻤﻫ FM شور
نارﺎﻤﻴﺑ ﺺﻴﺨﺸﺗ رد HIV
سﺎﺴﺣ ﺖﺒﺜﻣ ﻲﻣ ﻞﻤﻋ ﺮﺗ
ﺪﻧدﺮﻛ دﺎﻬﻨﺸﻴﭘ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد و ﺪﻨﻛ
ﻪﻛ شور ﻦﻳا زا ﺺﻴﺨﺸﺗ رد ﻪﻴﻟوا شور ﻚﻳ ناﻮﻨﻋ ﻪﺑ
هدﺎﻔﺘﺳا ﻞﺳ ﻪﺑ كﻮﻜﺸﻣ نارﺎﻤﻴﺑ دﻮﺷ
) 16 (.
ﻪﻌﻟﺎﻄﻣ رد ﺣ
ﺮﺿﺎ
ﺎﺑ ﺰﻴﻧ ﻪﻧﻮﻤﻧ راﺮﻜﺗ ﺖﻴﺳﺎﺴﺣ ﺎﻫ
ZN شور 7 % اﺪﻴﭘ ﺶﻳاﺰﻓا
دﻮﻤﻧ ) زا 35 % ﻪﺑ 42 (%
.
ﻪﻌﻟﺎﻄﻣ رد Githui
يور ﺮﺑ نارﺎﻜﻤﻫ و 1480
،رﺎﻤﻴﺑ ﻲﺻﺎﺼﺘﺧا و ﺖﻴﺳﺎﺴﺣ
FM ندﻮﺑ ZN و ﺖﺑﻮﻧ ﻚﻳ درﻮﻣ رد
ﺪﻳدﺮﮔ ﻪﺴﻳﺎﻘﻣ ﻢﻫ ﺎﺑ ﺮﻴﻤﺳا و
ﺖﻴﺳﺎﺴﺣ ﺖﺑﻮﻧ ﻚﻳ رد FM
80
% ﺖﻴﺳﺎﺴﺣ و 68ZN
% ﺪﺷ شراﺰﮔ .
ﻮﻣ ﻦﻴﻤﻫ رد ،در
شور
ﺖﻴﺻﺎﺼﺘﺧاZN 96
% و FMشور ﺖﻴﺻﺎﺼﺘﺧا 98
% نﺎﺸﻧ ار
داد . ﻘﻘﺤﻣ ﺎ رد ن دﻮﺧ شراﺰﮔ دﺎﻬﻨﺸﻴﭘ
،ﺪﻧدﺮﻛ ﻪﻛ يدراﻮﻣ رد
ﻲﻔﻨﻣ لﺎﻤﺘﺣا شور ندﻮﺑ
ﻢﻛ ﻞﻴﻟد ﻪﺑ ZN ﻞﻴﺳﺎﺑ داﺪﻌﺗ ندﻮﺑ
،ﺖﺳا دﺎﻳز FM شور
ﻲﻣ ﺷور ناﻮﻨﻋ ﻪﺑ ﺪﻧاﻮﺗ ﻲ
و سﺎﺴﺣ
ﻦﻳﺰﮕﻳﺎﺟ ﻪﻓﺮﺻ ﻪﺑ نوﺮﻘﻣ ZN شور
دﻮﺷ ﻦﻴﻨﭽﻤﻫ ؛ رد
ﺸﻳﺎﻣزآ ﻪﻧﻮﻤﻧ دﺪﻌﺗ ﻞﻴﻟد ﻪﺑ ﻪﻛ ﻲﻳﺎﻬﻫﺎﮕ ﻲﻟﺎﺳرا يﺎﻫ
، ﺖﻗو
راﺮﻜﺗ ياﺮﺑ ﻲﻤﻛ ﻲﻣ ،دراد دﻮﺟو ZN
شور زا ناﻮﺗ ﻪﺑ FM
ناﻮﻨﻋ ﻚﻳ شور هدﺎﻔﺘﺳا دﺎﻤﺘﻋا ﻞﺑﺎﻗ و سﺎﺴﺣ ﻦﻳﺰﮕﻳﺎﺟ دﺮﻛ
) 17 (.
ﻪﻌﻟﺎﻄﻣ رد ﺮﺿﺎﺣ
ﻲﮔدﻮﻟآ تﺪﺷ سﺎﺳا ﺮﺑ
، ﺖﻴﺳﺎﺴﺣ
ZN شور دﻮﺑ توﺎﻔﺘﻣ ﺖﻴﺳﺎﺴﺣ ﻲﮔدﻮﻟآ تﺪﺷ ﺶﻳاﺰﻓا ﺎﺑ و
ﻦﻳا شور اﺰﻓا داد نﺎﺸﻧ ﺶﻳ .
Yanagisawa Shimada و
درﻮﻣ رد ﻬﺷور
ﻲﺑﺎﻳزرا يﺎ
يﺎﻫرﺎﻴﻌﻣ ﻲﺑﺎﻳزرا و نﺎﻣرد ﻪﺑ ﺦﺳﺎﭘ هﻮﺤﻧ ﺖﻬﺟ نارﺎﻤﻴﺑ نﺎﺘﺳرﺎﻤﻴﺑ رد نﺎﺘﺳرﺎﻤﻴﺑ زا ﺺﻴﺧﺮﺗ City Ida
ﻪﻘﻄﻨﻣ رد
Kanto ندﻮﺑ ﻲﺻﺎﺼﺘﺧا و ﺖﻴﺳﺎﺴﺣ ﻪﺴﻳﺎﻘﻣ ﺎﺑ ،ﻦﭘاژ
شور
و ZN ﻦﻳﺎﺘﺷا نﻮﻟ ﻂﻴﺤﻣ رد ﺖﺸﻛ دراﺪﻧﺎﺘﺳا شور ﺎﺑ FM
ﻧﺎﺟ شور ﺎﺑ نارﺎﻤﻴﺑ ﻲﺑﺎﻳزرا ﻪﻛ ﺪﻧﺪﻴﺳر ﻪﺠﻴﺘﻧ ﻦﻳا ﻪﺑ ،نﻮﺴ
ﻲﻨﺌﻤﻄﻣ شور FM ﺟ
نﺎﻣرد ﻪﺑ ﺦﺳﺎﭘ هﻮﺤﻧ ﻦﻴﻴﻌﺗ ﺖﻬ
ﻲﻣ ﻲﻣ ﻦﻳا ﺮﺑ هوﻼﻋ و ﺪﺷﺎﺑ ﺷور ناﻮﻨﻋ ﻪﺑ ﺪﻧاﻮﺗ
ﻲ ياﺮﺑ ﺮﺒﺘﻌﻣ
ﺪﻳﺎﻤﻧ ﻞﻤﻋ ﺰﻴﻧ نﺎﺘﺳرﺎﻤﻴﺑ زا ﺺﻴﺧﺮﺗ يﺎﻫرﺎﻴﻌﻣ ﻦﺘﺷاﺬﮔ )
18 (.
رد ﺮﺘﺸﻴﺑ مﺎﺠﻧا تﺎﻌﻟﺎﻄﻣ هﺪﺷ
، ﮓﻧر ﺖﻴﺳﺎﺴﺣ ﻪﺑ يﺰﻴﻣآ
ر ZN شو دوﺪﺣ 25 - 75
% ﺖﺳا هﺪﺷ شراﺰﮔ )
3 - 6 .(
رد
ﻪﻌﻟﺎﻄﻣ ﺮﺿﺎﺣ ﻦﺘﻓﺮﮔ راﺮﻗ رﺎﻴﻌﻣ سﺎﺳا ﺮﺑ شور
ﮓﻧر يﺰﻴﻣآ
،FM شور ﮓﻧر يﺰﻴﻣآ ﺖﻴﺳﺎﺴﺣ ZN
3 / 77
% داد نﺎﺸﻧ ار .
ﮓﻧر ﺖﻴﺳﺎﺴﺣ ناﺰﻴﻣ ﺮﺑ ﺮﺛﺆﻣ ﻞﻣاﻮﻋ شور ﻪﺑ يﺰﻴﻣآ
ZN
زا ﺪﻨﺗرﺎﺒﻋ :
1 - هﺪﺷ ﻪﺘﻓﺮﮔ ﻪﻧﻮﻤﻧ ندﻮﺑ بﻮﻠﻄﻣ
2 - ﻪﻧﻮﻤﻧ داﺪﻌﺗ ﺪﺷ ﻲﺳرﺮﺑ يﺎﻫ
ه
3 - ﻪﻧﻮﻤﻧ ﻲﮔدﻮﻟآ تﺪﺷ هﺪﺷ ﻪﺘﻓﺮﮔ يﺎﻫ
٥٤ 4 - مﺎﺠﻧا دﺮﻓ ﻪﻠﺻﻮﺣ و ﺖﻗد ناﺰﻴﻣ ﺶﻳﺎﻣزآ هﺪﻨﻫد
شور ﮓﻧر يﺰﻴﻣآ هدﺎﺳ ZN
سﺮﺘﺳد ﻞﺑﺎﻗ و ﻦﻳﺮﺗ ﻦﻳﺮﺗ
شور ﻞﺳ ﻲﻫﺎﮕﺸﻳﺎﻣزآ ﺺﻴﺨﺸﺗ ياﺮﺑ ﺖﺳا
زﺎﻴﻧ ﺖﻠﻋ ﻪﺑ ﻲﻟو
ﻞﻗاﺪﺣ ﻲﺳرﺮﺑ ﻪﺑ 100
ﺎﺑ ﻲﭘﻮﻜﺳوﺮﻜﻴﻣ نﺎﺷ ﻨﮔرﺰﺑ
ﻲﻳﺎﻤ 100
ﺮﺑاﺮﺑ
، و ﺖﻗد ﺪﻨﻣزﺎﻴﻧ ﺎﻳز ﻪﻠﺻﻮﺣ
د ﺶﻳﺎﻣزآ ﻦﻳا مﺎﺠﻧا ﺖﻬﺟ
ﻲﻣ ﺪﺷﺎﺑ . شور ﮓﻧر ﻦﻴﻣاروا يﺰﻴﻣآ -
زا هدﺎﻔﺘﺳا ﺎﺑ ﻦﻴﻣادور
پﻮﻜﺳوﺮﻜﻴﻣ ﺎﻬﻨﺗ نﺪﻳد ﺎﺑ ﺎﺗ دراد ار ﺖﻴﻠﺑﺎﻗ ﻦﻳا FM
10 نﺎﺷ
ﺎﺑ ﻲﻳﺎﻤﻨﮔرﺰﺑ 10
ﺮﺑاﺮﺑ ﺪﻳﺎﻤﻧ ﻦﻜﺳا ار ﻲﻳﺎﻨﻴﺑ ناﺪﻴﻣ نﺎﻤﻫ
؛ ﺎﺑ
ﺎﻔﺗ ﻦﻳا و رﺎﻛ ﻦﻳا ياﺮﺑ مزﻻ نﺎﻣز تﺪﻣ ﻪﻛ ت ﭼ
ﻪﻘﻴﻗد ﺪﻨ
دﻮﺑ ﺪﻫاﻮﺧ )
15 .(
يﺎﻬﻴﮔﮋﻳو FMشور
ﮓﻧر ياﺮﺑ يﺰﻴﻣآ
زا ﺪﻨﺗرﺎﺒﻋAFB :
ﻒﻟا - ﺎﺑ مﻻ ﻲﺳرﺮﺑ ﺖﻴﻠﺑﺎﻗ ﻲﻳﺎﻤﻨﮔرﺰﺑ
ﺮﺘﻤﻛ
ب - ﻦﻜﺳا ﺖﻴﻠﺑﺎﻗ ﺪﻨﭼ ضﺮﻋ رد مﻻ ﺢﻄﺳ ﻊﻳﺮﺳ ندﺮﻛ
ﻪﻘﻴﻗد
ج - ﻪﻧﻮﻤﻧ ﻲﺳرﺮﺑ ﺖﻴﻠﺑﺎﻗ ﺎﺑ ﻪﻛ ﻢﻛ ﻞﻴﺳﺎﺑ ياراد يﺎﻫ
ZN شور ﻲﻤﻧ هداد ﺺﻴﺨﺸﺗ ﺪﻧﻮﺷ
.
د - ﻦﻳا شور
ًﻼﻣﺎﻛ نﺎﻣز رد ﻢﻫ ﻪﻓﺮﺻ ﻪﺑ نوﺮﻘﻣ ﻢﻫ و
ﻪﻨﻳﺰﻫ رد و ﺖﺳا
ياﺮﺑ يﺎﻬﻫﺎﮕﺸﻳﺎﻣزآ ﻻﺎﺑ ﻪﻧﻮﻤﻧ ﻢﺠﺣ ﺎﺑ
ﻪﻴﺻﻮﺗ ﻲﻣ دﻮﺷ ) 15 .(
ذ - ﮓﻧر شور درﻮﻣ رد ﺮﮕﻳد ﻪﺘﻜﻧ يﺰﻴﻣآ
ﺖﺳا ﻦﻳا FM ﻪﻛ
هدﺎﻔﺘﺳا درﻮﻣ يﺎﻬﺷور ياﺮﺑ
Cytocentrifugation
، ﺗﺄ ﺮﻴﺛ
ﻪﻨﻳﺰﻫ ﻂﻘﻓ و ﺪﻧراﺪﻧ شور ﻦﻳا ﺖﻴﺳﺎﺴﺣ ﺶﻳاﺰﻓا ﺮﺑ يدﺎﻳز ﺸﻳﺎﻣزآ ﺎﻬ ﻻﺎﺑ ار ﻲﻣ ﺪﻧﺮﺑ ) 19 (.
ﺞﻳﺎﺘﻧ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ داد نﺎﺸﻧ
يﺎﭘﺎﻛ ﻖﻓاﻮﺗ ﺐﻳﺮﺿ ﻪﻛ
ﻻﺎﺑ ﻳ شور ﻦﻴﺑ ﻲ و ZN
دراد دﻮﺟو FM )
660 / 0 (
) 001 / P<0 (
؛ ﻲﻣ ﻦﻳاﺮﺑﺎﻨﺑ ناﻮﺗ
شور ود ﺮﻫ ﺖﻔﮔ ﺖﻬﺟ
ﻲﻣ ﻲﺒﺳﺎﻨﻣ يﺎﻬﺷور ﻞﺳ يرﺎﻤﻴﺑ ﺺﻴﺨﺸﺗ ﺪﻨﺷﺎﺑ
.
ﻲﻣ دﺎﻬﻨﺸﻴﭘ دﻮﺷ
ﮓﻧر نﺎﻜﻣا ﻪﻛ يﺰﻛاﺮﻣ رد يﺰﻴﻣآ
FM
دراد دﻮﺟو
، رﻮﻈﻨﻣ ﻪﺑ ﺖﻋﺮﺳ ﺶﻳاﺰﻓا
ﺸﻳﺎﻣزآ ﺖﻴﺳﺎﺴﺣ و
،ﺎﻬ
ﻪﻧﻮﻤﻧ اﺪﺘﺑا ﺎﺑ ﺎﻫ
شور ﮓﻧر يﺰﻴﻣآ ﻦﻴﻣاروا - ﻲﺳرﺮﺑ ﻦﻴﻣادور
ﺷ ﻮ ﻧ ﺪ
، ﻪﻧﻮﻤﻧ ﺲﭙﺳ ﺎﺑ ﺖﺒﺜﻣ يﺎﻫ
شور ﮓﻧر يﺰﻴﻣآ ﺪﻴﻳﺄﺗ ZN
ﺪﻧدﺮﮔ .
و ﺮﻳﺪﻘﺗ ﺮﻜﺸﺗ
زا تدﺎﻌﺳ ﺎﺿﺮﻴﻠﻋ يﺎﻗآ ﻮﺟ
ﻪﻛ يرﺎﻣآ يﺎﻬﻴﺳرﺮﺑ ﻦﻳا
ﺰﻴﻧ و ﺪﻨﺘﺷاد هﺪﻬﻋ ﺮﺑ ار ﻖﻴﻘﺤﺗ زا
يﺎﻗآ ﻲﺴﻳوا ﺮﺘﻛد ﻪﻛ
رد
ﻘﻣ ﻦﻳوﺪﺗ ﻪﻟﺎ
و ﺪﻨﺘﺷاد يرﺎﻜﻤﻫ زا
نﺎﻳﺎﻗآ ﻦﻳدﺮﻓ ﺪﻴﻌﺳﺮﺘﻛد و ﺮﻓ
ﻊﻤﺟ رد ﻪﻛ ﻲﻧﺎﺷﺎﻛ نﺎﻤﻳا ﺮﺘﻛد تﺎﻋﻼﻃا يروآ
يرﺎﻜﻤﻫ
ﺪﻨﺘﺷاد
، ﻲﻣ ﻲﻧادرﺪﻗ و ﺮﻜﺸﺗ ددﺮﮔ
.
ﻊﺑﺎﻨﻣ :
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Emerging Infectious Diseases [serial online] 1998; 4 (2): 32-50. Available from:
url:http://www.cdc.gov/ncidod/eid/vol4no2/contents.htm. Accessed Des 21, 2003.
2- Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL. Harrison's Principles of Internal Medicine.
15th ed. New York: McGraw-Hill; 2001. pp: 1024-31.
3- Centers for Disease Control and Prevention (CDC). Trends in tuberculosis--United States, 2004. MMWR Morb Mortal Wkly Rep. 2005 Mar 18;54(10):245-9.
4- Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. New York: Churchill- Livingstone; 2000. pp: 43, 2579, 2581-83, 2588-89, 2603.
5- Somoskovi A, Hotaling JE, Fitzgerald M, O'Donnell D, Parsons LM, Salfinger M. Lessons from a proficiency testing event for acid-fast microscopy. Chest. 2001; 120 (1): 250-57.
6- Sinha SK, Chatterjee M, Bhattacharya S, Pathak SK, Mitra RB, Karak K, et al. Diagnostic evaluation of extrapulmonary tuberculosis by fine needle aspiraton (FNA) supplemented with AFB smear and culture. J Indian Med Assoc. 2003; 101 (10): 588, 590-1.
7- Scott CP, Dos Anjos Filho L, De Queiroz Mello FC, Thornton CG, Bishai WR, Fonseca LS, et al. Comparison of
٥٥
C(18)-carboxypropylbetaine and standard N-acetyl-L-cysteine-NaOH processing of respiratory specimens for increasing tuberculosis smear sensitivity in Brazil. J Clin Microbiol. 2002; 40 (9): 3219-22.
8- Alp A, Pinar A, Hascelik G. Comparison of Cobas Amplicor system and microscopic examination with bactec radiometric method for the detection of Mycobacterium tuberculosis in clinical samples. Mikrobiyol Bul. 2004; 38 (3):
193-201. Turkish.
9- Aljafari AS, Khalil EA, Elsiddig KE, El Hag IA, Ibrahim ME, Elsafi ME, et al. Diagnosis of tuberculous lymphadenitis by FNAC, microbiological methods and PCR: a comparative study. Cytopathology. 2004; 15 (1): 44-8.
10- Selvakumar N, Sudhamathi S, Duraipandian M, Frieden TR, Narayanan PR. Reduced detection by Ziehl-Neelsen method of acid-fast bacilli in sputum samples preserved in cetylpyridinium chloride solution. Int J Tuberc Lung Dis.
2004; 8 (2): 248-52.
11- Ashok R, Awdhesh K, Nishat A. Multidrug-Resistant Mycobacterium tuberculosis: Molecular Perspectives.
Emerging Infectious Diseases [serial online] 1998 April- June; 4(2): 32-50. Available from:
url:http://www.cdc.gov/ncidod/eid/vol4no2/contents.htm Accessed Des 21, 2003.
12- Laboratory Services in Tuberculosis Control: Part 2. Microscopy. Geneva, Switzerland: World Health Organization, 1998;258.
13- Habeenzu C, Lubasi D, Fleming AF. Improved sensitivity of direct microscopy for detection of acid-fast bacilli in sputum in developing countries. Trans R Soc Trop Med Hyg. 1998; 92 (4): 415-16.
14- Murray SJ, Barrett A, Magee JG, Freeman R. Optimisation of acid fast smears for the direct detection of mycobacteria in clinical samples. J Clin Pathol. 2003; 56 (8): 613-15.
15- Ulukanligil M, Aslan G, Tasci S. A comparative study on the different staining methods and number of specimens for the detection of acid fast bacilli. Mem Inst Oswaldo Cruz. 2000; 95 (6): 855-58.
16- Kivihya-Ndugga LE, van Cleeff MR. A comprehensive comparison of Ziehl-Neelsen and fluorescence microscopy for the diagnosis of tuberculosis in a resource-poor urban setting. Int J Tuberc Lung Dis. 2003; 7 (12): 1163-71.
17- Githui W, Kitui F, Juma ES. A comparative study on the reliability of the fluorescence microscopy and Ziehl- Neelsen method in the diagnosis of pulmonary tuberculosis. East Afr Med J. 1993; 70 (5): 263-66.
18- Yanagisawa N, Shimada H. Current status of the criteria for discharging patients with pulmonary tuberculosis results of questionnaire survey on the criteria for discharging patients from tuberculosis wards of the hospitals in Kanto area. Kekkaku. 2004; 79 (6): 375-80.
19- Woods GL. Concentration of sputum by cytocentrifugaion for preparation of smears for detection of acid fast bacilli doesn’t increase sensitivity of the flurochrome stain. J Clin Microbial. 1995; 33 (7): 1915-16.
٥٦
A comparison of Fluoresence microscipy with the Ziehl-Neelsen and technique for the
detection of acid-fast bacilli
M. Ziaee*, Gh. Azarkar**, P. Maleki Nejad***
* Assistant Professor, Department of Infectious Diseases, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
** General Practitioner
*** Student of Medicine
Abstract
Background and Aim: Nowadays new methods are used to detect TB. But due to their costs and technological limitations for all, we compare two old staining methods, Ziehl-Neelsen (ZN) and fluorescence, and their diagnostic values in detection of TB.
Materials and Methods: This descriptive analytical study was done in two steps. First, 1430 patients of suspected having TB who were referred to central TB laboratory of Birjand and 3125 specimens were collected between April 1995 and April 2002. These specimens were stained by carbolfuchsin (Ziehl-Neelsen) and auramin – 0 (fluorochorom) to detect acid fast bacilli (AFB). In the second step 500 patients out of 1430 cases were studied applying ZN and FM methods. Among these, 30 cases of FM and 26 cases of ZN had positive smear. On the whole, 37 cases were positive, using either method. The gathered data were analyzed by means of kappa agreement multiplex statistical test.
Results: In this study 116 patients (8.1%) were smear positive with fluorescence microscopy (FM) and 41 patients of this group (2.9%) were also positive with ZN. ZN staining showed 35%
sensitivity in positive FM specimens. When the first and second specimens, were simultaneously studied, sensitivity of ZN rose from 35% to 42%. The 500 patients were studied with both ZN and FM. 30 specimens were positive with FM, and 26 were positive with ZN, and in addition 37 specimens were positive with both techniques. Agreement multiplex kappa for these detective methods-ZN and FM- was 0.660 (P<0.001). In this study by setting FM as a basement, ZN sensitivity was 77.3%, specificity was 98.5%, positive predictive value 85%, and negative predictive value 97.6%.
Conclusion: These results showed that due to high agreement between ZN and FM, both FM and ZN methods have detective value for the diagnosis of TB, but when only one specimen is available, FM is preferred. So, we suggest that, where possible, suspected specimens are first stained by FM [to improve velocity and sensitivity] then positive specimens be checked with ZN staining.
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Key Words: Mycobacterium tuberculosis; Fluorescence microscopy; Ziehl-Neelsen; Acid fast bacilli
