SYNOPSIS The Ziehl-Neelsen stain is compared with three alternative methods of staining tubercle bacilli in paraffin sections: Fite's method (1938); a modification by Armstrong and Price (1947) of Fite's method; and a fluorescent method using the auramine-phenol stain.The fluorescent method was found to be the most effective of the four methods and its use is recommended as a routine tool in diagnostic histopathology.The Ziehl-Neelsen stain is the most commonly used technique in Britain for the demonstration of tubercle bacilli in histological sections. In our experience, however, this stain yields a disquietingly low incidence of positive results in sections from lesions which are histologically typical of tuberculosis. In such cases, a diagnosis of tuberculosis is often made in spite of the failure to demonstrate the organism, although a slight doubt as to the true nature of the lesion may remain in the pathologist's mind.Any technique which produces better results than those obtained with the Ziehl-Neelsen stain would therefore be welcome to histologists. This investigation involves a comparison of the Ziehl-Neelsen stain with two alternative fuchsin stains and with a fluorescent technique in an attempt to determine which is of the most value in the routine examination of histological sections. MaterialSeventy cases which had been diagnosed as 'tuberculosis' were selected at random from the files of the Department of Pathology, University of Manchester. Sections from all these cases showed epithelioid cell granulomata and areas of caseation. The tissues were from a variety of anatomical sites including lymph nodes (21), kidney (9), gastrointestinal tract (6), epididymus (5), liver (4), omentum (4), synovium (3), brain (1), vagina (1), heart (1), spleen (1), and skin (1).Sections from each case were cut and stained by the following methods:
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