Acid-fast mycobacteria resist decolorization by acid-alcohol after primary staining owing to the high lipid (mycolic acid) content in their cell walls. The identification of mycobacteria with auramine O is due to the affinity of the mycolic acid in the cell walls for the fluorochromes. The dye will bind to the mycobacteria, which appear as bright yellow luminous rods against a dark background. The potassium permanganate helps prevent non-specific fluorescence.
All acid-fast organisms will be stained by Auramine O, including some parasites. Slides stained with auramine O may be restained with Ziehl-Neelsen or Kinyoun stain directly, as long as the oil has been removed. This provides a convenient method of confirming and differentiating morphology of positive slides with the traditional stains. The fluorochromes stains are recommended for specimen examination because of their increased sensitivity and speed.