Background: Confirmation of pulmonary tuberculosis (PTB) in young children is difficult as they seldom expectorate sputum. Aim: To compare sputa obtained by nasopharyngeal aspiration and by sputum induction for staining and culture of Mycobacterium tuberculosis. Patients and methods: Patients from Mulago Hospital, Kampala with symptoms suggestive of PTB were considered for inclusion in the study. Those with a positive tuberculin test and/or a chest radiograph compatible with tuberculosis were recruited. Infection with human immunodeficiency virus (HIV) was confirmed by duplicate enzyme-labelled immunosorbent assay or in children ,15 months by polymerase chain reaction (PCR). Direct PCR was undertaken on 82 nasopharyngeal aspirates. Results: Of 438 patients referred, 94 were recruited over a period of 5 months. Median (range) age was 48 (4-144) months. Of 63 patients tested, 69.8% were infected with HIV. Paired and uncontaminated culture results were available for 88 patients and smear results for 94 patients. Nasopharyngeal aspirates were smear-positive in 8.5% and culture-positive in 23.9%. Induced sputa were smear-positive in 9.6% and culture positive in 21.6%. Overall, 10.6% were smear-positive, 25.5% were culture-positive and 26.6% had smear and/or culture confirmed tuberculosis. Direct PCR on nasopharyngeal aspirates had a sensitivity of 62% and specificity of 98% for confirmation of culture-positive tuberculosis. Conclusions: Nasopharyngeal aspiration is a useful, safe and low-technology method for confirmation of PTB and, like sputum induction, can be undertaken in outpatient clinics.T he diagnosis of pulmonary tuberculosis (PTB) in young children is usually based on contact history, positive tuberculin test and compatible chest radiography. However, confirmation of tuberculosis by culture is important where, for example, there is difficulty in clinical diagnosis, the contact history is not known or drug sensitivities are not available. In developing countries the diagnosis of PTB is particularly difficult as the contact history is often not clear (especially where tuberculosis/human immunodeficiency virus (HIV) co-infection in the household is common) and the tuberculin test is often falsely negative. Chest radiography may be difficult to interpret, especially when there is HIV-related pulmonary disease such as lymphocytic interstitial pneumonitis (LIP). Obtaining sputum in young children who are unable to expectorate is problematic. Gastric aspiration usually requires a child to be admitted for up to 3 days and has to be undertaken in the early morning while the child is recumbent and fasted overnight.3 Alternative methods include sputum induction (SI), 4 5 laryngeal swab (LS) 6 7 and nasopharyngeal aspiration (NPA).8 9 This study aimed to compare the value of NPA with SI for confirmation of PTB. METHODSThe study was undertaken at Mulago Hospital, Kampala during the period January to June 2004. A diagnostic room was set up for SI, NPA and tuberculin testing, organised by a dedicated paediatrician, a nur...

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Collecting uncontaminated urine specimens from infants is difficult. Commonly, an adhesive urinecollecting bag is used, which is uncomfortable. This study determined bacterial contamination rates using three methods of urine collection sequentially on the same infant (without known urinary tract infection)-clean-catch, cotton wool (sanitary) pad and urine bag. The study was undertaken in children under 3 years of age in the Institute of Maternal and Child Health of Pernambuco (IMIP), Recife, Brazil. Urine samples were analysed using phase contrast microscopy and routine culture. Culture of bacteria at any level was interpreted as a contaminated urine specimen. Cultures with > 10(5) colony-forming units/ml of one species by all three collection methods were regarded as true urinary tract infection and these children were excluded. Altogether, 534 urine samples from 191 patients were analysed. Median age was 2 months (1 day-36 months) and 124 (65%) were boys. Twelve children (6.3%) were considered to have true urinary tract infection, three were indeterminate and in 16 one or more samples were missing and all were excluded from analysis. There were more missing samples using the clean-catch method (12%) than when using the bag (4%) or pad (4%). Seventy-six of 160 (47.5%) children had evidence of bacterial contamination. Clean-catch specimens showed the least contamination (14.7%) and rates were similar between pads (29%) and bags (26.6%) (kappa = 0.40). Urine contamination rates were similar for sanitary pads and urine bags and significantly higher than for clean-catch (p<0.01). However, pads were a simple, non-invasive and comfortable alternative to bags.

Of 260 children with acute diarrhea in Erbil, Iraqi Kurdistan, 96 (37%) were infected with rotavirus. Reverse transcription–polymerase chain reaction identified G1, G4, G2, G9, P[8], P[6], and P[4] as the most common genotypes. Eight G/P combinations were found, but P[8]G1 and P[4]G2 accounted for >50% of the strains.

The effectiveness of tepid sponging, in addition to antipyretic medication, in the reduction of temperature in febrile children living in a tropical environment, was assessed in a prospective, randomized, open trial. Seventy-five children aged between 6 and 53 months who attended the casualty department of the Children's Hospital, Bangkok, Thailand, with fever (rectal temperature > or = 38.5 degrees C) of presumed viral origin were randomized to received either tepid sponging and oral paracetamol (sponged group) or paracetamol alone (control group). Rectal temperature and the occurrence of crying, irritability, and shivering were recorded over the following 2 hours. A greater and more rapid fall in mean rectal temperature occurred in the sponged group than in the control group. Temperature fell below 38.5 degrees C sooner in children in the sponged group than in control children (P < 0.001). At 60 minutes, 38 (95.0%) of the controls still had a temperature of 38.5 degrees C or greater, compared with only 15 children (42.9%) in the sponged group (P < 1 x 10(-5). Crying was associated with sponging, but shivering and irritability occurred in only one child who was being sponged. It is concluded that tepid sponging, in addition to antipyretic medication, is clearly more effective than antipyretic medication alone in reducing temperature in febrile children living in a tropical climate.