Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study

Zar, Heather J.; Hanslo, D.; Apolles, Patricia; Swingler, George; Hussey, Gregory

doi:10.1016/s0140-6736(05)17702-2

Cited by 439 publications

(385 citation statements)

References 14 publications

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“…For culture confirmation, the yield from a single induced sputum was equivalent to that obtained from three gastric lavages in HIV-infected and uninfected children. 42 Induced sputum using hypertonic saline should therefore be the primary diagnostic procedure in a child with suspected pulmonary TB.…”

Section: Mycobacterial Infectionsmentioning

confidence: 99%

Chronic lung disease in human immunodeficiency virus (HIV) infected children

Zar

2007

Pediatric Pulmonology

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The development of chronic lung disease is common in HIV‐infected children. The spectrum of chronic HIV‐associated lung disease includes lymphocytic interstitial pneumonia (LIP), chronic infections, immune reconstitution inflammatory syndrome (IRIS), bronchiectasis, malignancies, and interstitial pneumonitis. Chronic lung disease may result from recurrent or persistent pneumonia due to bacterial, mycobacterial, viral, fungal or mixed infections. In high tuberculosis (TB) prevalence areas, M. tuberculosis is an important cause of chronic respiratory illness. With increasing availability of highly active antiretroviral therapy (HAART) for children in developing countries, a rise in the incidence of IRIS due to mycobacterial or other infections is being reported. Diagnosis of chronic lung disease is based on chronic symptoms and persistent chest X‐ray changes but definitive diagnosis can be difficult as clinical and radiological findings may be non‐specific. Distinguishing LIP from miliary TB remains a difficult challenge in HIV‐infected children living in high TB prevalence areas. Treatment includes therapy for specific infections, pulmonary clearance techniques, corticosteroids for children with LIP who are hypoxic or who have airway compression from tuberculous nodes and HAART. Children who are taking TB therapy and HAART need adjustments in their drug regimes to minimize drug interactions and ensure efficacy. Preventative strategies include immunization, chemoprophylaxis, and micronutrient supplementation. Early use of HAART may prevent the development of chronic lung disease. Pediatr Pulmonol. 2008; 43:1–10. © 2007 Wiley‐Liss, Inc.

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Section: Mycobacterial Infectionsmentioning

confidence: 99%

Chronic lung disease in human immunodeficiency virus (HIV) infected children

Zar

2007

Pediatric Pulmonology

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“…17,18,26,27 Using the total number of tuberculosis cases (culture-confirmed, plus cases meeting an author-defined diagnosis of clinical tuberculosis) as a denominator, the incremental yield of Xpert on a second specimen ranged from 8·3% to 17·5%, and from 0% to 12·5% on a third specimen. The incremental yield of culture (Löwenstein-Jensen or Mycobacteria Growth Indicator Tube values) ranged from 14·3% to 21·9% on the second specimen.…”

Section: Resultsmentioning

confidence: 99%

“…The yield of culture in childhood tuberculosis ranges from 20% to 70% depending on factors such as age, disease severity, and type and quality of the specimen, and culture method used. 27,28 All these factors probably also interact with smear status. Disease severity might be a proxy for bacillary load as shown in one study assessing pulmonary tuberculosis in children, in which the yield of culture ranged from 35% in uncomplicated lymph-node disease and 82% in complicated parenchymal disease, to 93% in disseminated and 100% in adult-type disease.…”

Section: Discussionmentioning

confidence: 99%

Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: A systematic review and meta-analysis

2015

Indian Journal of Tuberculosis

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“…(7,8,(10)(11)(12)(13)(14)23,24) Anderson et al (8) compared a single IS sample with BAL specimens in HIV-negative patients and also reported low sensitivity for AFB smear testing using both techniques (19% and 12%, respectively), although the sensitivity of culture was 73% in IS and 87% in BAL fluid. Another group of authors (11) demonstrated higher sensitivity for AFB smear testing, comparing 3 IS samples with BAL specimens, and found no difference between HIV-negative and HIV-positive patients (34% and 36% for IS, and 38% and 40% for BAL fluid, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…However, the invasive nature of bronchoscopy, together with its higher cost, has motivated researchers to assess its yield in the diagnosis of pulmonary TB. (7)(8)(9)(10)(11)(12)(13)(14) The objective of our study was to assess the diagnostic sensitivity of the bacteriologic analysis of induced sputum (IS) for the diagnosis of pulmonary TB in a tertiary referral hospital in a region with a high prevalence of TB, as well as to identify the clinical characteristics associated with the confirmed diagnosis. In addition, we evaluated the diagnostic yield of bronchoscopy performed after IS samples have tested negative for AFB.…”

Section: Introductionmentioning

confidence: 99%

Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital

et al. 2009

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Objective: To determine the diagnostic sensitivity of bacteriological analyses in induced sputum (IS) for the diagnosis of pulmonary tuberculosis (TB) and to identify the clinical characteristics associated with the confirmed diagnosis, as well as to determine the diagnostic yield of bronchoscopy carried out when IS tests negative for AFB in smear microscopy. Methods: A retrospective, cross-sectional study of patients suspected of having active pulmonary TB and referred to our clinic for sputum induction. We consecutively reviewed the laboratory data of all patients submitted to sputum induction between June of 2003 and January of 2006, as well as their electronic medical records. In addition, the results of the bacteriological analysis of bronchoscopic specimens collected from the patients whose AFB tests were negative in IS were reviewed. Results: Of the 417 patients included in the study, 83 (19.9%) presented IS samples that tested positive for TB (smear microscopy or culture). In the logistic regression analysis, radiological findings of cavitation (OR = 3.8; 95% CI: 1.9-7.6) and of miliary infiltrate (OR = 3.7; 95% CI: 1.6-8.6) showed the strongest association with the diagnosis of pulmonary TB. In 134 patients, bronchoscopy was carried out after negative AFB results in IS and added 25 (64.1%) confirmed diagnoses of pulmonary TB. Conclusions: In our clinical practice, the frequency of confirmed diagnosis of pulmonary TB using IS (19.9%) was lower than that previously reported in controlled trials. Cavitation and miliary infiltrate increase the diagnostic probability of pulmonary TB using IS. The use of bronchoscopy when IS tests negative for AFB significantly increases sensitivity in the diagnosis of pulmonary TB.Keywords: Tuberculosis, pulmonary; Diagnosis; Sputum. ResumoObjetivo: Verificar a sensibilidade diagnóstica da análise bacteriológica do escarro induzido (EI) para o diagnós-tico de tuberculose (TB) pulmonar e identificar as variáveis clínicas associadas com o diagnóstico confirmado. Além disso, avaliar o rendimento diagnóstico da broncoscopia realizada se a pesquisa de BAAR for negativa no EI. Métodos: Estudo transversal e retrospectivo de pacientes com suspeita de TB pulmonar ativa, encaminhados ao serviço para a indução de escarro. Foram revisados consecutivamente os registros laboratoriais de todos os pacientes submetidos à indução de escarro entre junho de 2003 e janeiro de 2006, assim como o prontuário eletrônico de cada caso. Também foram revisados os resultados bacteriológicos das amostras broncoscópicas coletadas dos pacientes cujos resultados de BAAR em EI foram negativos. Resultados: Dos 417 pacientes estudados, 83 (19,9%) tiveram resultados positivos (BAAR e/ou cultura) no EI. Na análise de regressão logística, os achados radiológicos de cavitação pulmonar (OR = 3,8; IC95%: 1,9-7,6) e de infiltrado de padrão miliar (OR = 3,7; IC95%: 1,6-8,6) associaram-se mais significativamente com o diagnóstico de TB pulmonar. A broncoscopia foi realizada, após resultado de BAAR negativo no EI...

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Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study

Cited by 439 publications

References 14 publications

Chronic lung disease in human immunodeficiency virus (HIV) infected children

Chronic lung disease in human immunodeficiency virus (HIV) infected children

Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: A systematic review and meta-analysis

Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital

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