“Induced sputum versus gastric lavage for the diagnosis of pulmonary tuberculosis in children”

Abstract

BackgroundDiagnosis of pulmonary tuberculosis (PTB) is difficult in infants and young children. For microbiological confirmation of PTB children, sequential gastric lavage (GL) is recommended. Induced sputum (IS) may be an alternative or complementary tool, but the information is limited in children in developed countries. The aim of this study is to assess the safety and diagnostic yield from IS combined with GL for PTB diagnosis in non-HIV infected children.MethodsThe study involved 22 children with suspected PTB admitted to the Getafe Hospital from January 2007 to May 2011. IS and GL were performed on three consecutive days, according to a standardized protocol. In all samples, BK staining, culture and PCR were carried out, including Genotype MTBDR plus for resistance to INH-RIF (Isoniazid-Rifampin) since 2008. A preliminary analysis of an ongoing prospective study is presented.ResultsMedian age was 72 months (range 1 month to 14 years of age). Seven (33%) were ≤ 5 years of age. Seventeen were clinically diagnosed of PTB based on positive PPD and radiological criteria. Microbiological confirmation was achieved in 10 (58.8%) by either GL or IS. M. tuberculosis was identified by GL in 8 children (47.1%) and by IS in 7 (41.2%). One infant (2 IS samples) had transient oxygen desaturation recovered spontaneously.ConclusionsIS appears to be safe and well tolerated by children for diagnosis of PTB and is more convenient. Increasing the diagnostic yield of PTB in children with PTB may be a complementary technique. Largest studies are necessary to define the role of IS in paediatric PTB.

Stool Xpert® MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis at primary clinics in Zimbabwe

“…Previous studies have shown high sensitivity of Xpert when sputum,6–8 gastric lavage,9,10 bronchoalveolar lavage11 and nasopharyngeal aspirates12 were used. Xpert was therefore endorsed by the World Health Organization as an initial test for diagnosing TB in children.…”

Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan

“…[5][6][7][8] The availability of isolation rooms with negative pressure required for SI, and the presence of bronchoscopy facilities only in specialised hospital settings, however, hinders the wider use of these procedures in resource-limited settings. GA is commonly used in children to obtain sputum specimens, 6,[8][9][10][11][12][13] but is less common in adults with difficulties in expectoration.…”

Prevalence of and risk factors for pulmonary tuberculosis among newly diagnosed HIV-1 infected Nigerian children

“…5 The diagnosis of PTB in children remains challenging, partly due to the inability of children <8 years to generate a productive sputum specimen 17 and because of their paucibacillary nature. 18 The majority (70%) of our study subjects were children <5 years of age. Thus, in typical HIV care and treatment settings in Africa, our methods of PTB diagnosis would be considered more representative since routine sputum or gastric aspirate smear microscopy is uncommon.…”