Multiple Sampling in One Day to Optimize Smear Microscopy in Children with Tuberculosis in Yemen

Al-Aghbari, Nasher; Al-Sonboli, Najla; Yassin, Mohammed A.; Coulter, J. B. S.; Atef, Zayed; Al-Eryani, Ali; Cuevas, Luís E.

doi:10.1371/journal.pone.0005140

Cited by 38 publications

(38 citation statements)

References 8 publications

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“…36,40 Multiple specimens are helpful at achieving the maximum yield. 16,38,41 Urine tests for mycobacterial lipoarabinomannan by both ELISA and lateral flow were reported to be sensitive in adults with advanced HIV disease, but had low sensitivity and specificity in children. 42,43 …”

Section: Review and Discussionmentioning

confidence: 99%

Extensively drug-resistant tuberculosis in a young child after travel to India

Salazar-Austin

Ordoñez

Hsu

et al. 2015

The Lancet Infectious Diseases

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Extensively drug-resistant (XDR) tuberculosis is becoming increasingly prevalent worldwide, but little is known about XDR tuberculosis in young children. In this Grand Round we describe a 2-year-old child from the USA who developed pneumonia after a 3 month visit to India. Symptoms resolved with empirical first-line tuberculosis treatment; however, a XDR strain of Mycobacterium tuberculosis grew in culture. In the absence of clinical or microbiological markers, low-radiation exposure pulmonary CT imaging was used to monitor treatment response, and guide an individualised drug regimen. Management was complicated by delays in diagnosis, uncertainties about drug selection, and a scarcity of child-friendly formulations. Treatment has been successful so far, and the child is in remission. This report of XDR tuberculosis in a young child in the USA highlights the risks of acquiring drug-resistant tuberculosis overseas, and the unique challenges in management of tuberculosis in this susceptible population.

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Section: Review and Discussionmentioning

confidence: 99%

Extensively drug-resistant tuberculosis in a young child after travel to India

Salazar-Austin

Ordoñez

Hsu

et al. 2015

The Lancet Infectious Diseases

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“…Al-Aghbari et al [20], reported that the combined yield of single expectorated sputum, NPA, SI and GA specimens was similar to the yield of specimens collected over consecutive days (e.g. three GA).…”

Section: Why Is Childhood Tb Not Considered a Major Public Health Promentioning

confidence: 90%

“…Initial studies reported that NPA had better sensitivity than IS [18] and similar yield to GA [19]. However, later studies in Yemen [20] and Peru [21] have suggested that the method has a lower yield. The few studies available however have included a wide range of settings, from reference hospitals to community-based populations, and these findings may reflect a differential yield for children with mild and severe illnesses.…”

Section: Why Is Childhood Tb Not Considered a Major Public Health Promentioning

confidence: 99%

The Urgent Need for New Diagnostics for Symptomatic Tuberculosis in Children

Cuevas

2010

Indian J Pediatr

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TB is a major public health problem causing 9 million cases, of which 10%-15% occur in children each year. Historically, children have received lower priority within TB control activities because they are considered less infectious than smear-positive adults. This review argues that TB is a public health problem in children and that poor awareness of the magnitude of the problem emanates from the lack of suitable pediatric diagnostic tests for TB and the characteristics of the disease in young children. New TB diagnostics, approved for use in adults have not been evaluated in children, although there is limited evidence that some of these tests hold promise and should be assessed. There are several approaches that could be used to improve the performance of tests in pediatric patients. These include improved methods for specimen collection and processing. The value of collecting specimens from multiple anatomical sites to shorten the diagnostic process and improve sensitivity was reported recently and the combination of expectorated sputum, nasopharyngeal aspirate, induce sputum and gastric aspirate may result in a similar yield than specimens collected over consecutive days. Methods for sample collection such as fine needle aspiration biopsy should be used more frequently and the Microscopic Observation Drug Sensitivity (MODS) assay has higher sensitivity than LJ culture. There is however very scanty evidence of the performance of other promising tests such as the fully automated NAAT (Xpert) and Line Probe Assays and loop mediated isothermal amplification. Although the future holds promise, increased support from international organizations and funding agencies is needed to promote the evaluation and development of new diagnostics that are suitable for TB in children.

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“…According to the WHO and IULTD recommendations, the use of BAL or sputum induction for the diagnosis of TB is only justified if the patient is unable to produce sufficient sputum for examination, or when 2-3 high quality early morning sputum samples have been smear negative and a high index of suspicion of pulmonary TB persists [7][8][9][10][11][12]. Gastric lavage is appropriate in children under 5 who are unable to produce sputum reliably [9,13,14]. Some centers have used induced sputum [10], naso-pharyngeal aspiration [15], BAL [16] or a combination of BAL and GL [17] in children with varying degrees of success.…”

Section: Discussionmentioning

confidence: 99%

The Use of Broncho-Alveolar or Gastric Lavage for the Diagnosis of Pulmonary Tuberculosis in Ouagadougou, Burkina Faso

Diandé¹,

Kolk²,

Moyenga³

et al. 2013

UCMS

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Background: the national and international guidelines of the WHO and the IUALTD recommend priority sputum smears for diagnosis of pulmonary tuberculosis. We studied the use and diagnostic yield of sputum, broncho-alveolar and gastric lavage (BAL, GL) in the reference national mycobacteria Laboratory (NRL) (Burkina Faso) to see if clinicians follow the recommendations in the prescription of specimens. Methods: We analyzed by microscopy all samples sent to the RNL from 8 public and 6 private health care facilities in 2010. Results: 2638 patients were included. We have reported on 2414 early morning sputum samples, BAL from 191 patients and gastric lavage from 33. There were significant differences in the type of sample submitted per institution. Sputum formed 95% of the 862 samples from one hospital, whereas 78% of the 223 samples submitted by one private clinic were BAL samples. No sputum samples were submitted from these patients and in this clinic the diagnostic yield of BAL was just 4%. The overall diagnostic yield for early morning sputum specimens was 12% (290/2414), for BAL 3.7% (7/191) and for GL 6% (2/33). Conclusion: there was considerable variation in the diagnostic procedure used. Invasive methods are used at some sites in preference to safer and simpler means of obtaining material for diagnosis. Our review shows the need for constant vigilance and close adherence to internationally accepted guidelines for the diagnosis of pulmonary TB.

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Multiple Sampling in One Day to Optimize Smear Microscopy in Children with Tuberculosis in Yemen

Cited by 38 publications

References 8 publications

Extensively drug-resistant tuberculosis in a young child after travel to India

Extensively drug-resistant tuberculosis in a young child after travel to India

The Urgent Need for New Diagnostics for Symptomatic Tuberculosis in Children

The Use of Broncho-Alveolar or Gastric Lavage for the Diagnosis of Pulmonary Tuberculosis in Ouagadougou, Burkina Faso

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