Saline Nebulization before Gastric Lavage in the Diagnosis of Pulmonary Tuberculosis in Children and Adolescents

Abstract

The main objective is to assess whether nebulization before gastric lavage (GL) improves its sensitivity for the diagnosis of childhood tuberculosis (TB). Children and adolescents suspected of pulmonary TB were randomly assigned (1 : 2) to nebulization with hypertonic saline 30 min before GL (Neb group; n = 36) or GL without prior nebulization (controls; n = 68). The proportion of positive GL smears was greater in Neb group than in the control group; however, no statistical significance was observed (36.3% vs. 22.2%; p = 0.4). Inhalation of nebulized hypertonic saline before GL did not improve TB diagnosis in this study. Nevertheless, the validation of our data will require large longitudinal studies.

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

“…19,[21][22][23][24][25][26] Maciel et al studied variations in procedures in a systematic review and highlighted the need for a standardised protocol for GA in children. 27 Variations observed in the yield of GS in adults are probably also due to non-standardisation of the protocol used for GA and the processing of GS.…”

Alternative sputum collection methods for diagnosis of childhood intrathoracic tuberculosis: a systematic literature review

“…Out of 440 records screened, 30 studies (31 articles)5–35 were included in the review (online Supplementary figure 1).…”

“…GA was performed early morning, after an overnight or 4–8 hours fast. Only two studies29 30 reported the minimum volume of gastric liquid aspirated: 10 mL for the first and 20 mL for the second. Four studies16 25 29 33 reported the use of a normal saline wash to collect gastric liquid and in two studies, the use of sterile water in case of aspiration of less than 3 mL of gastric fluid 7 27.…”

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

“…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.…”

“…Ouagadougou, Burkina Faso 49 yields have been reported from gastric lavage, e.g., 28.3% in Brazilian children [13], 61.2% in Turkish adults [11] and 90% in Pakistani adults and children [18]. Low yields were also reported with gastric lavage from children in Zimbabwe, in Malawi and in South Africa (Table 3).…”