BACKGROUND: For microbiological confirmation of diagnosis of pulmonary tuberculosis in young children, sequential gastric lavages are recommended; sputum induction has not been regarded as feasible or useful. We aimed to compare the yield of Mycobacterium tuberculosis from repeated induced sputum with that from gastric lavage in young children from an area with a high rate of HIV and tuberculosis. METHODS: We studied 250 children aged 1 month to 5 years who were admitted for suspected pulmonary tuberculosis in Cape Town, South Africa. Sputum induction and gastric lavage were done on three consecutive days according to a standard procedure. Specimens were stained for acid-fast bacilli; each sample was cultured singly for M tuberculosis. FINDINGS: Median age of children was 13 months (IQR 6-24). A positive smear or culture for M tuberculosis was obtained from 62 (25%) children; of these, 58 (94%) were positive by culture, whereas almost half (29 [47%]) were smear positive. Samples from induced sputum and gastric lavage were positive in 54 (87%) and 40 (65%) children, respectively (difference in yield 5.6% [1.4-9.8%], p=0.018). The yield from one sample from induced sputum was similar to that from three gastric lavages (p=1.0). Microbiological yield did not differ between HIV-infected and HIV-uninfected children (p=0.17, odds ratio 0.7 [95% CI 0.3-1.3]). All sputum induction procedures were well tolerated; minor side-effects were increased coughing, epistaxis, vomiting, or wheezing. INTERPRETATION: Sputum induction is safe and useful for microbiological confirmation of tuberculosis in young children. This technique is preferable to gastric lavage for diagnosis of pulmonary tuberculosis in both HIV-infected and HIV-uninfected infants and children.
BACKGROUND: For microbiological confirmation of diagnosis of pulmonary tuberculosis in young children, sequential gastric lavages are recommended; sputum induction has not been regarded as feasible or useful. We aimed to compare the yield of Mycobacterium tuberculosis from repeated induced sputum with that from gastric lavage in young children from an area with a high rate of HIV and tuberculosis. METHODS: We studied 250 children aged 1 month to 5 years who were admitted for suspected pulmonary tuberculosis in Cape Town, South Africa. Sputum induction and gastric lavage were done on three consecutive days according to a standard procedure. Specimens were stained for acid-fast bacilli; each sample was cultured singly for M tuberculosis. FINDINGS: Median age of children was 13 months (IQR 6-24). A positive smear or culture for M tuberculosis was obtained from 62 (25%) children; of these, 58 (94%) were positive by culture, whereas almost half (29 [47%]) were smear positive. Samples from induced sputum and gastric lavage were positive in 54 (87%) and 40 (65%) children, respectively (difference in yield 5.6% [1.4-9.8%], p=0.018). The yield from one sample from induced sputum was similar to that from three gastric lavages (p=1.0). Microbiological yield did not differ between HIV-infected and HIV-uninfectedchildren (p=0.17, odds ratio 0.7 [95% CI 0.3-1.3]). All sputum induction procedures were well tolerated; minor side-effects were increased coughing, epistaxis, vomiting, or wheezing. INTERPRETATION: Sputum induction is safe and useful for microbiological confirmation of tuberculosis in young children. This technique is preferable to gastric lavage for diagnosis of pulmonary tuberculosis in both HIV-infected and HIV-uninfectedinfants and children.
Authors: Christina Lancioni; Melissa Nyendak; Sarah Kiguli; Sarah Zalwango; Tomi Mori; Harriet Mayanja-Kizza; Stephen Balyejusa; Megan Null; Joy Baseke; Deo Mulindwa; Laura Byrd; Gwendolyn Swarbrick; Christine Scott; Denise F Johnson; LaShaunda Malone; Philipa Mudido-Musoke; W Henry Boom; David M Lewinsohn; Deborah A Lewinsohn Journal: Am J Respir Crit Care Med Date: 2011-10-27 Impact factor: 21.405
Authors: Nicole Salazar-Austin; Alvaro A Ordonez; Alice Jenh Hsu; Jane E Benson; Mahadevappa Mahesh; Elizabeth Menachery; Jafar H Razeq; Max Salfinger; Jeffrey R Starke; Aaron M Milstone; Nicole Parrish; Eric L Nuermberger; Sanjay K Jain Journal: Lancet Infect Dis Date: 2015-11-16 Impact factor: 25.071
Authors: P du Cros; A Swaminathan; O I Bobokhojaev; Z D Sharifovna; C Martin; K Herboczek; C Höhn; J A Seddon Journal: Public Health Action Date: 2015-06-21