Combined Use of Gastric Aspirate and Induced Sputum Increases the Microbiological Diagnosis of Tuberculosis in Children

Abstract

Objective Diagnosis of pulmonary tuberculosis (PTB) in pediatrics is a challenge due to the paucibacillary condition of the disease in this population, low sputum expectoration, and diverse unspecific symptomatology. Mycobacterial isolation through culture remains a priority. The objective of this study is to explore gastric aspirates and induced sputum techniques in the pediatric population for positivity on mycobacterial cultures.

Methods In this observational analytical study, two temporal groups were evaluated. A comparison of the isolation rate defined as positive culture confirmation by gastric aspirate (GA), induced sputum (IS), or combination of these both techniques in children under 10 years of age. The study included 86 children, 37 in the first evaluated study group and 49 in the second group.

Discussion Culture positivity was 10.8 and 30.6% for the first and second case series, respectively. These findings showed that the combination of GA and IS in two consecutive days yielded a significantly higher detection rate to confirm pulmonary tuberculosis by culture.

Conclusion The combination of GA plus IS samples for collection of M. tuberculosis culture can be a useful, nonexpensive, and safe diagnostic tool in low- and middleincome countries to diagnose tuberculosis in children.

Keywords

pulmonary tuberculosis - gastric aspirate - induced sputum - child

Publication History

Received: 06 December 2019

Accepted: 06 March 2020

Article published online:
21 April 2020

• References

• 1 WHO. Global Tuberculosis Report 2014. Available at: https://apps.who.int/iris/bitstream/handle/10665/137094/9789241564809_eng.pdf?sequence=1&isAllowed=y
• 2 Jenkins HE. Global burden of childhood tuberculosis. Pneumonia 2016; 8: 24
• 3 Faddoul D. Childhood tuberculosis: an overview. Adv Pediatr 2015; 62 (01) 59-90
• 4 Abadco DL, Steiner P. Gastric lavage is better than bronchoalveolar lavage for isolation of Mycobacterium tuberculosis in childhood pulmonary tuberculosis. Pediatr Infect Dis J 1992; 11 (09) 735-738
• 5 CDC. Reported tuberculosis in the United States. 2015: 206 . Available at: https://www.cdc.gov/tb/statistics/default.htm
• 6 Marais BJ, Schaaf HS. Tuberculosis in children. Cold Spring Harb Perspect Med 2014; 4 (09) a017855
• 7 Lobato MN, Loeffler AM, Furst K, Cole B, Hopewell PC. Detection of Mycobacterium tuberculosis in gastric aspirates collected from children: hospitalization is not necessary. Pediatrics 1998; 102 (04) E40
• 8 Planting NS, Visser GL, Nicol MP, Workman L, Isaacs W, Zar HJ. Safety and efficacy of induced sputum in young children hospitalised with suspected pulmonary tuberculosis. Int J Tuberc Lung Dis 2014; 18 (01) 8-12
• 9 Hatherill M, Hawkridge T, Zar HJ. , et al. Induced sputum or gastric lavage for community-based diagnosis of childhood pulmonary tuberculosis?. Arch Dis Child 2009; 94 (03) 195-201
• 10 Gonzalez-Angulo Y, Wiysonge CS, Geldenhuys H. , et al. Sputum induction for the diagnosis of pulmonary tuberculosis: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2012; 31 (07) 1619-1630
• 11 Perez-Velez CM, Wilches-Luna EC, Hernández-Sarmiento JM. , et al. Preliminary results of a comparative yield study of induced sputum, string test, and gastric aspirate for the microbiological diagnosis of pulmonary tuberculosis in children. Am J Respir Crit Care Med 2010; 181: A1775
• 12 Graham SM, Cuevas LE, Jean-Philippe P. , et al. Clinical case definitions for classification of intrathoracic tuberculosis in children: an update. Clin Infect Dis 2015; 61 (61) (Suppl. 03) S179-S187
• 13 Schaaf HS, Garcia-Prats AJ, Hesseling AC, Seddon JA. Managing multidrug-resistant tuberculosis in children: review of recent developments. Curr Opin Infect Dis 2014; 27 (03) 211-219
• 14 Zar HJ, Tannenbaum E, Apolles P, Roux P, Hanslo D, Hussey G. Sputum induction for the diagnosis of pulmonary tuberculosis in infants and young children in an urban setting in South Africa. Arch Dis Child 2000; 82 (04) 305-308
• 15 Zar HJ, Hanslo D, Apolles P, Swingler G, Hussey G. Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study. Lancet 2005; 365 (9454): 130-134
• 16 Marais BJ, Hesseling AC, Gie RP, Schaaf HS, Enarson DA, Beyers N. The bacteriologic yield in children with intrathoracic tuberculosis. Clin Infect Dis 2006; 42 (08) e69-e71
• 17 Ruiz Jiménez M, Guillén Martín S, Prieto Tato LM. , et al. “Induced sputum versus gastric lavage for the diagnosis of pulmonary tuberculosis in children”. BMC Infect Dis 2013; 13: 222
• 18 López J, Penín M, Retamosa M, Casado J. Jugo gástrico versus esputo inducido para el diagnóstico de tuberculosis pulmonar en niños. Enferm Infecc Microbiol Clin 2012; 30 (03) 165-166
• 19 Lewinsohn DM, Leonard MK, Lobue PA. , et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines. Diagnosis of Tuberculosis in Adults and Children. 2017; 64: 1-33
• 20 Atehortúa S, Ramírez F, Echeverri LM, Peñata A, Ospina S. Xpert MTB/RIF test performance assay in respiratory samples at real work settings in a developing country. Biomedica 2015; 35 (01) 125-130