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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31829f5c58
Original Studies

Ambulatory Gastric Lavages Provide Better Yields of Mycobacterium tuberculosis Than Induced Sputum in Children With Intrathoracic Tuberculosis

Mukherjee, Aparna MD*; Singh, Sarman MD; Lodha, Rakesh MD*; Singh, Varinder MD; Hesseling, A. C. PhD§; Grewal, Harleen M. S. PhD¶‖; Kabra, Sushil K. MD*; for the Delhi Pediatric TB Study Group

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Objective: To compare mycobacterial yield by induced sputum (IS) and gastric lavage (GL), performed on an ambulatory basis in children with probable intrathoracic tuberculosis.

Design: Diagnostic accuracy study.

Setting: Two tertiary care hospitals in Delhi, India.

Patients: Children aged 6 months to 15 years with newly diagnosed intrathoracic tuberculosis.

Methods: GL and IS were performed in children on 2 consecutive days on ambulatory basis. Samples were examined by Ziehl-Neelsen staining and cultured on an automated BACTEC-MGIT 960TM system.

Outcome Measure: Mycobacterial yields (smear and culture) for the 2 sample types (IS and GL) were compared.

Results: Four hundred three children (56.6% girls), median age 111 months (interquartile range: 68, 144) were enrolled. Overall yield for acid-fast bacilli and/or Mycobacterium tuberculosis (MTB) by either IS and/or GL was 152 (37.7%). Acid-fast bacilli positivity from IS and GL were 5.7% (23) and 10.4% (42), respectively. Confirmed MTB on culture from IS and GL were 17.9% (72) and 32.5% (127), respectively (P < 0.001). IS and GL identified 17 (4.2%) and 73 (18.1%) additional cases respectively when the other method failed to identify MTB. The combined yields (acid-fast bacilli positivity/MTB) with GL and IS on day 1 (115, 28.5%) were less than that obtained from 2 consecutive GL (135, 33.5%), but better than 2 consecutive IS samples (79, 19.6%; P < 0.001).

Conclusion: It is feasible to collect induced sputum and gastric lavage on an ambulatory basis. The yield of MTB obtained by GL is superior to that obtained by IS.

© 2013 by Lippincott Williams & Wilkins, Inc.


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