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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

The Pediatric Infectious Disease Journal: December 2013 - Volume 32 - Issue 12 - p 1313–1317
doi: 10.1097/INF.0b013e31829f5c58
Original Studies

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.

From the *Department of Pediatrics; Department of Laboratory Medicine, Division of Clinical Microbiology & Molecular Medicine, All India Institute of Medical Sciences; Department of Pediatrics, Kalawati Saran Children Hospital and Lady Hardinge Medical College, New Delhi, India; §Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa; Section for Microbiology and Immunology, the Gade Institute, University of Bergen; and Department of Microbiology, Haukeland University Hospital, Bergen, Norway.

Accepted for publication June 6, 2013.

Data reported here are a part of larger randomized controlled trial, results of which are in the process of being reported separately.

A.M., R.L., V.S. and S.K.K. involved in development of project, operational aspect of project, data collection, data analysis and article writing. H.M.S.G. involved in development of project, monitoring of project, data analysis and article writing. S.S. involved in development of project, carrying out microbiological investigations and article writing. A.C.H. involved in development of project, monitoring and article writing. S.K.K. acts as the guarantor for all data.

Delhi Pediatric TB study group (in alphabetical order): S. Aneja, Tina Arya, S. Bhatnagar, J. Chandra, A. K. Dutta, T. M. Doherty (Denmark), H. Friis (Denmark), Harleen M. S. Grewal (Norway), A. C. Hesseling (South Africa), S. K. Kabra, Rakesh Lodha, B. Marais (Australia), Aparna Mukherjee, Deepak Parashar, Suneel Prajapati, Kamna Purohit, Deepak Saini, Savita Saini, Ravi Raj Singh, Sarman Singh, Varinder Singh. Supported by Norwegian Programme for Development, Research and Education NUFUPRO-2007/10183 and the Research Council of Norway (GLOBVAC). The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Sushil K. Kabra, MD, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc.