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. 2017 Jun 15;64(suppl_3):S309-S316.
doi: 10.1093/cid/cix099.

The Incremental Value of Repeated Induced Sputum and Gastric Aspirate Samples for the Diagnosis of Pulmonary Tuberculosis in Young Children With Acute Community-Acquired Pneumonia

David P Moore  1   2   3 , Melissa M Higdon  4 , Laura L Hammitt  4   5 , Christine Prosperi  4 , Andrea N DeLuca  4   6 , Pedro Da Silva  7   8 , Vicky L Baillie  1   2 , Peter V Adrian  1   2 , Azwifarwi Mudau  1   2 , Maria Deloria Knoll  4 , Daniel R Feikin  4   9 , David R Murdoch  10   11 , Katherine L O'Brien  4 , Shabir A Madhi  1   2
Affiliations

The Incremental Value of Repeated Induced Sputum and Gastric Aspirate Samples for the Diagnosis of Pulmonary Tuberculosis in Young Children With Acute Community-Acquired Pneumonia

David P Moore et al. Clin Infect Dis. .

Abstract

Background.: Mycobacterium tuberculosis (Mtb) contributes to the pathogenesis of childhood acute community-acquired pneumonia in settings with a high tuberculosis burden. The incremental value of a repeated induced sputum (IS) sample, compared with a single IS or gastric aspirate (GA) sample, is not well known.

Methods.: Two IS samples were obtained for Mtb culture from children enrolled as cases in the Pneumonia Etiology Research for Child Health (PERCH) study in South Africa. Nonstudy attending physicians requested GA if pulmonary tuberculosis was clinically suspected. We compared the Mtb yield of 2 IS samples to that of 1 IS sample and GA samples.

Results: . Twenty-seven (3.0%) culture-confirmed pulmonary tuberculosis cases were identified among 906 children investigated with IS and GA samples for Mtb. Results from 2 IS samples were available for 719 children (79.4%). Of 12 culture-confirmed pulmonary tuberculosis cases identified among children with ≥2 IS samples, 4 (33.3%) were negative at the first IS sample. In head-to-head comparisons among children with both GA and IS samples collected, the yield of 1 GA sample (8 of 427; 1.9%) was similar to that of 1 IS sample (5 of 427, 1.2%), and the yield of 2 GA samples (10 of 300; 3.3%) was similar to that of 2 IS samples (5 of 300; 1.7%). IS samples identified 8 (42.1%) of the 19 culture-confirmed pulmonary tuberculosis cases that were identified through submission of IS and GA samples.

Conclusions.: A single IS sample underestimated the presence of Mtb in children hospitalized with severe or very severe pneumonia. Detection of Mtb is enhanced by combining 2 IS with GA sample collections in young children with acute severe pneumonia.

Keywords: child; gastric aspirate; induced sputum; tuberculosis; yield..

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Figures

Figure 1.
Figure 1.
Added value of induced sputum (IS) and gastric aspirate (GA) specimens in the detection of Mycobacterium tuberculosis (Mtb). Added value represents the number of cases positive for Mtb that were detected by submission of specimens/specimen groups and not by the comparator specimens/specimen groups. P values were determined with exact McNemar tests. Boxes with diagonal lines represent categories not applicable for comparison.
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