Background: Confirmation of pulmonary tuberculosis (PTB) in young children is difficult as they seldom expectorate sputum. Aim: To compare sputa obtained by nasopharyngeal aspiration and by sputum induction for staining and culture of Mycobacterium tuberculosis. Patients and methods: Patients from Mulago Hospital, Kampala with symptoms suggestive of PTB were considered for inclusion in the study. Those with a positive tuberculin test and/or a chest radiograph compatible with tuberculosis were recruited. Infection with human immunodeficiency virus (HIV) was confirmed by duplicate enzyme-labelled immunosorbent assay or in children ,15 months by polymerase chain reaction (PCR). Direct PCR was undertaken on 82 nasopharyngeal aspirates. Results: Of 438 patients referred, 94 were recruited over a period of 5 months. Median (range) age was 48 (4-144) months. Of 63 patients tested, 69.8% were infected with HIV. Paired and uncontaminated culture results were available for 88 patients and smear results for 94 patients. Nasopharyngeal aspirates were smear-positive in 8.5% and culture-positive in 23.9%. Induced sputa were smear-positive in 9.6% and culture positive in 21.6%. Overall, 10.6% were smear-positive, 25.5% were culture-positive and 26.6% had smear and/or culture confirmed tuberculosis. Direct PCR on nasopharyngeal aspirates had a sensitivity of 62% and specificity of 98% for confirmation of culture-positive tuberculosis. Conclusions: Nasopharyngeal aspiration is a useful, safe and low-technology method for confirmation of PTB and, like sputum induction, can be undertaken in outpatient clinics.T he diagnosis of pulmonary tuberculosis (PTB) in young children is usually based on contact history, positive tuberculin test and compatible chest radiography. However, confirmation of tuberculosis by culture is important where, for example, there is difficulty in clinical diagnosis, the contact history is not known or drug sensitivities are not available. In developing countries the diagnosis of PTB is particularly difficult as the contact history is often not clear (especially where tuberculosis/human immunodeficiency virus (HIV) co-infection in the household is common) and the tuberculin test is often falsely negative. Chest radiography may be difficult to interpret, especially when there is HIV-related pulmonary disease such as lymphocytic interstitial pneumonitis (LIP). Obtaining sputum in young children who are unable to expectorate is problematic. Gastric aspiration usually requires a child to be admitted for up to 3 days and has to be undertaken in the early morning while the child is recumbent and fasted overnight.3 Alternative methods include sputum induction (SI), 4 5 laryngeal swab (LS) 6 7 and nasopharyngeal aspiration (NPA).8 9 This study aimed to compare the value of NPA with SI for confirmation of PTB. METHODSThe study was undertaken at Mulago Hospital, Kampala during the period January to June 2004. A diagnostic room was set up for SI, NPA and tuberculin testing, organised by a dedicated paediatrician, a nur...

Rationale: The immunologic events surrounding primary Mycobacterium tuberculosis infection and development of tuberculosis remain controversial. Young children who develop tuberculosis do so quickly after first exposure, thus permitting study of immune response to primary infection and disease. We hypothesized that M. tuberculosis-specific CD8 1 T cells are generated in response to high bacillary loads occurring during tuberculosis. Objectives: To determine if M. tuberculosis-specific T cells are generated among healthy children exposed to M. tuberculosis and children with tuberculosis.Methods: Enzyme-linked immunosorbent spot assays were used to measure IFN-g production in response to M. tuberculosis-specific proteins ESAT-6/CFP-10 by peripheral blood mononuclear cells and CD8 1 T cells isolated from Ugandan children hospitalized with tuberculosis (n ¼ 96) or healthy tuberculosis contacts (n ¼ 62). Measurements and Main Results: The proportion of positive CD8 1 T-cell assays and magnitude of CD81 T-cell responses were significantly greater among young (,5 yr) tuberculosis cases compared with young contacts (P ¼ 0.02, Fisher exact test, P ¼ 0.01, Wilcoxon rank-sum, respectively). M. tuberculosis-specific T-cell responses measured in peripheral blood mononuclear cells were equivalent between groups. Conclusions: Among young children, M. tuberculosis-specific CD8 1 T cells develop in response to high bacillary loads, as occurs during tuberculosis, and are unlikely to be found after M. tuberculosis exposure. T-cell responses measured in peripheral blood mononuclear cells are generated after M. tuberculosis exposure alone, and thus cannot distinguish exposure from disease. In young children, IFN-g-producing M. tuberculosis-specific CD8 1 T cells provide an immunologic signature of primary M. tuberculosis infection resulting in disease.