Coleta de lavado gástrico para diagnóstico de tuberculose pulmonar infantil: revisão sistemática

Abstract

OBJECTIVE:To analyze standardization of gastric lavage protocols in the diagnosis of pulmonary tuberculosis in children. METHODS:A systematic review was conducted for the period between 1968 and 2008 in the following databases: LILACS, SCIELO and MEDLINE. The search strategy included the following terms: "gastric lavage and tuberculosis" or "gastric washing and tuberculosis" with the restriction of "children aged up to 15 years;" "gastric lavage and tuberculosis and childhood" or "gastric washing and tuberculosis and childhood." There were retrieved 80 articles and their analysis was based on information on the gastric lavage protocol for the diagnosis of pulmonary tuberculosis in children: preparation of children and fasting; time of gastric aspiration; aspiration of gastric residues; total volume of aspirate; solution used for aspiration of gastric contents; decontaminant solution; buffer solution; and time for forwarding samples to the laboratory. After a thorough analysis, 14 articles were selected. RESULTS:No article detailed the whole procedure. Some articles had missing information on: amount of gastric aspirate; aspiration before or after solution injection; solution used for gastric aspiration; buffer solution used; and waiting time between specimen collection and laboratory processing. These results showed inconsistencies of gastric lavage protocols. CONCLUSIONS:Although gastric lavage is a secondary diagnostic approach used only in special cases that did not reach the diagnostic scoring as recommended by the Brazilian Ministry of Health, there is a need to standardize gastric lavage protocols for the diagnosis of pulmonary tuberculosis in children.

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

“…One or 2 IS specimens and 1–3 GA specimens submitted for Mtb culture were positive in 9% and 14% of the children with a clinical or culture-confirmed tuberculosis diagnosis in our study, which is toward the lower estimates of test positivity (7%–43%) in previous reports of children with clinically suspected pulmonary tuberculosis [6, 37]. The extent of lung disease in children with classic pulmonary tuberculosis symptoms may be greater than that occurring in children with primary tuberculosis and concomitant bacterial pneumonia presenting with acute symptoms, making it difficult to draw direct comparisons about sample yields for pulmonary tuberculosis between studies.…”

Gastric Perforation Associated with Tuberculosis: A Case Report

“…Interestingly, the presence of TB in the stomach secondary to swallowed pulmonary TB may be relatively common. In children, the use of gastric lavage has been utilized to diagnose TB [12]. A majority of the patients were outpatients in this systematic review.…”

Which sample type is better for Xpert MTB/RIF to diagnose adult and pediatric pulmonary tuberculosis?

“…Low operational requirements, less invasive sampling, and ready access enable NPA to become an alternative to BAL for pediatric PTB, but not for adult PTB due to significantly different airway microbial composition between NPA and BAL [ 17 ]. Young children, particularly who under 5 years, are unable to expectorate sputum and always swallow sputum in their stomach by mistake, thus GA is collected by a nasogastric tube during night in three consecutive mornings to detect MTB for pediatric PTB [ 19 , 20 ]. Nonetheless, MTB is less likely to be detected in GA than smear in adults, and therefore, and thus GA is not regarded as an option for detecting MTB for adult PTB [ 21 ].…”