Detection of <i>Mycobacterium tuberculosis</i> in Gastric Aspirates Collected From Children: Hospitalization Is Not Necessary

Lobato, Mark N.; Loeffler, Ann M.; Furst, K.; Cole, Barbara; Hopewell, Philip C.

doi:10.1542/peds.102.4.e40

Cited by 67 publications

(44 citation statements)

References 15 publications

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“…[5][6][7][8] The availability of isolation rooms with negative pressure required for SI, and the presence of bronchoscopy facilities only in specialised hospital settings, however, hinders the wider use of these procedures in resource-limited settings. GA is commonly used in children to obtain sputum specimens, 6,[8][9][10][11][12][13] but is less common in adults with difficulties in expectoration.…”

mentioning

confidence: 99%

Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan

Aslam¹,

Tahseen²,

Schomotzer

et al. 2017

public health action

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mentioning

confidence: 99%

Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan

Aslam¹,

Tahseen²,

Schomotzer

et al. 2017

public health action

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“…Gastric aspirates (GAs) are reported to yield smear positivity in no more than 20% of children and positive cultures in less than 50% of children with suspected tuberculosis. Neutralization of gastric aspirates with sodium bicarbonate is conventionally recommended to improve yield on culture (5,6). To our knowledge, there have been no studies that evaluated the efficacy of neutralization of gastric aspirates with sodium bicarbonate or sodium carbonate.…”

mentioning

confidence: 99%

Does Neutralization of Gastric Aspirates from Children with Suspected Intrathoracic Tuberculosis Affect Mycobacterial Yields on MGIT Culture?

Parashar¹,

Kabra

Lodha

et al. 2013

J Clin Microbiol

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The microbiological confirmation of pulmonary tuberculosis in children relies on cultures of gastric aspirate (GA) specimens. Conventionally, GAs are neutralized to improve culture yields of mycobacteria. However, there are limited data to support this practice. To study the utility of neutralization of GAs with sodium bicarbonate in children with intrathoracic tuberculosis, a total of 116 children of either sex, aged 6 months to 14 years (median age, 120 months; interquartile range [IQR], 7 to 192 months), underwent gastric aspiration on 2 consecutive days. Gastric aspirates were divided into two aliquots, and only one aliquot was neutralized with 1% sodium bicarbonate. Both aliquots were processed for smear and culture examinations. Out of the 232 gastric aspirates, 12 (5.17%) were acid-fast bacilli (AFB) smear positive. There were no differences in smear positivity rates from samples with or without neutralization. The yield of Mycobacterium tuberculosis on a Bactec MGIT 960 culture system was significantly lower in the neutralized samples (16.3% [38/232]) than in the nonneutralized samples (21.5% [50/232]) (P ‫؍‬ 0.023). There was no significant difference between the neutralized and the nonneutralized samples in time to detection using the MGIT 960 system (average, 24.6 days; IQR, 12 to 37 days) (P ‫؍‬ 0.9). The contamination rates were significantly higher in the neutralized samples than in the nonneutralized samples (17.2% [40/232] versus 3.9% [9/232]) (P ‫؍‬ 0.001). The agreement for positive mycobacterial culture between the two approaches was 66.5% (P ‫؍‬ 0.001). Hence, we recommend that gastric aspirate samples not be neutralized with sodium bicarbonate prior to culture for M. tuberculosis. Diagnosis of tuberculosis (TB) in children is based on history, clinical examination, the results of tuberculin skin testing, and imaging. Microbiological confirmation is difficult in children (1) because of the paucibacillary nature of mycobacteria (2, 3). The bacteriological confirmation has relied on the culture of specimens from sequential gastric lavages (4). Gastric aspirates (GAs) are reported to yield smear positivity in no more than 20% of children and positive cultures in less than 50% of children with suspected tuberculosis. Neutralization of gastric aspirates with sodium bicarbonate is conventionally recommended to improve yield on culture (5, 6). To our knowledge, there have been no studies that evaluated the efficacy of neutralization of gastric aspirates with sodium bicarbonate or sodium carbonate. We report here our experience using the liquid Bactec MGIT 960 culture system to perform mycobacterial cultures on gastric aspirates, with and without neutralization with sodium bicarbonate, from children with newly diagnosed intrathoracic tuberculosis. MATERIALS AND METHODSStudy sites and population. This prospective clinical study was conducted in two settings, the All India Institute of Medical Sciences and the Kalawati Saran Children Hospital in New Delhi, India, between January and June 2010. A total ...

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“…It is possible that the yield may have been higher if it was a hospital-based study on "sick" children. Also, gastric aspirates were done on the children as day cases after a fast [28]. Perhaps the yield might have improved if they were admitted overnight but this was not feasible for this community-based study.…”

Section: Discussionmentioning

confidence: 99%

“…These children were made to fast prior to each visit for early morning gastric aspirations, which were done on three consecutive days as day cases [28]. Cases were stratified by social class according to their parent's characteristics using a social score index as described by Olusanya et al [29].…”

Section: Methodsmentioning

confidence: 99%

Tuberculosis in Children Living amongst Adults with Tuberculosis at the Tuberculosis and Leprosy Referral Hospital, Eku, Nigeria

Ewa¹,

Essiet²,

Monu³

2015

JTR

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Background: Tuberculosis (tb) causes significant morbidity and mortality worldwide. In Nigeria, the exact prevalence is not known but a progressive increase of the disease has been observed, with "epidemic states" reported in certain clusters. Even with the newer diagnostic tests for tb, diagnostic difficulties still occur. As a result, several diagnostic criteria have been adopted to aid the diagnosis of tuberculosis in these children. The main objective of this study was to identify Tb in children who were either living with adults who have Tb or in the environment of adults with Tb. Methodology: This was a prospective cross-sectional study conducted in Eku and Oria communities in Ethiope East Local Government Area of Delta State. Eku housed the Tuberculosis and Leprosy Referral Hospital where adults with tb were admitted in the first two months of their treatment. 128 children under 19 years of age were studied over a 3-month period. After obtaining relevant information from every child, a full physical examination and certain laboratory investigations were done. Results: There were 68 males and 60 females. The prevalence of Tb was 68% in those children living among adults with tb within the hospital and 50.6% in those living in the environment or community (p = 0.05). The prevalence of Tb in Bacille Calmette Guerin (BCG) immunized children was 66.2% as against 46.7% in those not vaccinated. Twenty-six of the infected children (57.8%) had only pulmonary disease while 45.7% had affectation of 2 or more organs. The positive predictive values of elevated erythrocyte sedimented rate (ESR), elevated white blood cells (WBC) count and positive gastric aspirates (GA) in diagnosing tb were 60.3%, 70.5% and 0% respectively, while that of abnormal chest X-ray (CXR) and positive Mantoux reaction were 93.6% and 93.7% respectively. Conclusion: The alarming prevalence of tb in these children was not surprising considering their contacts with the tb patients and was representative of simi-* Corresponding author. A. U. Ewa et al.81 lar high incidence areas as a whole. Active case finding efforts should be intensified for childhood contacts of adults with Tb for early identification of children with tuberculosis.

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Detection of Mycobacterium tuberculosis in Gastric Aspirates Collected From Children: Hospitalization Is Not Necessary

Cited by 67 publications

References 15 publications

Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan

Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan

Does Neutralization of Gastric Aspirates from Children with Suspected Intrathoracic Tuberculosis Affect Mycobacterial Yields on MGIT Culture?

Tuberculosis in Children Living amongst Adults with Tuberculosis at the Tuberculosis and Leprosy Referral Hospital, Eku, Nigeria

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