Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study
Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study
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DOI：
10.1016/s0140-6736(05)17702-2
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发表时间：
2005-01-14
期刊：
影响因子：
168.9
通讯作者：
Hussey, G
中科院分区：
文献类型：
--
作者：
Zar, HJ;Honslo, D;Hussey, G
背景：对于幼儿肺结核的微生物确诊，推荐序贯洗胃；痰诱导不被认为是可行或有用的。我们的目的是比较来自艾滋病毒和结核病高发地区的幼儿反复诱导痰和洗胃的结核分枝杆菌的产率。方法对南非开普敦因疑似肺结核入院的250名1个月至5岁儿童进行研究。按标准程序连续3天进行诱痰和洗胃。对标本进行抗酸杆菌染色；每个样本单独培养结核分枝杆菌。患儿年龄中位数为13个月（IQR 6-24）。62名（25%）儿童涂片或培养结核分枝杆菌阳性；其中，58例（94%）培养阳性，而几乎一半（29例[47%]）涂片阳性。诱导痰和洗胃标本阳性率分别为54例（87%）和40例（65%），差异率为5.6% [1.4 ~ 9.8%],p=0.018。1份诱导痰的产率与3次洗胃的产率相似（p=1.0）。hiv感染儿童和未感染儿童的微生物产率无差异（p=0.17，优势比0.7 [95% Cl 0.3-1.3]）。所有诱导痰方法均耐受良好；轻微的副作用是加重咳嗽、鼻出血、呕吐或喘息。结论：痰液诱导对幼儿结核病的微生物确证是安全有效的。在hiv感染和未感染的婴儿和儿童中，该技术比洗胃更适合诊断肺结核。
Background For microbiological confirmation of diagnosis of pulmonary tuberculosis in young children, sequential gastric lavages are recommended; sputum induction has not been regarded as feasible or useful. We aimed to compare the yield of Mycobacterium tuberculosis from repeated induced sputum with that from gastric lavage in young children from an area with a high rate of HIV and tuberculosis.Methods We studied 250 children aged 1 month to 5 years who were admitted for suspected pulmonary tuberculosis in Cape Town, South Africa. Sputum induction and gastric lavage were done on three consecutive days according to a standard procedure. Specimens were stained for acid-fast bacilli; each sample was cultured singly for M tuberculosis.Findings Median age of children was 13 months (IQR 6-24). A positive smear or culture for M tuberculosis was obtained from 62 (25%) children; of these, 58 (94%) were positive by culture, whereas almost half (29 [47%]) were smear positive. Samples from induced sputum and gastric lavage were positive in 54 (87%) and 40 (65%) children, respectively (difference in yield 5.6% [1.4-9.8%], p=0.018). The yield from one sample from induced sputum was similar to that from three gastric lavages (p=1.0). Microbiological yield did not differ between HIV-infected and HIV-uninfected children (p=0.17, odds ratio 0.7 [95% Cl 0.3-1.3]). All sputum induction procedures were well tolerated; minor side-effects were increased coughing, epistaxis, vomiting, or wheezing.Interpretation Sputum induction is safe and useful for microbiological confirmation of tuberculosis in young children. This technique is preferable to gastric lavage for diagnosis of pulmonary tuberculosis in both HIV-infected and HIV-uninfected infants and children.