title: Nasopharyngeal aspiration for diagnosis of pulmonary tuberculosis.
abstract: BACKGROUND
  Confirmation of pulmonary tuberculosis (PTB) in young children is difficult as they seldom expectorate sputum.
  
  
  OBJECTIVE
  To compare sputa obtained by nasopharyngeal aspiration and by sputum induction for staining and culture of Mycobacterium tuberculosis.
  
  
  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.
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: S
authors.initials: S
authors.lastname: Owens
authors.forename: I E
authors.initials: IE
authors.lastname: Abdel-Rahman
authors.forename: S
authors.initials: S
authors.lastname: Balyejusa
authors.forename: P
authors.initials: P
authors.lastname: Musoke
authors.forename: R P D
authors.initials: RP
authors.lastname: Cooke
authors.forename: C M
authors.initials: CM
authors.lastname: Parry
authors.forename: J B S
authors.initials: JB
authors.lastname: Coulter
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D009305:Nasopharynx; D016133:Polymerase Chain Reaction; D012462:Saline Solution, Hypertonic; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology*; D013396:Suction; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis*; D014454:Uganda
chemical_list: D012462:Saline Solution, Hypertonic