title: Induced sputum or gastric lavage for community-based diagnosis of childhood pulmonary tuberculosis?
abstract: OBJECTIVE
  To compare the diagnostic yield of Mycobacterium tuberculosis from induced sputum (IS) and gastric lavage (GL) among children in a community setting.
  
  
  METHODS
  Specimen-collection methods for bacteriological confirmation of pulmonary tuberculosis (PTB) were compared during a tuberculosis vaccine trial near Cape Town, South Africa (2001-2006). Children with a tuberculosis contact or compatible symptoms were investigated for suspected PTB. Diagnostic yields from 764 paired IS and GL specimens were compared in 191 culture-confirmed cases.
  
  
  RESULTS
  The crude yield of M tuberculosis was 10.4%, n = 108 by IS (5.8%) and n = 127 by GL (6.8%), from a total of 194 cases, of which three had incomplete IS/GL specimen pairs. Agreement between IS and GL was poor (kappa = 0.31). The comparative yield of a single IS sample (38%) was equivalent to a single GL sample (42%), with a difference in yield of -4% (95% CI -15% to +7%). The combined yield of same-day IS and GL specimens (67%) was equivalent to two consecutive GL specimens (66%), with a difference in yield of 1% (95% CI -9% to 11%), but significantly greater than two consecutive IS specimens (55%), with a difference in yield of 12% (95% CI 2% to 21%). The adjusted odds of a M tuberculosis culture were increased by a positive tuberculin skin test or chest radiograph compatible with PTB.
  
  
  CONCLUSIONS
  In this community setting, the diagnostic yield of a single IS sample was equivalent to that of a single GL sample. The optimal diagnostic yield may be obtained from paired IS and GL specimens taken on a single day or two GL specimens taken on consecutive days.
authors.affiliation: South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IIDMM), University of Cape Town, Cape Town, South Africa. mark.hatherill@uct.ac.za
authors.forename: M
authors.initials: M
authors.lastname: Hatherill
authors.forename: T
authors.initials: T
authors.lastname: Hawkridge
authors.forename: H J
authors.initials: HJ
authors.lastname: Zar
authors.forename: A
authors.initials: A
authors.lastname: Whitelaw
authors.forename: M
authors.initials: M
authors.lastname: Tameris
authors.forename: L
authors.initials: L
authors.lastname: Workman
authors.forename: L
authors.initials: L
authors.lastname: Geiter
authors.forename: W A
authors.initials: WA
authors.lastname: Hanekom
authors.forename: G
authors.initials: G
authors.lastname: Hussey
mesh_terms: D001431:Bacteriological Techniques / Q000379:methods; D003153:Community Health Services / Q000379:methods; D005751:Gastric Lavage; D006801:Humans; D007223:Infant; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D013048:Specimen Handling / Q000379:methods; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*