title: Sputum induction for microbiological diagnosis of childhood pulmonary tuberculosis in a community setting.
abstract: METHODS
  Sputum induction has increasingly enabled microbiological confirmation of pulmonary tuberculosis (PTB) in hospitalised children, but it has not been evaluated in a community setting.
  
  
  OBJECTIVE
  To investigate the yield, feasibility and safety of sputum induction for the  diagnosis of TB in children in a primary health care facility.
  
  
  METHODS
  A prospective study in a primary health care clinic in South Africa from April 2007 to June 2009. Consecutive children with clinically suspected PTB, with a household adult PTB contact or human immunodeficiency virus  infected with respiratory symptoms were enrolled. History, clinical examination, tuberculin skin test and chest X-ray results were recorded. Two sequential induced sputum specimens were obtained for smear and culture.
  
  
  RESULTS
  A total of 270 children were enrolled (median age 38 months);  sputum induction was successful in 269 (99%); 65 (24%) children were clinically diagnosed, of whom 11 (16.9%) were microbiologically confirmed. An additional 18 children not clinically diagnosed had microbiological confirmation of PTB and were placed on TB treatment thereafter, increasing  the diagnostic yield by 21.6%, from 65 to 83 cases. Sputum induction procedures were well tolerated; no major adverse events occurred.
  
  
  CONCLUSIONS
  Sputum induction is feasible and safe in a community setting. Sputum induction was useful for making a microbiological diagnosis, increasing  the number of children diagnosed and treated for PTB.
authors.affiliation: Kuyasa Clinic, Khayelitsha, Cape Town, South Africa. moores@tiscali.co.za
authors.forename: H A
authors.initials: HA
authors.lastname: Moore
authors.forename: P
authors.initials: P
authors.lastname: Apolles
authors.forename: P J T
authors.initials: PJ
authors.lastname: de Villiers
authors.forename: H J
authors.initials: HJ
authors.lastname: Zar
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D013019:South Africa; D013183:Sputum / Q000378:metabolism / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*