title: Ambulatory gastric lavages provide better yields of Mycobacterium tuberculosis than induced sputum in children with intrathoracic tuberculosis.
abstract: OBJECTIVE
  To compare mycobacterial yield by induced sputum (IS) and gastric lavage (GL), performed on an ambulatory basis in children with probable intrathoracic tuberculosis.
  
  
  METHODS
  Diagnostic accuracy study.
  
  
  METHODS
  Two tertiary care hospitals in Delhi, India.
  
  
  METHODS
  Children aged 6 months to 15 years with newly diagnosed intrathoracic tuberculosis.
  
  
  METHODS
  GL and IS were performed in children on 2 consecutive days on ambulatory basis. Samples were examined by Ziehl-Neelsen staining and cultured on an automated BACTEC-MGIT 960 system.
  
  
  METHODS
  Mycobacterial yields (smear and culture) for the 2 sample types (IS and GL) were compared.
  
  
  RESULTS
  Four hundred three children (56.6% girls), median age 111 months (interquartile range: 68, 144) were enrolled. Overall yield for acid-fast bacilli and/or Mycobacterium tuberculosis (MTB) by either IS and/or GL was 152 (37.7%). Acid-fast bacilli positivity from IS and GL were 5.7% (23) and 10.4% (42), respectively. Confirmed MTB on culture from IS and GL were 17.9% (72) and 32.5% (127), respectively (P < 0.001). IS and GL identified 17 (4.2%) and 73 (18.1%) additional cases respectively when the other method failed to identify MTB. The combined yields (acid-fast bacilli positivity/MTB) with GL and IS on day 1 (115, 28.5%) were less than that obtained from 2 consecutive GL (135, 33.5%), but better than 2 consecutive IS samples (79, 19.6%; P < 0.001).
  
  
  CONCLUSIONS
  It is feasible to collect induced sputum and gastric lavage on an ambulatory basis. The yield of MTB obtained by GL is superior to that obtained by IS.
authors: From the *Department of Pediatrics; †Department of Laboratory Medicine, Division of Clinical Microbiology & Molecular Medicine, All India Institute of Medical Sciences; ‡Department of Pediatrics, Kalawati Saran Children Hospital and Lady Hardinge Medical College, New Delhi, India; §Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa; ¶Section for Microbiology and Immunology, the Gade Institute, University of Bergen; and ‖Department of Microbiology, Haukeland University Hospital, Bergen, Norway.
authors: Aparna
authors: A
authors: Mukherjee
authors: Sarman
authors: S
authors: Singh
authors: Rakesh
authors: R
authors: Lodha
authors: Varinder
authors: V
authors: Singh
authors: A C
authors: AC
authors: Hesseling
authors: Harleen M S
authors: HM
authors: Grewal
authors: Sushil K
authors: SK
authors: Kabra
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005750:Gastric Juice / Q000382:microbiology; D005751:Gastric Lavage / Q000379:methods*; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D016032:Randomized Controlled Trials as Topic; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000382:microbiology*