BMC Infect Dis. 2013 May 16;13:222. doi: 10.1186/1471-2334-13-222.
Diagnosis of pulmonary tuberculosis (PTB) is difficult in infants and young children. For microbiological confirmation of PTB children, sequential gastric lavage (GL) is recommended. Induced sputum (IS) may be an alternative or complementary tool, but the information is limited in children in developed countries. The aim of this study is to assess the safety and diagnostic yield from IS combined with GL for PTB diagnosis in non-HIV infected children.
The study involved 22 children with suspected PTB admitted to the Getafe Hospital from January 2007 to May 2011. IS and GL were performed on three consecutive days, according to a standardized protocol. In all samples, BK staining, culture and PCR were carried out, including Genotype MTBDR plus for resistance to INH-RIF (Isoniazid-Rifampin) since 2008. A preliminary analysis of an ongoing prospective study is presented.
Median age was 72 months (range 1 month to 14 years of age). Seven (33%) were ≤ 5 years of age. Seventeen were clinically diagnosed of PTB based on positive PPD and radiological criteria. Microbiological confirmation was achieved in 10 (58.8%) by either GL or IS. M. tuberculosis was identified by GL in 8 children (47.1%) and by IS in 7 (41.2%). One infant (2 IS samples) had transient oxygen desaturation recovered spontaneously.
IS appears to be safe and well tolerated by children for diagnosis of PTB and is more convenient. Increasing the diagnostic yield of PTB in children with PTB may be a complementary technique. Largest studies are necessary to define the role of IS in paediatric PTB.
婴儿和幼儿结核病（PTB）的诊断较为困难。对于微生物学确诊的 PTB 患儿，推荐进行序贯胃灌洗（GL）。诱导痰（IS）可能是一种替代或补充工具，但在发达国家的儿童中，相关信息有限。本研究旨在评估 IS 联合 GL 用于非 HIV 感染儿童 PTB 诊断的安全性和诊断效果。
本研究纳入了 2007 年 1 月至 2011 年 5 月期间因疑似 PTB 入住 Getafe 医院的 22 名儿童。根据标准化方案，连续三天进行 IS 和 GL。对所有样本均进行 BK 染色、培养和 PCR 检测，自 2008 年起，还进行了包括基因型 MTBDR plus 在内的 INH-RIF（异烟肼-利福平）耐药检测。目前正在进行一项前瞻性研究，本次报告的是初步分析结果。
中位年龄为 72 个月（范围 1 个月至 14 岁）。7 名（33%）患儿年龄≤5 岁。17 名患儿基于 PPD 阳性和影像学标准临床诊断为 PTB。10 名（58.8%）患儿通过 GL 或 IS 获得了微生物学确诊。8 名患儿（47.1%）通过 GL 鉴定出结核分枝杆菌，7 名患儿（41.2%）通过 IS 鉴定出结核分枝杆菌。1 名婴儿（2 份 IS 样本）出现短暂性氧饱和度下降，可自行恢复。
IS 似乎对儿童 PTB 诊断安全且耐受良好，且更方便。IS 可能是一种增加 PTB 患儿 PTB 诊断效果的补充技术。有必要开展更大规模的研究来明确 IS 在儿科 PTB 中的作用。
