对于患有胸内结核的儿童，门诊洗胃获取结核分枝杆菌的阳性率高于诱导痰。

Ambulatory gastric lavages provide better yields of Mycobacterium tuberculosis than induced sputum in children with intrathoracic tuberculosis.

作者信息

Mukherjee Aparna, Singh Sarman, Lodha Rakesh, Singh Varinder, Hesseling A C, Grewal Harleen M S, Kabra Sushil K

机构信息

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.

出版信息

Pediatr Infect Dis J. 2013 Dec;32(12):1313-7. doi: 10.1097/INF.0b013e31829f5c58.

DOI:10.1097/INF.0b013e31829f5c58

PMID:23958816

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.

DESIGN

Diagnostic accuracy study.

SETTING

Two tertiary care hospitals in Delhi, India.

PATIENTS

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.

OUTCOME MEASURE

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).

CONCLUSION

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.

摘要

目的

比较在可能患有胸内结核的儿童中，门诊诱导痰（IS）和洗胃（GL）获取分枝杆菌的情况。

设计

诊断准确性研究。

地点

印度德里的两家三级医疗医院。

患者

6个月至15岁新诊断为胸内结核的儿童。

方法

对儿童连续两天进行门诊GL和IS操作。样本采用萋-尼染色检查，并在自动BACTEC-MGIT 960系统上培养。

观察指标

比较两种样本类型（IS和GL）的分枝杆菌检出率（涂片和培养）。

结果

纳入403名儿童（56.6%为女孩），中位年龄111个月（四分位间距：68，144）。IS和/或GL检测出抗酸杆菌和/或结核分枝杆菌（MTB）的总体检出率为152例（37.7%）。IS和GL的抗酸杆菌阳性率分别为5.7%（23例）和10.4%（42例）。IS和GL培养确诊的MTB分别为17.9%（72例）和32.5%（127例）（P<0.001）。当另一种方法未能检测出MTB时，IS和GL分别额外检出17例（4.2%）和73例（18.1%）病例。第1天GL和IS联合检测的检出率（抗酸杆菌阳性/MTB）（115例，28.5%）低于连续两次GL检测的结果（135例，33.5%），但优于连续两次IS样本检测的结果（79例，19.6%；P<0.001）。