Walters Elisabetta, Goussard Pierre, Bosch Corne, Hesseling Anneke C, Gie Robert P
Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa.
Pediatr Pulmonol. 2014 Nov;49(11):1133-7. doi: 10.1002/ppul.22970. Epub 2013 Dec 11.
Children with complicated intrathoracic tuberculosis (TB) require rapid confirmation of TB diagnosis and of drug susceptibility to institute appropriate therapy. In a pilot study, we evaluated the feasibility and potential utility of GeneXpert (Xpert) on bronchoalveolar lavage (BAL) samples in children undergoing routine diagnostic bronchoscopy.
We included children <13 years of age undergoing bronchoscopy for suspected complicated intrathoracic TB at Tygerberg Children's Hospital, October 1, 2012-May 15, 2013. A minimum of two respiratory specimens in addition to BAL were obtained from each child. In addition to fluorescent smear microscopy and automated liquid culture performed on all samples, BAL samples were analyzed by Xpert. Drug susceptibility was confirmed by GenoType(®) MTBDRplus.
Fourteen children (2 HIV positive, median age 16 months) were included. The Mantoux tuberculin skin test was positive in 11. On chest radiograph, six children had expansile pneumonia and nine had airway compression (one had both). The median duration of TB treatment before bronchoscopy was 8 days. TB was confirmed by either culture or Xpert from any sample in 11 (78%) children. Among 9/14 (64%) cases confirmed by culture, BAL Xpert was positive in 7 (78% sensitivity); in addition, Xpert confirmed 2 cases who had negative culture (14% additional diagnostic yield). Two drug resistant cases were identified: one by BAL Xpert and one from genotypic testing of a culture from gastric aspirate. All children were initiated on anti-TB treatment and responded well to therapy.
BAL Xpert resulted in additional diagnostic yield and also in the rapid detection of drug resistance in children with complicated intrathoracic TB. The clinical impact of this modality should be further evaluated in children.
患有复杂性胸内结核病（TB）的儿童需要迅速确诊结核病并确定药物敏感性，以便进行适当治疗。在一项试点研究中，我们评估了GeneXpert（Xpert）在接受常规诊断性支气管镜检查的儿童支气管肺泡灌洗（BAL）样本中的可行性和潜在效用。
我们纳入了2012年10月1日至2013年5月15日在泰格堡儿童医院因疑似复杂性胸内TB而接受支气管镜检查的13岁以下儿童。除BAL外，每个儿童至少获取两份呼吸道标本。除了对所有样本进行荧光涂片显微镜检查和自动化液体培养外，还通过Xpert对BAL样本进行分析。通过GenoType(®) MTBDRplus确认药物敏感性。
纳入了14名儿童（2名HIV阳性，中位年龄16个月）。11名儿童的结核菌素皮肤试验呈阳性。胸部X线片显示，6名儿童患有扩展性肺炎，9名儿童有气道受压（1名儿童两者皆有）。支气管镜检查前结核病治疗的中位持续时间为8天。11名（78%）儿童的任何样本通过培养或Xpert确诊为结核病。在9/14（64%）例经培养确诊的病例中，BAL Xpert呈阳性的有7例（敏感性为78%）；此外，Xpert确诊了2例培养结果为阴性的病例（额外诊断率为14%）。确定了2例耐药病例：1例通过BAL Xpert确诊，1例通过胃抽吸物培养的基因检测确诊。所有儿童均开始接受抗结核治疗，对治疗反应良好。
BAL Xpert提高了诊断率，并能快速检测出患有复杂性胸内TB的儿童的耐药情况。这种方法对儿童的临床影响应进一步评估。
