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Nasopharyngeal aspiration for diagnosis of pulmonary tuberculosis
  1. S Owens1,
  2. I E Abdel-Rahman1,
  3. S Balyejusa2,
  4. P Musoke2,
  5. R P D Cooke3,
  6. C M Parry4,
  7. J B S Coulter1
  1. 1Liverpool School of Tropical Medicine, Liverpool, UK
  2. 2Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
  3. 3Department of Medical Microbiology, Aintree Hospitals NHS Trust, Liverpool, UK
  4. 4Department of Medical Microbiology, University of Liverpool, UK
  1. Correspondence to:
    J B S Coulter
    Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK; coulters{at}fulwood11.wanadoo.co.uk

Abstract

Background: Confirmation of pulmonary tuberculosis (PTB) in young children is difficult as they seldom expectorate sputum.

Aim: To compare sputa obtained by nasopharyngeal aspiration and by sputum induction for staining and culture of Mycobacterium tuberculosis.

Patients and methods: Patients from Mulago Hospital, Kampala with symptoms suggestive of PTB were considered for inclusion in the study. Those with a positive tuberculin test and/or a chest radiograph compatible with tuberculosis were recruited. Infection with human immunodeficiency virus (HIV) was confirmed by duplicate enzyme-labelled immunosorbent assay or in children <15 months by polymerase chain reaction (PCR). Direct PCR was undertaken on 82 nasopharyngeal aspirates.

Results: Of 438 patients referred, 94 were recruited over a period of 5 months. Median (range) age was 48 (4–144) months. Of 63 patients tested, 69.8% were infected with HIV. Paired and uncontaminated culture results were available for 88 patients and smear results for 94 patients. Nasopharyngeal aspirates were smear-positive in 8.5% and culture-positive in 23.9%. Induced sputa were smear-positive in 9.6% and culture positive in 21.6%. Overall, 10.6% were smear-positive, 25.5% were culture-positive and 26.6% had smear and/or culture confirmed tuberculosis. Direct PCR on nasopharyngeal aspirates had a sensitivity of 62% and specificity of 98% for confirmation of culture-positive tuberculosis.

Conclusions: Nasopharyngeal aspiration is a useful, safe and low-technology method for confirmation of PTB and, like sputum induction, can be undertaken in outpatient clinics.

  • AFB, acid-fast bacillus
  • HIV, human immunodeficiency virus
  • LIP, lymphocytic interstitial pneumonitis
  • LS, laryngeal swab
  • MTB, Mycobacterium tuberculosis
  • NPA, nasopharyngeal aspiration
  • PCR, polymerase chain reaction
  • PTB, pulmonary tuberculosis
  • SI, sputum induction
  • nasopharyngeal aspirates
  • diagnosis
  • tuberculosis

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Footnotes

  • Published Online First 21 December 2006

  • Competing interests: None.

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