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Induced sputum or gastric lavage for community-based diagnosis of childhood pulmonary tuberculosis?
  1. Mark Hatherill (mark.hatherill{at}uct.ac.za)
  1. University of Cape Town, South Africa
    1. Tony Hawkridge (thawkridge{at}aeras.com)
    1. Aeras Gobal TB Vaccine Foundation, United States
      1. Heather Zar (heather.zar{at}uct.ac.za)
      1. University of Cape Town, South Africa
        1. Andrew Whitelaw (andrew.whitelaw{at}uct.ac.za)
        1. University of Cape Town, South Africa
          1. Michele Tameris (michele.tameris{at}uct.ac.za)
          1. University of Cape Town, South Africa
            1. Lesley Workman (lesley.workman{at}uct.ac.za)
            1. University of Cape Town, South Africa
              1. Lawrence Geiter (lgeiter{at}otsuka.org)
              1. Otsuka Pharmaceutical Development and Commercialization, Inc, United States
                1. Willem Hanekom (willem.hanekon{at}uct.ac.za)
                1. University of Cape Town, South Africa
                  1. Gregory Hussey (greg.hussey{at}uct.ac.za)
                  1. University of Cape Town, South Africa

                    Abstract

                    Objectives: To compare diagnostic yield of Mycobacterium tuberculosis from induced sputum (IS) and gastric lavage (GL) among children in a community setting.

                    Methods: Specimen collection methods for bacteriologic confirmation of pulmonary tuberculosis (PTB) were compared during a tuberculosis vaccine trial near Cape Town, South Africa (2001-2006). Children with a tuberculosis contact or compatible symptoms were investigated for suspected PTB. Diagnostic yields (95% confidence intervals, CI) from 764 paired IS and GL specimens were compared in 191 culture-confirmed cases.

                    Measurements and Main Results: The crude yield of M. tuberculosis was 10.4%, n = 108 by IS (5.8%) and n = 127 by GL (6.8%), in a total of 194 cases, of which 3 had incomplete IS/GL specimen pairs. Agreement between IS and GL was poor (kappa = 0.31). Comparative yield of a single IS (38%) was equivalent to a single GL (42%), with difference in yield of - 4% (CI -15 to +7%). Combined yield of same-day IS and GL (67%) was equivalent to two consecutive GL (66%), with difference in yield of 1% (-9 to 11%), but significantly greater than two consecutive IS (55%), difference in yield 12% (CI 2 to 21%). Adjusted odds of M. tuberculosis culture were increased by positive tuberculin skin test or chest radiograph.

                    Conclusions: In this community setting, diagnostic yield of a single IS was equivalent to a single GL. Optimal diagnostic yield may be obtained from paired IS and GL on a single day, or two GL on consecutive days.

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