Article Text

Alternative sputum collection methods for diagnosis of childhood intrathoracic tuberculosis: a systematic literature review
  1. Vincent Ioos1,
  2. Hugues Cordel2,
  3. Maryline Bonnet3
  1. 1Département Médical, Médecins Sans Frontières, Paris, Paris, France
  2. 2Infectious disease department, Avicenne Hospital, Bobigny, ‎Seine-Saint-Denis, France
  3. 3IRD UMI233 TransVIHMI-UM-INSERM U1175, Montpellier, France
  1. Correspondence to Dr Maryline Bonnet, Institut de recherche pour le developpement France-Sud, UMI 233 IRD – U1175 INSERM - Université de Montpellier, Montpellier 34394, France; maryline.bonnet{at}


Background Diagnosis of intrathoracic tuberculosis (ITB) is limited in children partly by their difficulty to produce sputum specimen.

Objective To systematically review the detection yields of mycobacterial culture and Xpert MTB/RIF from induced sputum (IS), nasopharyngeal aspirate (NPA) and gastric aspirate (GA) in children with presumptive ITB.

Design Pubmed, Embase and Biosis databases and grey literature were searched. Randomised controlled trials, cohort, cross-sectional or case control studies using IS, GA and NPA for diagnosis of ITB published between January 1990 and January 2018 were included. Data were extracted on study design, case definition of presumptive ITB, sample collection methods, outcome measures and results.

Results 30 studies were selected, including 11 554 children. Detection yields for culture ranged between 1% and 30% for IS, 1% and 45% for GA and 4% and 24% for NPA. For Xpert MTB/RIF, it was between 2% and 17% for IS, 5% and 51% for GA and 3% and 8% for NPA. There was a tendency of better yields with IS when the pretest probability of ITB was low to moderate and with GA when it was high. Sampling a second specimen contributed for 6%–33% of the cumulative yield and combination of different methods significantly increase the detection yields.

Conclusions Despite the important study heterogeneity, any of the specimen collection methods offers good potential to confirm childhood ITB. However, their operational challenges were poorly evaluated. In the absence of a sensitive non-sputum based test, only a minority of children with ITB can be confirmed.

  • gastric aspirate
  • sputum induction
  • nasopharyngeal aspirate
  • childhood tuberculosis
  • low-midle income countries

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  • Contributors VI designed the study, wrote the study protocol, performed the study screening, selection and data collection as first reviewer; performed the statistical analysis and wrote the manuscript. HC performed the study screening, selection and data collection as second reviewer and revised the manuscript. MB supervised the research work and was the third reviewer in case of discordance between VI and HC during study screening and selection and revised the manuscript.

  • Funding The study was part the work of a Master of Epidemiology (London School of Hygiene and Tropical Medicine) and was funded by Médecins Sans Frontières.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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