Nasopharyngeal aspiration for diagnosis of pulmonary tuberculosis. Issue 8 (21st December 2006)

• Record Type: Journal Article
• Authors: Owens, S; Abdel-Rahman, I E; Balyejusa, S; Musoke, P; Cooke, R P D; Parry, C M; Coulter, J B S
• Is Part Of: Archives of disease in childhood. Volume 92:Issue 8(2007)
• Page Start: 693
• Page End: 696
• Publication Date: 2006-12-21
• Subjects: 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; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/adc.2006.108308
• Languages: English
• ISSNs: 0003-9888

Abstract

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.