Arch Dis Child 2000; 82 :305–308 305 Sputum induction for the diagnosis of pulmonary tuberculosis in infants and young children in an urban setting in South Africa H J Zar, E Tannenbaum, P Apolles, P Roux, D Hanslo, G Hussey Abstract there are no reports of its use in infants or chil- Background —Bacteriological confirma- dren younger than 3 years. tion of pulmonary tuberculosis is di Y cult Gastric lavage (GL) is regarded as the stand- ard procedure to obtain specimens for staining in infants and young children. In adults and culture of Mycobacterium tuberculosis in and older children, sputum induction has younger children because they swallow their been successfully used; this technique has sputum and do not expectorate. Studies not been tested in younger children. comparing GL to induced sputum in adults Aims —To investigate whether sputum in- with suspected tuberculosis reported induced duction can be successfully performed in sputum to be more e V ective 4 5 ; however, one infants and young children and to deter- study reported that if GL was undertaken after mine the utility of induced sputum com- sputum induction the procedures produced pared to gastric lavage (GL) for the similar results. 6 A study of 13 children with diagnosis of pulmonary tuberculosis in pulmonary tuberculosis reported an improved HIV infected and uninfected children. yield from GL when preceded by a nebulisa- Subjects and methods —149 children (me- tion of superheated isotonic saline. 7 There are dian age 9 months) admitted to hospital no published studies comparing induced spu- with acute pneumonia who were known to tum to GL for culture of M tuberculosis in chil- be HIV infected, suspected to have HIV dren. Two studies of GL compared to broncho- infection, or required intensive care unit alveolar lavage (BAL) in children suggest that support. Sputum induction was per- GL provides a higher bacteriological yield than formed on enrolment. Early morning GL BAL for pulmonary tuberculosis. 8 9 was performed after a minimum four hour The aim of this study was to determine fast. Induced sputum and stomach con- whether sputum induction can be successfully tents were stained for acid fast bacilli and performed in infants and young children, to cultured for Mycobacterium tuberculosis . compare induced sputum with GL for the yield Results —Sputum induction was success- of M tuberculosis in children with pulmonary fully performed in 142 of 149 children. M tuberculosis, and to determine whether the tuberculosis , cultured in 16 children, grew yield was influenced by HIV status. from induced sputum in 15. GL, per- formed in 142 children, was positive in nine; in eight of these M tuberculosis also Methods grew from induced sputum. The di V er- PATIENTS ence between yields from induced sputum A prospective one year study during 1998 was compared to GL was 4.3% (p = 0.08). M performed in the paediatric wards of four hos- tuberculosis was cultured in 10 of 100 HIV pitals in Cape Town, South Africa—Red Cross infected children compared to six of 42 War Memorial Children’s Hospital, Somerset, HIV uninfected children (p = 0.46). Conradie, and Groote Schuur. Children en- Conclusion —Sputum induction can be rolled in this study were participants in a larger safely and e V ectively performed in infants study to determine the aetiology of acute Department of and young children. Induced sputum pro- pneumonia in hospitalised, HIV infected chil- Paediatrics and Child vides a satisfactory and more convenient Health, Red Cross War dren. Children with a primary diagnosis of specimen for bacteriological confirmation Memorial Children’s pneumonia according to World Health Organ- of pulmonary tuberculosis in HIV infected Hospital, University of isation criteria 10 (defined as the presence of Cape T own, South and uninfected children. tachypnoea or lower chest indrawing) and who Africa ( Arch Dis Child 2000; 82 :305–308) were known to be HIV infected, were sus- H J Zar pected of having HIV infection, or were admit- E Tannenbaum Keywords: induced sputum; tuberculosis; HIV P Apolles ted to the intensive care unit (ICU) but were P Roux not intubated were studied. A suspicion of HIV D Hanslo Bacteriological confirmation of pulmonary infection was based on the presence (in G Hussey tuberculosis in infants and children remains addition to pneumonia) of two or more of the di Y cult. Sputum induction has been used to following: generalised lymphadenopathy, Correspondence to: Dr H Zar, Child Health diagnose pulmonary tuberculosis in HIV in- weight below the 3rd centile for age, hepatome- Unit, 46 Sawkins Road, fected and immunocompetent adults. 1 Older galy, splenomegaly, oral candidiasis, enlarged Rondebosch, 7700, South children can produce or be induced to produce parotid glands, or chronic diarrhoea. Children Africa email: heather@ sputum; this method has been used for the were enrolled during working hours from rmh.uct.ac.za diagnosis of Pneumocystis carinii pneumonia Monday to Friday. Informed consent for and more recently for tuberculosis. 2 3 However, enrolment in the study and for HIV testing (in Accepted 24 November 1999
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