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Published on: April 30, 2020
Sputum scarcity and respiratory sample availability among children with presumptive tuberculosis in high burden
Mary Gaeddert1, Jennifer Habbes1, Julian Meister1
1Department of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany.
Insights
Diagnosing childhood tuberculosis (TB) is challenging as children often can't produce sputum. This review found gastric aspirates highly effective for TB sample collection in children, unlike self-expectorated sputum which has high scarcity rates.
Area of Science:
- Pediatric infectious diseases
- Respiratory medicine
- Global health
Background:
- Tuberculosis (TB) diagnosis in children is hindered by difficulties in obtaining sputum samples.
- Children, particularly those under 5, frequently cannot produce self-expectorated sputum.
- This review focuses on respiratory sample collection methods for presumed TB in pediatric populations.
Purpose of the Study:
- To investigate the efficacy of various respiratory sampling methods for diagnosing tuberculosis in children.
- To assess the feasibility and success rates of self-expectorated sputum, induced sputum, gastric aspirates, and nasopharyngeal aspirates.
- To identify optimal diagnostic sample collection strategies for children in high TB burden settings.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Embase, Cochrane, Web of Science, clinical trials).
- Studies published between January 2010 and June 2024, focusing on children evaluated for presumed TB in high TB burden countries, were included.
- Data on sputum scarcity and sample collection success rates were extracted and meta-analyzed using random effects models.
Main Results:
- 36 studies involving 14,018 children were analyzed, with sampling methods varying by age.
- Self-expectorated sputum collection had high scarcity rates (38% in 5-15 year olds).
- Gastric aspirates showed minimal scarcity (median 0.0%), and sputum induction with nasopharyngeal suctioning had 3% scarcity in children under 15.
Conclusions:
- Collecting respiratory samples for pediatric TB diagnosis is complex and age-dependent.
- Alternative methods like gastric aspirates are crucial for children unable to produce sputum, especially in resource-limited settings.
- Development of easier-to-collect sample-based TB diagnostics for children is urgently needed.
Background:
Tuberculosis (TB) diagnosis typically relies on testing sputum samples, but children often cannot produce sputum. Our review investigated the collection of self-expectorated and induced sputum, and alternative methods of sampling including gastric and nasopharyngeal aspirates, among children evaluated for presumed TB in healthcare facilities.
Methods:
We searched PubMed, Embase, Cochrane Library, Web of Science, and clinical trials databases from January 2010 to June 2024. Studies not reporting sufficient information on respiratory sampling or not conducted in high TB burden countries were excluded. Summary data was extracted, and the risk of bias was assessed. Sputum scarcity was defined as the proportion of children who could not provide a sample among those attempting. The pooled estimate of sputum scarcity was calculated by random effects meta-analysis. The review protocol was registered with PROSPERO (CRD42023473882).
Findings:
The search identified 6,751 records and 36 studies were included which enrolled 14,018 children from 14 high burden countries. Respiratory sampling methods varied by age. In children under 5, a pooled estimate of 4% (95% CI: 2-6%, n=5) provided self-expectorated sputum, but collection was not attempted routinely. In studies collecting one or two self-expectorated spot sputum samples in children 5 to 15 years, the pooled estimate of sputum scarcity was 38% (95%CI: 20-55%, n=6). Studies performing sputum induction assisted by nasopharyngeal suctioning in children under 15 had pooled scarcity of 3% (95% CI:0-6%, n=8). For studies performing gastric aspirates, the median proportion without a sample was 0.0% (95% CI: 0·0-0·8%, IQR: 0·0-2·0%, n=23).
Interpretation:
Collecting respiratory samples in children with presumed TB is complex and age-dependent. Children, especially under 5, are often unable to produce self-expectorated sputum and depend on alternative methods, such as induction or gastric aspirates. TB diagnostics using samples that are easier to collect from children in resource-limited settings are needed.
Funding:
Gates Foundation (INV-069540).
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