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Detection of Mycobacterium tuberculosis in gastric aspirates collected from children: hospitalization is not
M N Lobato1, A M Loeffler, K Furst
1Department of Pediatrics, San Francisco General Hospital, University of California, CA 94110, USA.
Insights
Gastric aspirates for Mycobacterium tuberculosis culture yield comparable results in outpatient and inpatient pediatric settings. Outpatient collection reduces costs and inconvenience while still providing crucial drug susceptibility data.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Public Health
Background:
- Tuberculosis (TB) diagnosis in children often relies on microbiological confirmation.
- Gastric aspirates are a common method for collecting samples for Mycobacterium tuberculosis (Mtb) culture in pediatric populations.
- Comparing diagnostic yields between outpatient and inpatient settings is crucial for optimizing healthcare resource allocation.
Purpose of the Study:
- To compare the diagnostic yield of gastric aspirates for Mtb culture in pediatric outpatients versus inpatients.
- To identify factors associated with a positive Mtb culture from gastric aspirates in children.
Main Methods:
- Retrospective study of 100 children under 12 years old diagnosed with TB.
- Analysis of gastric aspirates collected from both outpatient and inpatient settings.
- Evaluation of factors correlating with positive Mtb cultures.
Main Results:
- Mtb was isolated from 41% of children with gastric aspirates.
- Inpatients showed a slightly higher positive culture rate (48%) than outpatients (37%), though not statistically significant.
- Factors associated with higher yield included identified source case, age <2 years, US birth, symptomatic disease, and pulmonary involvement.
Conclusions:
- Gastric aspirate culture for Mtb in pediatric outpatients yields results comparable to inpatients.
- Outpatient collection is cost-effective and convenient.
- Despite a relatively low overall yield, gastric aspirates provide valuable diagnostic information, including drug susceptibility patterns.
Objective:
To compare the yields of gastric aspirates collected for culture of Mycobacterium tuberculosis from children evaluated as outpatients versus inpatients and to determine factors associated with a positive culture.
Methods:
Retrospective study of 100 children <12 years of age with tuberculosis diagnosed at a pediatric referral hospital or in one of two tuberculosis control programs in California.
Results:
Of the 100 children who had tuberculosis, 80 had at least one gastric aspirate collected. M tuberculosis was isolated from 33 (41%) of the 80 children who had a gastric aspirate; 4 children had a positive culture from an aspirate subsequent to the first. Inpatients had a higher proportion of positive gastric aspirates than that of children who had aspirates collected as outpatients (48% vs 37%); however, this difference was not statistically significant. Resistance to isoniazid was found in three isolates (9%) of children all of whose presumptive source case had a susceptible strain of M tuberculosis. Characteristics that were associated with an approximately 50% yield from gastric aspirates were identification of a source case, age <2 years, birth in the United States, symptomatic tuberculosis, and pulmonary disease.
Conclusions:
The culture of M tuberculosis from gastric aspirates of children in the outpatient setting has a yield comparable to aspirates collected from hospitalized children. Collection of gastric aspirates in the outpatient setting will reduce both the cost and the inconvenience of the procedure. Although the yield from gastric aspirates is relatively low, important information including drug susceptibility patterns may be obtained. tuberculosis, gastric aspirate, children.