Indian J Pediatr (November 2011) 78(11):1429–1430
DOI 10.1007/s12098-011-0452-7
SCIENTIFIC LETTERS TO THE EDITOR
Microbiological Diagnosis of Pulmonary Tuberculosis
in Children: Comparative Study of Induced Sputum
and Gastric Lavage
Umar Amin Qureshi & Ashok K. Gupta &
Bella Mahajan & Mariya Amin Qurieshi & Uruj Altaf &
Ravi Parihar & Kulwant Singh Bhau
Received: 13 January 2011 / Accepted: 2 May 2011 / Published online: 26 May 2011
# Dr. K C Chaudhuri Foundation 2011
Sir,
Even under ideal circumstances, isolation rates of
Mycobacterium Tuberculosis (M.Tb) from gastric lavage
range from 28% to 40% in children with suspected
pulmonary tuberculosis, although rates can rise to 75% in
infants [1]. One year prospective study was undertaken in
SMGS Hospital, Jammu to compare Induced Sputum (IS)
with Gastric lavage (GL) for yield of M.Tb in children
with suspected pulmonary tuberculosis.
U. A. Qureshi (*)
Department of Neonatology and Pediatrics, SKIMS,
Post Box no 1402, GPO Srinagar, Kashmir, India
e-mail: dromarqureshi@rediffmail.com
A. K. Gupta : R. Parihar
Department of Pediatrics, SMGS Hospital,
Jammu, India
B. Mahajan
Department of Microbiology, GMC,
Jammu, India
M. A. Qurieshi
Department of Community Medicine, Amrita School of Medicine,
AIMS, Kochi, Kerala, India
U. Altaf
Department of Community Medicine, SKIMS,
Srinagar, Kashmir, India
K. S. Bhau
Department of Surgery, SMHS Hospital,
Srinagar, Kashmir, India
Children aged 6 months to 18 years admitted for chronic
cough (more than 28 days) who could not expectorate and
had one of the following: household contact (within past
2 years); failure to gain or loss of weight (in 3 months);
Positive mantoux test (>10 mm); Chest radiography with
pleural effusion, lymphadenopathy or nonresolving consol-
idation, were included in the study.
Sixty-five children were initially included. Sixty children
in whom successful sputum induction (SI) was possible
took part in the study. They underwent GL and SI on three
consecutive days according to a standard protocol [2].
Children underwent morning GL after an overnight fast
of at least 4 h. Gastric aspirate was immediately placed in a
tube containing sodium carbonate. SI was undertaken after
2–3 h fast about 6 h after GL. Sputum was obtained by
suctioning through nasopharynx after chest percussion.
Samples were subjected to decontamination (Petroff’s
method) and centrifugation. Treated specimens were inoc-
ulated simultaneously on Lowenstein Jenson (LJ) medium
and in Middlebrook 7 H9 media (MB7H9). Mycobacterial
presence was confirmed by Acid Fast Bacilli (AFB) on
direct smears or culture media. Classification as M.Tb was
made by typicality of colony morphology and a positive
niacin test.
The median age of children was 4 years. Samples
from IS to GL were positive in 8 (13%) and 5 (8%)
children, respectively. The difference between yields for
M.Tb from AFB smears to cultures on IS and GL was
statistically insignificant (p=0.99) using the χ2 test. Zar
HJ, et al. noted that SI was more sensitive than GL,
detecting almost twice the number of children with
pulmonary tuberculosis [3].
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M. Tb was identified from the first sample of IS to GL in
7 and 4 children respectively. In each procedure, second
sample yielded an additional one case. Third sample did not
increase the yield.
Of the 60 children, six were 6 months-1 year, 30 were
1–5 years, 13 were 5–10 years, and 11 were 10–18 years of age.
The yield of M.Tb was maximum (50%) in both IS and GL in
infants (6 months to 1 year).
Although no statistical significance was encountered in
difference between yields for M.Tb on IS and GL, use of IS
should be considered as a first line investigation in children
suspected of having pulmonary tuberculosis.
Indian J Pediatr (November 2011) 78(11):1429–1430
References
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Detection of Mycobacterium tuberculosis in gastric aspirates
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sputum versus gastric lavage for microbiological confirmation of
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Sputum induction for the diagnosis of pulmonary tuberculosis in
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