Nasopharyngeal Aspiration Useful to Confirm TB in Children

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NEW YORK (Reuters Health) Aug 10 - New research suggests that nasopharyngeal aspiration can be a safe and effective method of confirming pulmonary tuberculosis in young children, and it can be performed on an outpatient basis.

Confirming pulmonary tuberculosis in young children is problematic since these patients are typically unable to expectorate. Gastric aspiration can confirm the diagnosis, but it may require the child to be hospitalized for up to 3 days.

The goal of the present study, reported in the Archives of Diseases in Childhood for August, was to examine the usefulness of nasopharyngeal aspiration as a confirmatory method.

The study included 94 subjects, between 4 and 144 months of age, with symptoms suggestive of pulmonary tuberculosis and a positive tuberculin test, chest radiograph consistent with pulmonary tuberculosis, or both. All of the children were patients at Mulago Hospital, Kampala, Uganda.

Nasopharyngeal aspiration smear results were obtained for all 94 children and culture results were available in 88, Dr. J. B. S. Coulter, from the Liverpool School of Tropical Medicine in the UK, and colleagues note. Of the 63 children who were also tested for HIV, 44 were positive.

Smear-positive and culture-positive nasopharyngeal aspirates were noted in 8.5% and 23.9% of subjects, respectively. The corresponding rates with induced sputum were 9.6% and 21.6%. The rates when both methods were combined were 10.6% and 25.5%.

Direct polymerase chain reaction analysis of nasopharyngeal aspirates was 62% sensitive and 98% specific in confirming culture-positive pulmonary tuberculosis.

"Where facilities for smear and culture are available, nasopharyngeal aspiration is a useful low-technology method for diagnosis of tuberculosis. Both nasopharyngeal aspiration and sputum induction are useful for outpatients as well as inpatients and are likely to have higher smear-positive yields than gastric aspiration," the authors conclude.

Arch Dis Child 2007;92:693-696.

Source: http://www.medscape.com/viewarticle/561273?sssdmh=dm1.293374&src=nldne