Intensified specimen collection to improve tuberculosis diagnosis in children from Rural South Africa, an observational study

• Published in: BMC infectious diseases Vol. 14; no. 1; p. 11
• Main Authors: Thomas, Tania A, Heysell, Scott K, Moodley, Prashini, Montreuil, Romualde, Ha, Xia, Friedland, Gerald, Bamber, Sheila A, Moll, Anthony P, Gandhi, Neel, Brant, William E, Sturm, Willem, Shah, Sarita
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 09.01.2014; BioMed Central
• Subjects: Acquired immune deficiency syndrome; Age; AIDS; Care and treatment; Charitable foundations; Child; Child, Preschool; Diagnosis; Disease; Drug resistance in microorganisms; Extensively Drug-Resistant Tuberculosis - diagnosis; Female; Gastrointestinal Contents - microbiology; Health aspects; HIV; HIV Seropositivity; Hospitalization; Human immunodeficiency virus; Humans; Infant; Male; Medicine; Methods; Mycobacterium; Mycobacterium tuberculosis - isolation & purification; Pediatrics; Risk factors; Rural Population; South Africa; Specimen Handling; Sputum - microbiology; Studies; Tuberculosis; Tuberculosis - blood; Tuberculosis - diagnosis; Tuberculosis - urine; South Africa
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/1471-2334-14-11

In drug-resistant TB settings, specimen collection is critical for drug-susceptibility testing (DST). This observational study included multiple specimen types collected from pediatric TB suspects with the aim to determine diagnostic yield and inform clinical practice in children with drug-resistant and drug-susceptible TB. From 03/2009-07/2010, TB suspects aged ≥6 months and ≤12 years were recruited among outpatient and inpatient settings. Subjects were new TB suspects or had persistent symptoms despite ≥2 months of TB treatment. The protocol included collection of a single blood and urine specimen, a single sputum induction and, if inpatients and <5 years of age, collection of 3 gastric aspirates (GA). Samples were cultured on solid and/or liquid media. DST was by 1% proportion method. Among 118 children with possible, probable or confirmed TB, the mean age was 4.9 years [SD 3.2] and 64 (62%) of those tested were HIV-positive. Eight (7%) subjects were culture-positive from at least one specimen; yield did not differ by HIV status or TB treatment history. Among those with positive cultures, 7/8 (88%) were from induced sputum, 5/6 (83%) from GA, 3/8 (38%) from blood, and 3/7 (43%) from urine. In subjects with both induced sputum and GA collection, sputum provided one additional case compared to GA. Multidrug resistant (MDR)-TB was detected by urine culture alone in one child >5 years old. Pan-resistant extensively drug resistant (XDR)-TB was identified by cultures from all sites in one subject. TB was cultured from HIV-positive and -negative children, and allowed for identification of MDR and XDR-TB cases. Urine and induced sputum each provided an additional TB diagnosis and, when compared to GA, may be considered a less invasive, same-day method of specimen collection for childhood TB suspects. This study illustrates the continued challenges and limitations of available strategies for pediatric TB diagnostics.