Does multiple gastric aspirate collection increase sensitivity of M.
tuberculosis detection in children with pulmonary tuberculosis?
Objectives . This study aims to investigate the
sensitivity of microscopy, culture and polymerase chain reaction on
three gastric aspirates (GAs) in the microbiological confirmation of
active pulmonary tuberculosis (TB) and to identify possible changes in
sensitivity derived from the collection of a different number of
aspirates. Methods. Children with clinical
and radiological diagnoses of active pulmonary TB who underwent three
GAs between March 2007 and June 2019 were retrospectively evaluated.
Clinical, radiological, and microbiological data were collected. The
sensitivity of microbiological tests on GAs was calculated. Moreover,
differences in sensitivity according to age and radiological pattern
were investigated. Results. Overall, 156
children with active pulmonary TB were enrolled with a median age of
51.5 (IQR: 25.2–113.2) months. Microbiological investigations on the
first GA showed a sensitivity of 34% (95%CI 26.7, 42), the cumulative
sensitivity of first and second GAs was 40.4% (95%CI 32.7, 48.5) and
of the three GAs was 47.4% (95%CI 39.8, 55.2). The collection of three
GAs leads to an overall increase in sensitivity of the first GA by
13.4% (95%CI 2.8, 24.1%; p=0.014). Moreover, the increase in
sensitivity was significantly higher in children < 4 years of
age and in those with uncomplicated TB (p=0.008).
Conclusions. Performing a higher number of GAs
increases the sensitivity of microbiological confirmation of active
pulmonary TB, particularly in children ≤ 4 years and with an
uncomplicated radiological pattern.