Sputum induction for microbiological diagnosis of childhood pulmonary tuberculosis in a community setting

SETTING: Sputum induction has increasingly enabled microbiological confi rmation of pulmonary tuberculosis (PTB) in hospitalised children, but it has not been evaluated in a community setting. OBJECTIVE: To investigate the yield, feasibility and safety of sputum induction for the diagnosis of TB in children in a primary health care facility. DESIGN: A prospective study in a primary health care clinic in South Africa from April 2007 to June 2009. Consecutive children with clinically suspected PTB, with a household adult PTB contact or human immunodefi ciency virus infected with respiratory symptoms were enrolled. History, clinical examination, tuberculin skin test and chest X-ray results were recorded. Two sequential induced sputum specimens were obtained for smear and culture. RESULTS: A total of 270 children were enrolled (median age 38 months); sputum induction was successful in 269 (99%); 65 (24%) children were clinically diagnosed, of whom 11 (16.9%) were microbiologically confi rmed. An additional 18 children not clinically diagnosed had microbiological confi rmation of PTB and were placed on TB treatment thereafter, increasing the diagnostic yield by 21.6%, from 65 to 83 cases. Sputum induction procedures were well tolerated; no major adverse events occurred. CONCLUSION: Sputum induction is feasible and safe in a community setting. Sputum induction was useful for making a microbiological diagnosis, increasing the number of children diagnosed and treated for PTB. © 2011 The Union.