Published online June 2, 2006
PEDIATRICS Vol. 118 No. 1 July 2006, pp. e100-e106 (doi:10.1542/peds.2005-2623)
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Improved Recovery of Mycobacterium tuberculosis From Children Using the Microscopic Observation Drug Susceptibility Method

Richard A. Oberhelman, MDa,1, Giselle Soto-Castellares, MDb, Luz Caviedes, MSc, Maria E. Castillo, MDd, Patricia Kissinger, PhDa, David A.J. Moore, MDb,c,e, Carlton Evans, MDb,c,e,f and Robert H. Gilman, MDb,c,f

a Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
b Asociación Benéfica PRISMA, Lima, Peru
c Department of Pathology, Faculty of Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
d Instituto de Salud del Niño, Lima, Peru
e Wellcome Trust Centre for Clinical Tropical Medicine, Imperial College, London, United Kingdom
f Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

OBJECTIVE. The diagnosis of pulmonary tuberculosis presents challenges in children, because symptoms are nonspecific, sputa are not accessible, and Mycobacterium tuberculosis cultures and smears often are negative. The Microscopic Observation Drug Susceptibility technique is a simple, inexpensive method for Mycobacterium tuberculosis isolation with superior speed and sensitivity over Lowenstein-Jensen culture in studies of adults with pulmonary tuberculosis. The objective of this study was to determine whether Microscopic Observation Drug Susceptibility culture can improve the sensitivity and the speed of Mycobacterium tuberculosis recovery among Peruvian children with symptoms suggestive of pulmonary tuberculosis.

METHODS. Two specimens of each type (gastric aspirate, nasopharyngeal aspirate, and stool specimens) were collected from each patient, examined by auramine stain, and cultured by Microscopic Observation Drug Susceptibility and Lowenstein-Jensen techniques. Patients (n = 165) were enrolled between April 2002 and February 2004 at the Instituto de Salud del Niño, the major pediatric hospital in Lima, Peru. Inclusion criteria were age ≤12 years, Stegen-Toledo clinical score ≥5 points, and absence of antituberculous therapy. The main outcome measurements were (1) proportion of specimens that were culture positive by Microscopic Observation Drug Susceptibility versus Lowenstein-Jensen and (2) days required for positive culture result, stratified by specimen type and auramine stain result.

RESULTS. Fifteen (9%) patients had at least 1 positive Mycobacterium tuberculosis culture (from stool in 3 cases, nasopharyngeal aspirate in 8 cases, and gastric aspirate in 15 cases). Thirty-eight culture-positive specimens were obtained (22 gastric aspirate, 12 nasopharyngeal aspirates, and 4 stools). Microscopic Observation Drug Susceptibility provided significantly more positive cultures than Lowenstein-Jensen (33 of 38 specimens culture positive by Microscopic Observation Drug Susceptibility vs 21 of 38 by Lowenstein-Jensen). This was attributed to enhanced recovery of Mycobacterium tuberculosis from auramine-negative specimens (19 of 23 by Microscopic Observation Drug Susceptibility vs 9 of 23 by Lowenstein-Jensen), in contrast to similar detection rates for the 2 tests with auramine-positive samples. Similar results were found for analyses that were limited to gastric aspirates. Isolation was faster by Microscopic Observation Drug Susceptibility than Lowenstein-Jensen.

CONCLUSIONS. Isolation of Mycobacterium tuberculosis from children with suspected pulmonary tuberculosis by Microscopic Observation Drug Susceptibility demonstrated greater yield and faster recovery than by Lowenstein-Jensen method, significantly improving local capabilities to detect pediatric tuberculosis in resource-poor settings.

Key Words: tuberculosis • isolation • diagnosis • children • Peru

Abbreviations: TB—tuberculosis • WHO—World Health Organization • PTB—pulmonary tuberculosis • MTB—Mycobacterium tuberculosis • MODS—Microscopic Observation Drug Susceptibility • LJ—Lowenstein-Jensen culture • NPA—nasopharyngeal aspirate • GA—gastric aspirate • ST—Stegen-Toledo criteria

Accepted Jan 17, 2006.




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