Sputum induction for the diagnosis of pulmonary tuberculosis in infants and young children in an urban setting in South Africa

Background-Bacteriological confirmation of pulmonary tuberculosis is diffic ult in infants and young children. In adults and older children, sputum ind uction has been successfully used; this technique has not been tested in yo unger children. Aims-To investigate whether sputum induction can be successfully performed in infants and young children and to determine the utility of induced sputu m compared to gastric lavage (GL) for the diagnosis of pulmonary tuberculos is in HIV infected and uninfected children. Subjects and methods-149 children (median age 9 months) admitted to hospita l with acute pneumonia who were known to be HIV infected, suspected to have HIV infection, or required intensive care unit support. Sputum induction w as performed on enrolment. Early morning GL was performed after a minimum f our hour fast. Induced sputum and stomach contents were stained for acid fa st bacilli and cultured for Mycobacterium tuberculosis. Results-Sputum induction was successfully performed in 142 of 149 children. M tuberculosis, cultured in 16 children, grew from induced sputum in 15. G L, performed in 142 children, was positive in nine; in eight of these M tub erculosis also grew from induced sputum. The difference between yields from induced sputum compared to GL was 4.3% (p = 0.08). M tuberculosis was cult ured in 10 of 100 HIV infected children compared to six of 42 HIV uninfecte d children (p = 0.46). Conclusion-Sputum induction can be safely and effectively performed in infa nts and young children. Induced sputum provides a satisfactory and more con venient specimen for bacteriological confirmation of pulmonary tuberculosis in HIV infected and uninfected children.