A51 DIAGNOSIS OF LATENT AND ACTIVE TUBERCULOSIS / Thematic Poster Session / Sunday, May 16/8:15 AM-4:00 PM / Area

L, Hall G (First Level), Morial Convention Center

Preliminary Results Of A Comparative Yield Study Of Induced Sputum, String Test, And Gastric Aspirate
For The Microbiological Diagnosis Of Pulmonary Tuberculosis In Children

C. M. Perez-Velez1, E. C. Wilches-Luna2, J. M. Hernández-Sarmiento3, A. L. Casanova-Reynolds4, N. Hernández3, S. P.

Moreno-Ortega4, S. L. Atehortúa-Muñoz5, J. C. Rozo-Anaya6, G. I. Mejía7, V. Gómez8, B. E. Ferro9, A. E. Prada-Quiroz10, C. A.
Moreira11, W. Duque-Loaiza12, M. Martínez8, C. L. Daley13, J. A. Robledo14
1National Jewish Health / University of Colorado, Denver, CO, United States of America, 2Universidad del Valle, Cali, Colombia, 3

Corporacion para Investigaciones Biologicas, Medellin, Colombia, 4Hospital Departamental de Buenaventura, Buenaventura, Colombia, 5
Universidad Pontificia Bolivariana, Medellín, Colombia, 67. Centro Internacional de Entrenamiento e Investigaciones Médicas, Cali,
Colombia, 7Centro Internacional de Entrenamiento e Investigaciones Médicas, Medellín, Colombia, 8Corporación para Investigaciones
Biológicas, Medellín, Colombia, 9Centro Internacional de Entrenamiento e Investigaciones Médicas, Cali, Colombia, 10Universidad de
Antioquia, Medellín, Colombia, 11Secretaría Departamental de Salud, Gobernación del Valle del Cauca, Cali, Colombia, 121. Grupo
Tuberculosis Valle-Colorado, Buenaventura, Colombia, 13National Jewish Health, Denver, CO, United States of America, 144. Corporación
para Investigaciones Biológicas, Medellín, Colombia

Corresponding author's email: CMPerezVelez@Gmail.com

Rationale: For the microbiological confirmation of pulmonary tuberculosis (PTb) in children, the gastric aspirate (GA) has a very low yield
and multiple difficulties for its collection (e.g.,invasiveness;hospitalization) and preservation (e.g.,neutralization). The aim of this study is to
compare the yield of the GA to two alternative specimens—the string test (ST) and induced sputum (IS), which have the advantage of
being collected ambulatorily, deemed less invasive by patients and parents, easier to collect/process by health professionals, and reported
to have a comparable—and possibly superior—yield. Methods: Ongoing, prospective, non-randomized, comparative yield study,
comparing the yields of GA, ST, and IS, in a convenience sample of children with “highly-probable” PTb defined as meeting all WHO criteria
(household-contact of adult with smear-positive-Tb, chronic symptoms, physical signs, abnormal chest radiographs, positive
PPD-tuberculin-skin-test). Each specimen is collected on three consecutive days (i.e.,total of nine samples/patient), in children aged 0-15
years, residing in Buenaventura or Medellín, Colombia. Each sample is cultured in solid (Middlebrook-7H10 or Lowenstein-Jensen) and
liquid (Middlebrook-7H9 in ) media. Results: Patient recruitment began in March/2009, and will end in December/2010. As of
November-4-2009, 5 of the 29 patients who met all inclusion criteria had Mycobacterium tuberculosis isolated from either GA, ST, or IS.
M.tb was isolated from 13.7% of the GA samples, versus 11.4% of ST samples (p=0.9), versus 6.8% of IS samples (p=0.26). Given the very
low number of confirmations thus far, there is no statistically significant difference to date. Of 41 patients who did not meet inclusion
criteria because they only had three of four criteria, 3 (7.3%) were microbiologically confirmed. HIV-serology was negative in all patients.
No single type of specimen was consistently positive in all microbiologically-confirmed cases. Conclusions: Microbiological confirmation
is still remarkably low in children who meet all four WHO criteria, and was nil in those meeting only three criteria. The yield of the ST and IS
appears to be similar to that of the GA. Due to the low yield of any one particular specimen, and the fact that some patients were positive
by only one of the three types of specimens, the combined yield of two specimens collected in series can be complimentary. If by the end
of the study there are still no statistically significant differences between GA versus ST and/or IS, the latter two specimens have the
advantage of being easier to collect/process for the clinician, and less invasive and thereby more acceptable to patient/parent.

This abstract is funded by: Colciencias

Am J Respir Crit Care Med 181;2010:A1775

Internet address: www.atsjournals.org Online Abstracts Issue