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 difficult in infants and young children. In adults and older children, sputum induction has been successfully used; this technique has not been tested in younger children. AIMS: To investigate whether sputum induction can be successfully performed in infants and young children and to determine the utility of induced sputum compared to gastric lavage (GL) for the diagnosis of pulmonary tuberculosis in HIV infected and uninfected children. SUBJECTS AND METHODS: 149 children (median age 9 months) admitted to hospital with acute pneumonia who were known to be HIV infected, suspected to have HIV infection, or required intensive care unit support. Sputum induction was performed on enrollment. Early morning GL was performed after a minimum four hour fast. Induced sputum and stomach contents were stained for acid fast 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. GL, performed in 142 children, was positive in nine; in eight of these M tuberculosis also grew from induced sputum. The difference between yields from induced sputum compared to GL was 4.3% (p = 0.08). M tuberculosis was cultured in 10 of 100 HIV infected children compared to six of 42 HIV uninfected children (p = 0.46). CONCLUSION: Sputum induction can be safely and effectively performed in infants and young children. Induced sputum provides a satisfactory and more convenient specimen for bacteriological confirmation of pulmonary tuberculosis in HIV infected and uninfected children.     

Sputum induction for the diagnosis of tuberculosis

Confirmation of tuberculosis in young children is difficult as they seldom expectorate sputum. Gastric aspirates are invasive and stressful and like laryngeal swabs are seldom smear positive. Induction of sputum by nebulised hypertonic saline (3%) was attempted in 30 Malawian children aged 3-15 years and was successful in 29. Four sputa were smear positive and Mycobacterium tuberculosis was cultured from three of them. A further four sputa were culture positive though smear negative. In all, the diagnosis of tuberculosis was confirmed in eight (28%) of 29 children. The presence of polymorphonuclear cells in the specimen was indicative of sputum, in contrast to epithelial cells which originate from saliva. A predominance of polymorphonuclear cells in specimens was more common in older children and these specimens were more likely to be smear positive or culture positive. Sputum induction is a useful method for the confirmation of tuberculosis and is possible in young children.     

Sputum induction for the diagnosis of tuberculosis.

Confirmation of tuberculosis in young children is difficult as they seldom expectorate sputum. Gastric aspirates are invasive and stressful and like laryngeal swabs are seldom smear positive. Induction of sputum by nebulised hypertonic saline (3%) was attempted in 30 Malawian children aged 3-15 years and was successful in 29. Four sputa were smear positive and Mycobacterium tuberculosis was cultured from three of them. A further four sputa were culture positive though smear negative. In all, the diagnosis of tuberculosis was confirmed in eight (28%) of 29 children. The presence of polymorphonuclear cells in the specimen was indicative of sputum, in contrast to epithelial cells which originate from saliva. A predominance of polymorphonuclear cells in specimens was more common in older children and these specimens were more likely to be smear positive or culture positive. Sputum induction is a useful method for the confirmation of tuberculosis and is possible in young children.     

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喘鸣是婴幼儿时期呼吸道疾病中最常见的症状,病因很多,并非所有的喘鸣均由哮喘引起。气管、支气管炎及气管、支气管软骨软弱、异物、血管畸形,胸内肿瘤以及支气管淋巴结核等,均可引起喘鸣。分析天津市儿童医院收治的以喘鸣为主要症状的3岁以下婴幼儿196例,其主要病因见表1。表1天津市儿童医院收治的196例以喘鸣为主要症状的婴幼儿喘鸣病因病因例数大气道阻塞气管、支气管异物21气管、支气管淋巴结核51先天性气管、支气管、肺发育畸形12支气管软骨软化3纵隔囊肿和(或)肿瘤19血管畸形1中叶综合征5小气道阻塞毛细支气管炎30以喘息为表型的婴幼…     

Diagnosis of pulmonary tuberculosis in young children

The Stop TB Strategy encompasses promotion and support for childhood TB including diagnosis. The diagnosis of TB in low-income countries needs to be improved using existing technology. All hospitals involved in managing children with TB should have a regular stock of tuberculin. A chest radiograph (CXR) is an integral part of the diagnosis of pulmonary TB and hospitals should be able to take satisfactory CXRs of young children. If there is a reliable laboratory service, bacterial confirmation should be undertaken in selected cases. The laboratory should be able to deal satisfactorily with paediatric specimens. Gastric aspiration is the method of choice to obtain sputum from young children and generally produces higher yields than other methods, and, with good technique, results in outpatients may not be much lower than in inpatients. Nasopharyngeal aspiration is a simple alternative method requiring limited equipment. Sputum induction requires a special room, capital and recurrent equipment and a dedicated nurse. Laryngeal swabs are suitable for older outpatients unable to produce adequate sputum. Each hospital should have a clinician trained in the diagnosis and management of childhood TB, including the interpretation of CXRs and skill in fine-needle aspiration. Radiologists and clinicians should use a simple, clear, internationally accepted classification of paediatric CXRs. The clinician(s) in charge of TB services should oversee all inpatients with TB and be at the forefront in running the TB clinic. A TB nurse specialist(s) should be part of the team. There is now a will to improve the diagnosis and management of childhood TB but bringing it to fruition requires efforts by the local TB service, paediatricians, radiology departments and laboratory services.     

Advances in the diagnosis of pulmonary tuberculosis in children

Major challenges still exist in the accurate diagnosis of tuberculosis in children. Algorithms based on clinical and radiological features remain in widespread use despite poor performance. Newer molecular diagnostics allow for rapid identification of TB and detection of drug-resistance in a subset of children, but lack sensitivity. Molecular testing of multiple specimens, including non-traditional specimen types, such as nasopharyngeal aspirates and stool and urine, may improve sensitivity, but the optimal combination of specimens requires further research. Novel tests under development or evaluation include a urine lipoarabinomannan test with improved sensitivity and a range of biomarkers measured from stimulated or unstimulated peripheral blood.     

Psychological distress amongst AIDS-orphaned children in urban South Africa

BACKGROUND: South Africa is predicted to have 2.3 million children orphaned by Acquired Immune Deficiency Syndrome (AIDS) by 2020 (Actuarial Society of South Africa, 2005). There is little knowledge about impacts of AIDS-related bereavement on children, to aid planning of services. This study aimed to investigate psychological consequences of AIDS orphanhood in urban township areas of Cape Town, South Africa, compared to control groups of children and adolescents orphaned by other causes, and non-orphans. METHOD: One thousand and twenty-five children and adolescents (aged 10-19) were interviewed using socio-demographic questionnaires and standardised scales for assessing depression, anxiety, post-traumatic stress, peer problems, delinquency and conduct problems. RESULTS: Controlling for socio-demographic factors such as age, gender, formal/informal dwelling and age at orphanhood, children orphaned by AIDS were more likely to report symptoms of depression, peer relationship problems, post-traumatic stress, delinquency and conduct problems than both children orphaned by other causes and non-orphaned children. Anxiety showed no differences. AIDS-orphaned children were more likely to report suicidal ideation. Compared to Western norms, AIDS-orphaned children showed higher levels of internalising problems and delinquency, but lower levels of conduct problems. CONCLUSIONS: Children orphaned by AIDS may be a particularly vulnerable group in terms of emotional and, to a lesser extent, behavioural problems. Intervention programs are necessary to ameliorate the psychological sequelae of losing a parent to AIDS.     

婴幼儿食物过敏诊治建议

近20年来儿科疾病谱发生改变[1],过敏性疾病与自身免疫性疾病持续增加,其中过敏性疾病累及约25%的儿童[2].发达国家儿童食物过敏患病率约为3%～6%;美国近十年来食物过敏的儿童患病率上升了18%[3];近5年英国儿童花生过敏患病率增长了1倍.