Evaluation of Gastric Lavage in the diagnosis of Childhood Pulmonary Tuberculosis using Gabbet’s Cold Stain
Abstract
Introduction: Childhood tuberculosis is an important public health problem especially in developing countries like India. The diagnosis of tuberculosis is extremely challenging. The reason for this is the inability to demonstrate acid-fast bacilli (AFB) which is the gold standard for diagnosis.
Objective: To evaluate the role of Gastric Lavage (GL) in the diagnosis of pulmonary tuberculosis in children using Gabbet’s cold stain.
Materials and Methods: Based on simple random sampling method, a total of 100 children less than 12 years of age admitted to JSS Hospital were selected for this study. The WHO criteria were used for the selection of patients. The cases underwent Mantoux test and chest Xray. Early morning GL was performed on three consecutive days and the content was sent for AFB staining using Gabbet’s cold stain and culture. Results were analyzed using appropriate statistical methods.
Results: 70% of the GL positive cases were below 6 years of age, did not have history of contact and had a BCG scar. 82% of GL positive cases were malnourished. An initial positive smear from GL was followed by positive culture in 85% cases but a positive culture was preceded by a negative smear in 45% patients. GL was positive in 46% of mantoux negative patients. The sensitivity of GL in the diagnosis of pulmonary tuberculosis was 85% and the specificity was 82.5%.
Conclusion: GL properly collected, neutralized and examined using Gabbet’s cold staining method is an easier method to confirm the clinical diagnosis of pulmonary tuberculosis in children.
References
2. Pharmacist to play key role in STOP TB programme. www. expresspharmaonline.com http://www.tbcindia.org/key.asp accessed on 31st August 2011.
3. Starke JR, Taylor-Watts KT. Tuberculosis in the pediatric population of Houston, Texas. Pediatrics . 1989;84:28-35.
4. Ramachandran RS. Tuberculosis in children; Experience with 1284 cases. Ind Paed. 1968;5(12):564-71.
5. Gourley I. Tubercle bacilli in the gastric contents of tuberculous children. American Review of Tuberculosis and Pulmonary Diseases. 1934;29:461-70
6. Lloyd ACV. Bacteriological diagnosis of tuberculosis in children: A comparative study of gastric lavage and laryngeal swab method. East African Med. Journ. 1968;45 (3): 140-43.
7. Somu N, Swaminathan S, Paramasivan LN, Vijayasekharan D, Chandrabhooshanam A,Vijayan VK, Prabhakar R. Value of bronchoalveolar lavage and gastric lavage in the diagnosis
of pulmonary tuberculosis in children. Tubercle and lung disease. 1995;76: 295-299.
8. Migliori GB, Borghesi A, Oryem V, Comaschi E, Vocaturo G, Neri M. Gastric washing to evaluate the clinical outcome of under 5 children affected by pulmonary tuberculosis. In Abstract: Joint Meeting SEP-SEPCR.; 1990
9. Collin C.H, Grange JM, Yates MD. Organization and practice in tuberculosis Bacteriology. Butterworths, 1985;42-43.
10. Hok TT. Simple and Rapid Cold staining Method for Acid Fast Bacteria. Am Rev Resp Disc. 1962;85(5):753-754.
11. Gokhale S, Qadir S, Nagra JS, Chakraborty AK. Efficiency of cold staining method of AFB in sputum. A comparison with Ziehl– Neelsen method under field condition. Indian J Tuberc.
1990;37:135-13.
12. Pandey A, Madan M, Ashish K, Asthana, Kansal R and Das A. Cold acid fast staining method: Efficacy in diagnosis of Mycobacterium tuberculosis. African Journal of Microbiology Research. 2009;3 (9):546-549.
