Abstract
BackgroundThe microbiological diagnosis of pulmonary tuberculosis (Tb) in a pediatric population is hampered by both low pathogen burden and noncompliance with sputum sampling. Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been found useful for the evaluation of mediastinal pathologies in adults, for children, sparse data are available. Here, we have evaluated EBUS-TBNA as a diagnostic procedure in children and adolescents with suspected pulmonary Tb.MethodsIn this retrospective analysis, we reviewed the charts of unaccompanied refugee minors (URM) who were admitted between January 2016 and July 2018 and who, during their initial medical screening upon arrival in Germany, were found to have abnormal radiological pulmonary and mediastinal findings and/or immunological results indicative of Tb. For each patient, basic sociodemographic data, clinical features and data on diagnostic procedures performed were assessed. These included imaging, immunodiagnostic tests and microbiological data derived from sputum, bronchoalveolar lavage, EBUS-TBNA, bronchoscopy and pleural fluid sampling. All patients who underwent invasive sampling procedures were included in the study.ResultsOut of 42 URM with suspected Tb, 34 fulfilled the study’s inclusion criteria. Ages ranged from 14 to 17 years. All were of African origin, with 70.0% coming from Somalia, Eritrea and Ethiopia. Among the 21 patients for whom EBUS-TBNA was performed, the diagnostic yield was high: 66.7% positive results (MTb detected either by acid-fast stain, culture or PCR in 4.8, 42.9 and 61.9% of samples, respectively). Multidrug-resistant MTb was found in two patients from Somalia. No complications were associated with the procedure. Overall, pulmonary Tb was diagnosed in 29 patients (85.3%), miliary Tb in two patients (5.9%) and latent Tb in three patients (8.8%).ConclusionsEBUS-TBNA is a sensitive and safe method with high diagnostic yield in the evaluation of pediatric patients with mediastinal pathology and suspected Tb.
Highlights
The microbiological diagnosis of pulmonary tuberculosis (Tb) in a pediatric population is hampered by both low pathogen burden and noncompliance with sputum sampling
Tb incidence in Germany was at a stable, low level in the years prior to 2013, a significant increase in Tb was seen thereafter, with numbers peaking in 2016 [2]. This rise was driven by the increase of migrants seeking asylum in Germany during this period
Study population The study cohort consisted of unaccompanied refugee minors (URM) referred to the University Medical Center Freiburg, Center of Pediatrics and Adolescent Medicine, between January 2016 and July 2018, for workup of suspected Tb following infectious diseases screening according to the recommendations of the German Society of Pediatric Infectious Diseases (DGPI), the German Society of Tropical Pediatrics and International Child Health (GTP) and the German Professional Association of Pediatricians (BVKJ) [17]
Summary
The microbiological diagnosis of pulmonary tuberculosis (Tb) in a pediatric population is hampered by both low pathogen burden and noncompliance with sputum sampling. We have evaluated EBUS-TBNA as a diagnostic procedure in children and adolescents with suspected pulmonary Tb. The global burden of infections with M. tuberculosis (MTb) remains high [1]. As in many other lowincidence countries, Tb incidence in Germany reflects international migration dynamics: in 2018, 69.8% of newly diagnosed Tb patients in Germany were foreignborn. This translates to an incidence approximately 18 times higher among foreign nationals than among German citizens (37.3 vs 2.1 cases per 100,000 population, respectively). For patients with or without migration background, the pulmonary Tb form prevailed (72.9%) with a low detection rate of multiple drug resistance (3.1%; MDR) [2]
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