Abstract
BackgroundCollecting sputum specimens is a challenge in infants and young children. We assessed the performance and safety of induced sputum (IS) collection in this population, embedded in a prospective study evaluating respiratory cryptosporidiosis in Malawian children with diarrheal disease.MethodsWe assessed the sputum quality and correlation with detection of Cryptosporidium spp. and evaluated safety and adverse events in 162 children.ResultsAmong 159 stool specimens tested, 34 (21%, 95% CI 15.0 to 28%) were positive for Cryptosporidium spp. There were 160 IS and 161 nasopharyngeal (NP) specimens collected. IS and NP specimen collection was performed for each patient. The majority of IS specimens (122/147; 83%) were clear in appearance and 132/147 (90%) were of good quality. Among the respiratory specimens tested, 10 (6.3%, 95% CI 2.5 to 10%) IS and 4 (3%, 95% CI 0 to 5%) NP were positive for Cryptosporidium spp. When stool cryptosporidium PCR was the gold standard, IS PCR sensitivity was higher (29%, 95% CI 22 to 37%) compared with NP PCR (12%, 95% CI 7 to 17%) for detection of Cryptosporidium spp. One (0.4%) adverse event occurred, consisting of a drop in oxygen saturations at the 30-min postprocedure evaluation. Consciousness level, median respiratory rate and oxygen saturations were unchanged, before or after IS.ConclusionsIS provides good quality specimens, is more sensitive than NP specimens for diagnosis of respiratory cryptosporidiosis, and collection can be performed safely in children hospitalized with diarrheal disease.
Highlights
This is more challenging in infants and young children1 who require sputum induction and/or gastric aspiration to obtain diagnostic specimens
In Malawi, gastric aspiration is the standard method for obtaining pediatric sputum specimens in public hospitals
The participants were children aged 2–24 mo hospitalized with a primary diagnosis of diarrhea as part of a study evaluating the role of respiratory cryptosporidiosis in pediatric diarrheal disease
Summary
Sputum specimens are routinely collected for the diagnosis of respiratory diseases in adults.1 This is more challenging in infants and young children who require sputum induction and/or gastric aspiration to obtain diagnostic specimens.. In Malawi, gastric aspiration is the standard method for obtaining pediatric sputum specimens in public hospitals. These facilities are usually under-resourced, lack equipment for induced sputum (IS) collection and staff trained to conduct IS. Few studies evaluating the safety of IS have been performed in low-resource settings, and none have been conducted in a public tertiary hospital in Malawi. We assessed the performance and safety of induced sputum (IS) collection in this population, embedded in a prospective study evaluating respiratory cryptosporidiosis in Malawian children with diarrheal disease
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