Examination Of Gastric Aspirate Research Articles

Usefulness of gastric aspirates for diagnosing nontuberculous mycobacteriosis

Distinguishing between nontuberculous mycobacterial pulmonary disease (NTM-PD) and pulmonary tuberculosis (TB) is difficult. We aimed to evaluate the usefulness of gastric aspirate examination for NTM-PD diagnosis and for differentiating NTM-PD from other diseases, including pulmonary TB. We retrospectively collected data for 491 patients with negative sputum smears or a lack of sputum production at Fukujuji Hospital. We compared 31 patients with NTM-PD to 218 patients with other diseases (excluding 203 with pulmonary TB). Additionally, we compared 81 patients with NTM cultured from at least one sputum or bronchoscopy sample to the other 410 patients. Gastric aspirate examination for NTM-PD diagnosis showed 74.2% sensitivity and 99.0% specificity for culture positivity. There was no significant difference between the nodular bronchiectatic disease and cavitary disease types for culture positivity (p = 0.515). The significance of NTM isolation from gastric aspirate showed 64.2% sensitivity and 99.8% specificity for culture positivity. Gastric aspirate examination revealed NTM in one TB patient, allowing TB to be ruled out in 98.1% of patients with NTM cultured from gastric aspirates. Gastric aspirate examination is helpful for early-stage NTM diagnosis and ruling out pulmonary TB. This could lead to more accurate and timely treatment.

Usefulness of gastric aspirate for the diagnosis of smear-negative pulmonary tuberculosis

IntroductionGastric aspirate can be useful for the diagnosis of pulmonary tuberculosis (TB) in patients with smear-negative pulmonary TB or without sputum production. The gastric aspirate smear technique has low sensitivity, and a previous report demonstrated that no patient was diagnosed by only gastric aspirate analysis. However, some patients with TB have been negative on sputum examination but positive on gastric aspirate examination, and the incidence of such cases is uncertain. Therefore, this study investigated the usefulness of gastric aspirate in the diagnosis of pulmonary TB. MethodsTo analyze the diagnostic accuracy of gastric aspirate examination, the data of 513 patients with negative sputum smears or a lack of sputum production, including 203 patients with pulmonary TB (39.6%) and 93 patients with nontuberculous mycobacteriosis who underwent gastric aspiration at Fukujuji Hospital from January 2016 to March 2021, were collected retrospectively. ResultsThe accuracy rates of gastric aspirate examination for the diagnosis of pulmonary TB were as follows: 21.2% sensitivity and 91.9% specificity for smear positivity, 55.8% sensitivity and 99.6% specificity for nucleic acid amplification test positivity, and 71.4% sensitivity and 100% specificity for culture positivity. Twenty-three patients (11.2%) were diagnosed by gastric aspirate examination alone. Among the 356 patients who underwent three repeated sputum examinations in addition to gastric aspirate examination, the cumulative diagnostic rate for the 3 mycobacterial examinations plus gastric aspirate examination was higher than that for only three sputum examinations. ConclusionsGastric aspirate is useful for the diagnosis of TB in patients with smear-negative pulmonary TB or without sputum production.

Tuberculous meningitis during infancy: 26 cases in South Turkey among 20years.

Due to the lack of a standard case definifion and the diffuculty in estabilishing a definitive diagnsos, TB in children needs increasing attention by physicians caring for pediatric patients. Tuberculous meningitis (TBM) is the most serious form of extrapulmonary tuberculosis that is associated with significant morbidity and mortality rate in the pediatric age group, especially in infants. This descriptive study was conducted in an University hospital, at the South of Turkey, from May 1999 to May 2019. The hospital records of 26 TBM infant that was diagnosed at our hospital were retrospectively evaluated. The epidemiological findings (age, gender, family history of TB, tuberculin skin test results, status of BCG scaring), stage of TBM at admission and clinical, laboratory and radiological features were collected. Of the 26 infants, 61.5% were male and mean age of the patients was 7,65±2,6 (range, 3-12 months). The history of close contact with an infected adult was encountered in 73.1% (19 infant) of the cases. Only 69.2% of the patients (18 case) had a BCG scar. The prodromal stage (period between the onset of symptoms to hospital admission) ranged from 4 days to 180 days (39±51.3). 2 cases were defined as stage I, 10 cases as stage II and 14 cases as stage III TBM. Only two patients were initially positive for PPD test. While no neurological findings were found in 2 patients (diagnosed as stage I), neurologic findings at the time of admission included increased intracranial pressure; alteration in consciousness (92.3%), seizures (88.4%), vomiting (61.5%) cranial nerve palsy (23%), irritability 19.2%, hemiplegia 15.3% and meningeal signs (7%, only 2 patients). The presence of hepatomegaly 26.9 % and/or splenomegaly 11.5 % and/or extrapulmonary lymphadenopathy 3.8 % in nearly half of the cases suggested that totally 42,2% of cases had disseminated of tuberculosis. On admission, 46.1% of the patients were noted to have hyponatremia. Microbiologic confirmation was established in eleven (42.3%) of the 26 infant. A positive CSF culture for Mtb and/or smear for AFB and/or PCR was obtained in only 5 (19.2%) patients, whereas 3 of the cases had accompaining gastric aspirate examination positivity. Pulmonary consolidation in 14 (53.8%) patients, miliary patern in 10 (41.6%) and pulmonary hilar lymphadenopathy in only 5 (20.8%) patients. 23 (88.4 %) had hydrocephalus, 15 (57.6 %) infarction, 10 (38.4 %) basilar meningitis and 9 (34.6%) tuberculomas. Empiric anti-tuberculosis treatment was instituted in all, at a median of 3 days (range 1-15 days) following admission. 8 (30.7%) died, 3 (11.5%) recovered completely, and 15 (57.6%) recovered with sequelae. 12 case (2 died) of the infants had required ventriculoperitoneal shunting. As early diagnosis and specific treatment appears to prevent serious complications and reduce mortality, a high index of suspicion among pediatricians is especially required in an infant with an atypical picture suggestive of tuberculosis infection.

50 Years Ago in TheJournalofPediatrics: Neonatal Septicemia

Gotoff SP, Behrman RE. J Pediatr 1970;76:142-53. Gotoff and Behrman defined neonatal septicemia as generalized bacterial infection documented by positive blood culture in the first 4 weeks of life; it was categorized as early-onset sepsis (EOS) and late-onset sepsis (LOS; after 72 hours). A presumptive diagnosis was based on clinical evidence. Infected amniotic fluid was a major source of neonatal septicemia. The most common organisms causing EOS were Escherichia coli, Streptococcus faecalis, and Staphylococcus aureus; beta hemolytic streptococci were also reported. Organisms isolated in LOS included Pseudomonas, Proteus, Klebsiella-Aerobacter, and S aureus. First-line antibiotic therapy for EOS and LOS were ampicillin plus kanamycin and methicillin/oxacillin plus kanamycin, respectively, for 7-10 days. Whole blood as a plasma expander, injection sodium bicarbonate injection, and glucose infusion were being given for shock. Hydrocortisone injection and isoproterenol infusion as vasopressors were indicated in nonresponders. Intravascular coagulation was managed with fresh heparinized whole blood and heparin injection. Fifty years later, neonatal sepsis remains the third-leading global cause of death under age 5 years. The subdivision into EOS and LOS is now universally accepted. The major causative organisms for EOS in developed countries are group B streptococci and E coli. More than 50% of cases of LOS are caused by coagulase-negative staphylococci (CONS), and the remainder are caused by gram-negative organisms. In developing countries, common organisms causing neonatal sepsis include S aureus, E coli, and Klebsiella species. Absolute neutrophil count, C-reactive protein, and procalcitonin are increasingly being used to support the diagnosis. Urine culture, gastric aspirate examination, and body surface cultures are not routinely recommended. Today, first-line antibiotics for EOS are ampicillin/benzyl penicillin plus aminoglycoside (gentamicin) for 7-10 days. For LOS, combinations of third-generation cephalosporins plus aminoglycoside, ampicillin plus gentamicin, or vancomycin/flucloxacillin plus gentamicin/cefotaxime are recommended, based on local resistance patterns and whether hospital-acquired or community-acquired.1World Health Organization Antibiotic use for sepsis in neonates and children: 2016 evidence update.https://www.who.int/selection_medicines/committees/expert/21/applications/s6_paed_antibiotics_appendix4_sepsis.pdfDate accessed: July 6, 2019Google Scholar, 2Clinical Excellence CommissionNewborn antibiotic guideline for early- and late-onset sepsis during birth episode of care.http://www.cec.health.nsw.gov.au/data/assets/pdf_file/0009/348597/Newborn-Antibiotic-Guide∼or-early-and-late-onset-sepsis-during-birth-episode-of-care-Revised-June-2018.pdfDate: 2018Date accessed: July 3, 2019Google Scholar Treatment is given for 7-10 days except for meningitis, which is treated for 21 days. Fresh-frozen plasma is recommended for intravascular coagulation. Newer therapies in the pipeline include immunoglobulins, colony-stimulating factors, anti–tumor necrosis factor, and interleukin antagonists.

Prospective study to find out the role of gastric aspirate examination by Ziehl-Neelsen staining (ZN staining) and cartridge based nucleic acid amplification test (CB-NAAT) as a diagnostic method in childhood tuberculosis

Background: Tuberculosis in children has been relatively neglected mainly because clinical diagnosis has low specificity, radiological interpretation is subject to inter-observer variability and the tuberculin skin test is a marker of exposure, not disease. The recent introduction of Cartridge based nucleic acid amplification test has significantly transformed the diagnostics of tuberculosis in adults but its application for Paediatric Tuberculosis is under evaluation. Therefore, authors conducted a study on role of gastric aspirate examination by ZN stain and Cartridge based nucleic acid amplification test in the diagnosis of childhood Tuberculosis.Methods: Authors did a prospective hospital-based study from Nov 2016 to Nov 2017 consisting of 100 randomly selected patients suspected of tuberculosis who had their gastric aspirate tested for CBNAAT and ZN stain for acid fast bacilli (AFB) along with Mantoux test and other routine investigations. Chi square test was used.Results: Culture positive tuberculosis was found in 21 out of 100 children. The sensitivity, specificity, positive predictive value and negative predictive value for CBNAAT were 76.1%, 98.7%, 94.1% and 93.9% and for ZN stain were 47.6%, 98.7%, 90.9% and 87.6% respectively. Positive history of contact (p value 0.0217), reactive Mantoux test (p value < 0.001) and low socioeconomic status were independently associated with a positive CBNAAT result.Conclusions: Analysis of gastric aspirate samples with CBNAAT is a sensitive and specific method for rapid diagnosis of pulmonary tuberculosis in children who cannot produce sputum. Compared with microscopy, CBNAAT offers better sensitivity and its scale up will improve access to tuberculosis diagnostics in children.

Clinical characteristics in non-symptomatic infants with tuberculosis whose diagnostic clue was regular tuberculin skin test prior to BCG vaccination

Tuberculin skin test (TST) is a useful tool to find non-symptomatic infants with tuberculosis. In 2005, Japanese government starts direct BCG vaccination without prior TST, and we may miss one of the chances to find the above patients. In this study, we tried to find if there is any clinical examination to find non-symptomatic infants with tuberculosis instead of regular TST. We found out 20 non-symptomatic infants with tuberculosis among 131 infants who referred to our clinic because of positive TST prior to BCG vaccination from 1996 to 2003. We examined the data of gastric aspirate examination for Mycobacterium tuberculosis, complete blood counts, and serum chemistries in the 20 infants with tuberculosis. We also tried to find out the source of tuberculosis of these patients by the contact investigation. Induration of TST among 20 non-symptomatic infants with tuberculosis were 7 to 26 (median, 13.5) mm. Mycobacterium tuberculosis from gastric aspirates was positive in 13 infants (65%). The level of blood hemoglobin was more than 11 g/dl in all infants. The white blood cell count was increased in 6 infants (30%), and exaggerated lymphocyte predominance was recognized in 8 infants (40%). Serum CRP was normal, or subtly increased. Serum GOT (AST) was increased in 15 infants (75%), though the reason was unknown. Serum albumin was normal in all the infants. In the contact investigation, suspected sources were found in 11 infants (55%), and 6 out of 11 sources (55%) were their mothers. Nine sources did not belong to the risk groups for tuberculosis except two mothers coming from tuberculosis epidemic countries. In 20 non-symptomatic infants with tuberculosis, examination of gastric aspirate for Mycobacterium tuberculosis, TST, and chest imaging were useful tools to diagnose tuberculosis. However, these examinations are not done in non-symptomatic infants. Eleven family members who might infect the infants were found by the contact investigations, and none of them realized that they have tuberculosis. Our study suggests that there is no realistic clue to find non-symptomatic infants with tuberculosis instead of regular TST, and that the control of infant's tuberculosis still depends on the examination of close contacts of sporadic adult patients with tuberculosis.

Diagnostic value of gastric aspirate smear and polymerase chain reaction in smear-negative pulmonary tuberculosis.

The aim of this study was to determine the validity of acid-fast bacilli (AFB) smear and polymerase chain reaction (PCR) from gastric aspirates for the diagnosis of smear-negative pulmonary tuberculosis. A cross-sectional study was conducted in a university hospital. One hundred and nine patients with suspected pulmonary tuberculosis in whom either sputum smears were negative or who were not producing sputum were recruited to the study. All patients underwent gastric aspiration after an overnight fast followed by standard fibreoptic bronchoscopy. Specimens were subjected to AFB smear, culture, and pathological examination. PCR was performed on culture filtrate after 1 week of incubation. Eight patients did not complete the follow-up schedule. Of the 101 patients with final outcomes, a diagnosis of pulmonary tuberculosis from microbiological evidence was established in 54 patients. The gastric aspirate smear, PCR, or either one of them was positive in 34, 30, and 39 tuberculosis patients, respectively. There were 13 false positive smears from 47 non-tuberculosis patients, with five resulting from non-tuberculous mycobacteria (NTM). The PCR was falsely positive in eight patients, five of whom had previous histories of tuberculosis. The overall sensitivity, specificity, positive predictive value, and negative predictive value of gastric aspirate examination by combined smear and PCR were 72, 58, 66, and 64%, respectively. Gastric aspiration is a useful tool for the diagnosis of smear-negative pulmonary tuberculosis warranting institution of antituberculosis treatment. Interpretation of the results should be cautious in those who have had tuberculosis in the past or who have been at risk for acquisition of NTM.

Sepsis and hypothermia in the newborn infant: Value of gastric aspirate examination

Bacteriologic examination of blood, urine, CSF, and gastric aspirate was performed in 88 babies admitted with hypothermia (rectal temperature less than 35 degrees C) during the neonatal period. Infection was common in infants older than 3 days (late-onset hypothermia). In 36 of the 44 (81.8%) infected babies, the gastric aspirate was abnormal, whereas it was abnormal in only three of the 23 (13%) not infected. Infection was much less common in babies younger than 3 days (early-onset hypothermia), and in these the gastric aspirate was mostly normal. Two babies had RDS-like symptoms, and streptococci were cultured from the gastric aspirate. Examination of the gastric aspirate is a quick, efficient method of diagnosing severe infection, not only immediately after birth but throughout the neonatal period.