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Safety and diagnostic yield of endobronchial ultrasound-guided lymph node biopsy in children and adolescents with suspected tuberculosis
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  • Michael Barker,
  • Annette Günther,
  • Henrik Wurps,
  • Andreas Gebhardt,
  • Nicolas Schönfeld,
  • Silke Polsfuss,
  • Torsten Bauer
Michael Barker
HELIOS Klinikum Emil von Behring Berlin-Zehlendorf
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Annette Günther
HELIOS Klinikum Emil von Behring Berlin-Zehlendorf
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Henrik Wurps
HELIOS Klinikum Emil von Behring Berlin-Zehlendorf
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Andreas Gebhardt
HELIOS Klinikum Emil von Behring Berlin-Zehlendorf
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Nicolas Schönfeld
HELIOS Klinikum Emil von Behring Berlin-Zehlendorf
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Silke Polsfuss
HELIOS Klinikum Emil von Behring Berlin-Zehlendorf
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Torsten Bauer
HELIOS Klinikum Emil von Behring Berlin-Zehlendorf
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Abstract

Referring to a literature review published recently in this Journal, we report a single-center case series of 45 children and adolescents (age 2-17 years) with suspected tuberculosis (TB) and negative microscopy on repeated sputum or gastric aspirate samples. All subjects underwent flexible airway endoscopy including bronchoalveolar lavage (BAL) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) without adverse events. Among 41 subjects with a final TB diagnosis, Mycobacterium tuberculosis was detected by PCR and/or culture in 20 (49% bacteriological confirmation) with 11 cases relying exclusively on results from TBNA samples. Only 7 of 17 positive culture results related to sputum (17% confirmation rate), and 9 of 17 on the combination of sputum and BAL (22%) respectively. The sampling site of a person’s first positive culture was TBNA in 13 of 17 cases (76%). Bacteriological confirmation was essential for diagnostic accuracy and tailored treatment based on individual drug susceptibility testing. We therefore recommend the inclusion of bronchoscopy and EBUS-TBNA in a comprehensive diagnostic protocol for smear-negative pediatric TB suspects.