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\begin{document}

\title{Does multiple gastric aspirate collection increase sensitivity of M.
tuberculosis detection in children with pulmonary tuberculosis?}



\author[1]{Luisa Galli}%
\author[1]{Elisabetta Venturini}%
\author[1]{Barbara Bortone}%
\author[1]{Gianmaria Cini}%
\author[1]{Jacopo Venanzi}%
\author[2]{Anna Maria Bartolesi}%
\author[2]{Guendalina Vaggelli}%
\author[3]{Sandra Trapani}%
\author[3]{Giuseppe Indolfi}%
\author[1]{Leila Bianchi}%
\author[1]{Carlotta Montagnani}%
\author[1]{Elena Chiappini}%
\author[2]{Gian Maria Rossolini}%
\affil[1]{Azienda Ospedaliero Universitaria Meyer}%
\affil[2]{Azienda Ospedaliero Universitaria Careggi}%
\affil[3]{Universita degli Studi di Firenze}%


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  \date{May 16, 2024}


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\begin{abstract}
\emph{Objectives} \emph{.}~This study aims to investigate the
sensitivity of microscopy, culture and polymerase chain reaction on
three gastric aspirates (GAs) in the microbiological confirmation of
active pulmonary tuberculosis (TB) and to identify possible changes in
sensitivity derived from the collection of a different number of
aspirates.~ \emph{Methods.} \textbf{~}Children with clinical and
radiological diagnoses of active pulmonary TB who underwent three GAs
between March 2007 and June 2019 were retrospectively evaluated.
Clinical, radiological, and microbiological data were collected. The
sensitivity of microbiological tests on GAs was calculated. Moreover,
differences in sensitivity according to age and radiological pattern
were investigated. \emph{Results.} \textbf{~}Overall, 156 children with
active pulmonary TB were enrolled with a median age of 51.5 (IQR:
25.2--113.2) months. Microbiological investigations on the first GA
showed~a sensitivity of 34\% (95\%CI 26.7, 42), the cumulative
sensitivity of first and second GAs was 40.4\% (95\%CI 32.7, 48.5) and
of the three GAs was 47.4\% (95\%CI 39.8, 55.2).~The collection of three
GAs leads to an overall increase in sensitivity of the first GA by
13.4\% (95\%CI 2.8, 24.1\%; p=0.014). Moreover, the increase in
sensitivity was significantly higher in children~ \textless{}~4 years of
age~and in those~with uncomplicated TB (p=0.008).~ \emph{Conclusions.}
\textbf{~}Performing a higher number of GAs increases the sensitivity~of
microbiological confirmation of active pulmonary TB, particularly in
children [?] 4 years and with an uncomplicated radiological pattern.%
\end{abstract}%



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\textbf{Hosted file}

\verb`manuscript 03.10.22.doc`  available at \url{https://authorea.com/users/328556/articles/589044-does-multiple-gastric-aspirate-collection-increase-sensitivity-of-m-tuberculosis-detection-in-children-with-pulmonary-tuberculosis}

\textbf{Hosted file}

\verb`Figure 1.doc`  available at \url{https://authorea.com/users/328556/articles/589044-does-multiple-gastric-aspirate-collection-increase-sensitivity-of-m-tuberculosis-detection-in-children-with-pulmonary-tuberculosis}

\textbf{Hosted file}

\verb`Figure 2.docx`  available at \url{https://authorea.com/users/328556/articles/589044-does-multiple-gastric-aspirate-collection-increase-sensitivity-of-m-tuberculosis-detection-in-children-with-pulmonary-tuberculosis}

\textbf{Hosted file}

\verb`Figure 3.docx`  available at \url{https://authorea.com/users/328556/articles/589044-does-multiple-gastric-aspirate-collection-increase-sensitivity-of-m-tuberculosis-detection-in-children-with-pulmonary-tuberculosis}

\textbf{Hosted file}

\verb`Table 1.doc`  available at \url{https://authorea.com/users/328556/articles/589044-does-multiple-gastric-aspirate-collection-increase-sensitivity-of-m-tuberculosis-detection-in-children-with-pulmonary-tuberculosis}

\textbf{Hosted file}

\verb`Table 2.doc`  available at \url{https://authorea.com/users/328556/articles/589044-does-multiple-gastric-aspirate-collection-increase-sensitivity-of-m-tuberculosis-detection-in-children-with-pulmonary-tuberculosis}

\textbf{Hosted file}

\verb`Table 3.doc`  available at \url{https://authorea.com/users/328556/articles/589044-does-multiple-gastric-aspirate-collection-increase-sensitivity-of-m-tuberculosis-detection-in-children-with-pulmonary-tuberculosis}

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