Michael Barker1*, Annette
Günther1, Henrik Wurps2, Andreas
Gebhardt2, Nicolas Schönfeld2, Silke
Polsfuss3, Torsten T. Bauer2
1 Dept. of Pediatrics and 2 Dept. of
Respiratory Medicine, Heckeshorn Lung Unit;3 Institute for Medical Microbiology, Immunology and
Laboratory Medicine;
Helios Klinikum Emil von Behring, Berlin, Germany
*corresponding author, contact information:
Priv.-Doz. Dr. med. Michael Barker
Haderslebener Str. 21a
12163 Berlin, Germany
Phone +49 30 23 88 13 22
Fax +49 30 81 02 42 778
E-Mail michael@barker-berlin.de
Refers to: Review by Madan et al. in Jan. 2021 issue of Pediatr
Pulmonol (ref. 2)
In part presented as free communication at the annual congress of the
German-Swiss-Austrian Society for Pediatric Pulmonology (GPP e.V.) in
March 2018
Sources of support: None
Word count: 991
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.