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.