Comparison of Yield for Different Culture Collection Methods
Gastric aspiration is the classic method of culture collection.
Classically, three gastric aspirates are collected first thing in the morning after an
overnight fast. Traditionally, the yield is reported to be around 40%, with increased yield
in patients who are sicker, have more extensive pulmonary disease, have parenchymal
disease (rather than just intrathoracic adenopathy) and who are very young. Yields in
infants may be as high as 75%. The first gastric collected has the highest yield with 8893% of the positive results coming from the first specimen collected.
Starke JR. Taylor-Watts KT. Tuberculosis in the pediatric population of Houston, Texas. Pediatrics.
84(1):28-35, 1989
Schaaf HS. Gie RP. Kennedy M. Beyers N. Hesseling PB. Donald PR. Evaluation of young children in
contact with adult multidrug-resistant pulmonary tuberculosis: a 30-month follow-up. Pediatrics.
109(5):765-71, 2002
Kimerling ME. Vaughn ES. Dunlap NE. Childhood tuberculosis in Alabama: epidemiology of disease and
indicators of program effectiveness, 1983 to 1993. Pediatric Infectious Disease Journal. 14(8):678-84,
1995
Al-Dossary FS. Ong LT. Correa AG. Starke JR. Treatment of childhood tuberculosis with a six month
directly observed regimen of only two weeks of daily therapy. Pediatric Infectious Disease Journal.
21(2):91-7, 2002
Lobato MN. Loeffler AM. Furst K. Cole B. Hopewell PC. Detection of Mycobacterium tuberculosis in
gastric aspirates collected from children: hospitalization is not necessary. Pediatrics. 102(4):E40, 1998
Vallejo JG. Ong LT. Starke JR. Clinical features, diagnosis, and treatment of tuberculosis in infants.
Pediatrics. 94(1):1-7, 1994
Schaaf HS. Beyers N. Gie RP. Nel ED. Smuts NA. Scott FE. Donald PR. Fourie PB. Respiratory
tuberculosis in childhood: the diagnostic value of clinical features and special investigations. Pediatric
Infectious Disease Journal. 14(3):189-94, 1995
Berggren Palme I. Gudetta B. Bruchfeld J. Eriksson M. Giesecke J. Detection of Mycobacterium
tuberculosis in gastric aspirate and sputum collected from Ethiopian HIV-positive and HIV-negative
children in a mixed in- and outpatient setting. Acta Paediatrica. 93(3):311-5, 2004 Mar.
UI: 15124831
Gomez-Pastrana D. Torronteras R. Caro P. Anguita ML. Lopez-Barrio AM. Andres A. Navarro J.
Comparison of amplicor, in-house polymerase chain reaction, and conventional culture for the diagnosis
of tuberculosis in children. Clinical Infectious Diseases. 32(1):17-22, 2001
Pomputius WF 3rd. Rost J. Dennehy PH. Carter EJ. Standardization of gastric aspirate technique
improves yield in the diagnosis of tuberculosis in children. Pediatric Infectious Disease Journal.
16(2):222-6, 1997
From Pediatric TB: An Online Presentation by Ann Loeffler, MD. Produced by the Francis J. Curry National Tuberculosis Center.
Sputum induction
Sputum can be collected from even very young children by inducing cough and sputum
production with nebulized saline or bronchodilators and then asking the patient to
expectorate the sputum OR suctioning the back of the pharynx to collect sputum. The
recovery rate for sputum induction was 22% (Zar 2005), 28% (Shata 1996), and 30%
(Iriso 2005) in children suspected of having pulmonary TB.
Zar HJ. Hanslo D. Apolles P. Swingler G. Hussey G. Induced sputum versus gastric lavage for
microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study.
[erratum appears in Lancet. 2005 Jun 4-10;365(9475):1926]. Lancet. 365(9454):130-4, 2005 Jan 8-14.
Zar HJ. Tannenbaum E. Hanslo D. Hussey G. Sputum induction as a diagnostic tool for communityacquired pneumonia in infants and young children from a high HIV prevalence area. Pediatric
Pulmonology. 36(1):58-62, 2003
Zar HJ. Tannenbaum E. Apolles P. Roux P. Hanslo D. Hussey G. Sputum induction for the diagnosis of
pulmonary tuberculosis in infants and young children in an urban setting in South Africa.[see comment].
Archives of Disease in Childhood. 82(4):305-8, 2000
Shata AM. Coulter JB. Parry CM. Ching'ani G. Broadhead RL. Hart CA. Sputum induction for the
diagnosis of tuberculosis. Archives of Disease in Childhood. 74(6):535-7, 1996
Iriso R. Mudido PM. Karamagi C. Whalen C. The diagnosis of childhood tuberculosis in an HIV-endemic
setting and the use of induced sputum. International Journal of Tuberculosis & Lung Disease. 9(7):71626, 2005
BAL
Bronchoalveolar lavage (BAL) is particularly helpful in patients in whom the cause of
pulmonary disease or infection is not known. Various studies have reported M.
tuberculosis BAL yields of 4% (Bibi 2002), 10% (Abadco 1992), 12% (Somu 1995), 21%
(Norrman 1988), 22% (Singh 2000) and 43% (Petrovic 2005) from children suspected
of having pulmonary tuberculosis.
Petrovic S. [Diagnostic value of certain methods for isolation of Mycobacterium tuberculosis in children with
suspected pulmonary tuberculosis]. [Serbian] Medicinski Pregled. 58(5-6):231-5, 2005
Bibi H. Mosheyev A. Shoseyov D. Feigenbaum D. Kurzbart E. Weiller Z. Should bronchoscopy be performed in
the evaluation of suspected pediatric pulmonary tuberculosis? Chest. 122(5):1604-8, 2002
Singh M. Moosa NV. Kumar L. Sharma M. Role of gastric lavage and broncho-alveolar lavage in the
bacteriological diagnosis of childhood pulmonary tuberculosis. Indian Pediatrics. 37(9):947-51, 2000
Somu N. Swaminathan S. Paramasivan CN. Vijayasekaran D. Chandrabhooshanam A. Vijayan VK. Prabhakar
R. Value of bronchoalveolar lavage and gastric lavage in the diagnosis of pulmonary tuberculosis in children.
Tubercle & Lung Disease. 76(4):295-9, 1995
Norrman E. Keistinen T. Uddenfeldt M. Rydstrom PO. Lundgren R. Bronchoalveolar lavage is better than
gastric lavage in the diagnosis of pulmonary tuberculosis. Scandinavian Journal of Infectious Diseases.
20(1):77-80, 1988
Abadco DL. Steiner P. Gastric lavage is better than bronchoalveolar lavage for isolation of Mycobacterium
tuberculosis in childhood pulmonary tuberculosis. Pediatric Infectious Disease Journal. 11(9):735-8, 1992
From Pediatric TB: An Online Presentation by Ann Loeffler, MD. Produced by the Francis J. Curry National Tuberculosis Center.