Optimizing the recovery rate of Mycobacterium species from gastric lavages in children at an urban Zambian hospital

Tuberculosis (TB) has re-emerged as a major worldwide public health hazard with increasing incidence among adults and children. Although cases among children represent a small percentage of all TB cases, they are a reservoir from which many adult cases will arise. Estimates indicate that 9 million people develop TB annually, out of which 1 million (11 percent) occur in children less than 15 years old. Childhood tuberculosis is on the increase worldwide because of persisting inability to conform the diagnosis, leading to a large number of children dying of undiagnosed tuberculosis. Diagnosis of pulmonary tuberculosis has depended on bacteriological examination of sputum. In most of the developing countries sputum smear microscopy has been used as it has been found to be cheap and relative efficient. As a result of the high TB burden, there is an urgent need for improved methods of laboratory diagnosis of TB. This is especially needed in children were diagnosis is more challenging as mycobacteria is being detected in fewer than 50 percent of the cases. Children cannot produce adequate sputum samples for examination. Their sputum samples, if produced, has a low bacterial yield and making detection of mycobacteria by using the smear microscopy difficult. Therefore, gastric lavages from children are being recommended as the best specimen for culture. In this study, gastric lavages from 408 children suspected of having tuberculosis were examined for the recovery of mycobacteria. Recovery was optimized by the use of the relatively new non-radiometric fully automated BACTEC MGIT 960. BACTEC MGIT 960 produced a positivity rate of 27.2 percent against 17.2 percent that of Lowenstein-Jensen (L-J) media, which is a conventional culture method used widely. The direct microscopy which is the cheapest traditional method used in diagnosis of tuberculosis (TB) yielded a 5.6 percent positive rate. The BACTEC MGIT 960 had also a very high isolate detection rate of 98.2 percent compared to that of L-J media of 61.9 percent, and only 20.4 percent were detected with the direct microscopy. On time taken to detection or mean time to detection (TTD) of v isolates, the BACTEC MGIT 960 technique had a shorter mean time to detection, 12.5 days as compared to 34.3 days shown by the L-J media technique. The study showed that children normally get tuberculosis from adult members of the household. A positive TB case was found in the households of 55.4 percent of the suspects. The study has found that 46.4 percent of the children below the age of 4 years developed the disease, compared to 10.5 percent the older children in the age group 10 to 14 years. The study found that tuberculosis in children is mainly caused by Mycobacterium tuberculosis. Out of the 113 isolates detected, 110 (97.3 percent) were M. tuberculosis. The remaining 2.7 percent were the non-tuberculous M. avium complex and M. kansasii. It was inconclusive whether the 2.7 percent of other species were causing tuberculosis and this need to be studied furthe