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Does multiple gastric aspirate collection increase sensitivity of M. tuberculosis detection in children with pulmonary tuberculosis?
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  • Luisa Galli,
  • Elisabetta Venturini,
  • Barbara Bortone,
  • Gianmaria Cini,
  • Jacopo Venanzi,
  • Anna Maria Bartolesi,
  • Guendalina Vaggelli,
  • Sandra Trapani,
  • Giuseppe Indolfi,
  • Leila Bianchi,
  • Carlotta Montagnani,
  • Elena Chiappini,
  • Gian Maria Rossolini
Luisa Galli
Azienda Ospedaliero Universitaria Meyer

Corresponding Author:[email protected]

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Elisabetta Venturini
Azienda Ospedaliero Universitaria Meyer
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Barbara Bortone
Azienda Ospedaliero Universitaria Meyer
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Gianmaria Cini
Azienda Ospedaliero Universitaria Meyer
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Jacopo Venanzi
Azienda Ospedaliero Universitaria Meyer
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Anna Maria Bartolesi
Azienda Ospedaliero Universitaria Careggi
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Guendalina Vaggelli
Azienda Ospedaliero Universitaria Careggi
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Sandra Trapani
Universita degli Studi di Firenze
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Giuseppe Indolfi
Universita degli Studi di Firenze
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Leila Bianchi
Azienda Ospedaliero Universitaria Meyer
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Carlotta Montagnani
Azienda Ospedaliero Universitaria Meyer
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Elena Chiappini
Azienda Ospedaliero Universitaria Meyer
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Gian Maria Rossolini
Azienda Ospedaliero Universitaria Careggi
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Abstract

Objectives . 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.  Methods.  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. Results.  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  < 4 years of age and in those with uncomplicated TB (p=0.008).  Conclusions.  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.