VALUE OF BRONCHOALVEOLAR LAVAGE AND GASTRIC LAVAGE IN THE DIAGNOSIS OF PULMONARY TUBERCULOSIS IN CHILDREN

Setting: The diagnosis of pulmonary tuberculosis in children is based mainly on clinical and radiographic features because of the difficulty in bacteriologic confirmation. Objective: The aim of our study was to find out if bronchoalveolar lavage (BAL) would be better than gastric lavage for the isolation of Mycobacterium tuberculosis from paediatric patients with suspected pulmonary tuberculosis. Design: 50 children with suspected pulmonary tuberculosis at a mean age of 5.1 years (range 7 months to 12 years) were studied. Early morning gastric lavage was collected, Flexible bronchoscopy and bronchoalveolar lavage was performed under local anaesthesia after obtaining informed consent from the parents. The BAL fluid and gastric lavage specimens were subjected to smear examination for acid-fast bacilli (AFB) and culture for mycobacteria using established methods. Results: Of the 50 cases, M. tuberculosis was grown in 6 BAL samples (12%) and 16 gastric lavage samples (32%) making a total of 17 culture proven cases (34%), Out of the 6 BAL positive cases, gastric lavage was also positive in 5 cases. Conclusion: We conclude that gastric lavage is better than BAL for bacteriologic confirmation of pulmonary tuberculosis in children. The overall bacteriologic yield combining both procedures was 34% while gastric lavage alone was positive in 32% of the cases.