The effectiveness of broncho-alveolar lavage for the pathogen detection in children with pulmonary tuberculosis

Diagnosis and treatment for pulmonary tuberculosis (TB) among children and adolescents is difficult without pathogen identification. <b>Objective:</b> To define the effectiveness of Mycobacteria tuberculosis (MTB) detection via broncho-alveolar lavage fluid (BALF) assay among children and adolescents with pulmonary TB. <b>Methods:</b> 35 patients with pulmonary TB were examined: 12 - at the age of 3-7 years, 5 - 8-13 years and 18 - 14-17 years. All of them were MTB culture negative and had negative rapid molecular tests (RMT) results for MBT from sputum samples or were unable to produce sputum. BAL from the affected area was performed via bronchoscopy. Depending on the age, the total volume of the administered saline solution varied from 15 ml (for 3-4-year-olds) to 80 ml (for 15-17-year-olds). MTB detection in BALF was performed via RMT, liquid culture testing ("BACTEC MGIT 960") and smear microscopy (SM). <b>Results:</b> MTB were detected in the BALF via SM in 3/35 (8.6%) patients. 4/35 (11.4%) - were MTB culture positive from BALF. The most effective method was RMT. MTB DNA was detected in 21/35 (60.0%): among aged 3-7 years - in 4/12 (33.3%), 8-13 years - in 4/5 (80%), 14-17 years - in 13/18 (72.2%). 3/21 (14,3%) (11, 15, 15 years old) children were diagnosed with multidrug-resistant TB. All 4 culture positive patients had also positive RMT results from BALF samples, in 2 cases positive results were obtained by all three methods. <b>Conclusions:</b> BAL improves the effectiveness of MBT detection in children and adolescents with pulmonary TB without MTB positive sputum samples by 60 % (95%CI: 43.6 -74.5) Wilson9s method) due to RMT. Depending on the age, the effectiveness ranges from 33.3% to 80%.