MODS Culture Method Beneficial in TB Diagnosis

Pediatric study supports microscopic-observation drug-susceptibility technique, gastric specimens
By Eric Metcalf
HealthDay Reporter

MONDAY, July 26 (HealthDay News) -- The microscopic-observation drug-susceptibility (MODS) culture method, using duplicate gastric-aspirate specimens, may be the best diagnostic test for pulmonary tuberculosis in high-risk children in a resource-poor setting, according to research published online July 26 in The Lancet Infectious Diseases.

Richard A. Oberhelman, M.D., of the Tulane School of Public Health and Tropical Medicine in New Orleans, and colleagues compared 218 children with suspected pulmonary tuberculosis and 238 matched healthy controls from a low-income area in Lima, Peru. Cases were categorized as moderate- or high-risk by Stegen-Toledo score. Researchers examined two specimens of gastric aspirate, nasopharyngeal aspirate, and stool from each case using a variety of methods, including the MODS technique.

The researchers found that 22 cases had at least one positive Mycobacterium tuberculosis culture based on combined MODS and Lowenstein-Jensen results. M. tuberculosis was isolated from gastric specimens in all cases, nasopharyngeal specimens in 12 cases, and stool in four cases. MODS was more sensitive (90.9 versus 59.1 percent) -- and was associated with faster M. tuberculosis isolation (mean 10 versus 25 days) -- than Lowenstein-Jensen culture.

"Collection of duplicate gastric-aspirate specimens from high-risk children for MODS culture was the best available diagnostic test for pulmonary tuberculosis. PCR was insufficiently sensitive or specific for routine diagnostic use, but in high-risk children, duplicate gastric aspirate PCR provided same-day identification of half of all culture-positive cases," the authors write.

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