Diagnosis of Pediatric Pulmonary Tuberculosis by Stool PCR

Hilary Wolf Asociación Benéfica Prisma, Lima, Perú; Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Perú; Johns Hopkins Bloomberg School of Public Health, Baltimore; Faculty of Medicine, Universidad de Concepción, Concepción, Chile; Tulane School of Public Health and Tropical Medicine, Tulane, Louisiana; Wellcome Centre for Clinical Tropical Medicine and Department of Infectious Diseases and Immunity; Imperial College London Hammersmith Hospital Campus, London, United Kingdom

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Melissa Mendez Asociación Benéfica Prisma, Lima, Perú; Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Perú; Johns Hopkins Bloomberg School of Public Health, Baltimore; Faculty of Medicine, Universidad de Concepción, Concepción, Chile; Tulane School of Public Health and Tropical Medicine, Tulane, Louisiana; Wellcome Centre for Clinical Tropical Medicine and Department of Infectious Diseases and Immunity; Imperial College London Hammersmith Hospital Campus, London, United Kingdom

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Robert H. Gilman Asociación Benéfica Prisma, Lima, Perú; Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Perú; Johns Hopkins Bloomberg School of Public Health, Baltimore; Faculty of Medicine, Universidad de Concepción, Concepción, Chile; Tulane School of Public Health and Tropical Medicine, Tulane, Louisiana; Wellcome Centre for Clinical Tropical Medicine and Department of Infectious Diseases and Immunity; Imperial College London Hammersmith Hospital Campus, London, United Kingdom

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Patricia Sheen Asociación Benéfica Prisma, Lima, Perú; Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Perú; Johns Hopkins Bloomberg School of Public Health, Baltimore; Faculty of Medicine, Universidad de Concepción, Concepción, Chile; Tulane School of Public Health and Tropical Medicine, Tulane, Louisiana; Wellcome Centre for Clinical Tropical Medicine and Department of Infectious Diseases and Immunity; Imperial College London Hammersmith Hospital Campus, London, United Kingdom

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Giselle Soto Asociación Benéfica Prisma, Lima, Perú; Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Perú; Johns Hopkins Bloomberg School of Public Health, Baltimore; Faculty of Medicine, Universidad de Concepción, Concepción, Chile; Tulane School of Public Health and Tropical Medicine, Tulane, Louisiana; Wellcome Centre for Clinical Tropical Medicine and Department of Infectious Diseases and Immunity; Imperial College London Hammersmith Hospital Campus, London, United Kingdom

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Angie K. Velarde Asociación Benéfica Prisma, Lima, Perú; Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Perú; Johns Hopkins Bloomberg School of Public Health, Baltimore; Faculty of Medicine, Universidad de Concepción, Concepción, Chile; Tulane School of Public Health and Tropical Medicine, Tulane, Louisiana; Wellcome Centre for Clinical Tropical Medicine and Department of Infectious Diseases and Immunity; Imperial College London Hammersmith Hospital Campus, London, United Kingdom

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Mirko Zimic Asociación Benéfica Prisma, Lima, Perú; Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Perú; Johns Hopkins Bloomberg School of Public Health, Baltimore; Faculty of Medicine, Universidad de Concepción, Concepción, Chile; Tulane School of Public Health and Tropical Medicine, Tulane, Louisiana; Wellcome Centre for Clinical Tropical Medicine and Department of Infectious Diseases and Immunity; Imperial College London Hammersmith Hospital Campus, London, United Kingdom

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A. Roderick Escombe Asociación Benéfica Prisma, Lima, Perú; Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Perú; Johns Hopkins Bloomberg School of Public Health, Baltimore; Faculty of Medicine, Universidad de Concepción, Concepción, Chile; Tulane School of Public Health and Tropical Medicine, Tulane, Louisiana; Wellcome Centre for Clinical Tropical Medicine and Department of Infectious Diseases and Immunity; Imperial College London Hammersmith Hospital Campus, London, United Kingdom

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Sonia Montenegro Asociación Benéfica Prisma, Lima, Perú; Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Perú; Johns Hopkins Bloomberg School of Public Health, Baltimore; Faculty of Medicine, Universidad de Concepción, Concepción, Chile; Tulane School of Public Health and Tropical Medicine, Tulane, Louisiana; Wellcome Centre for Clinical Tropical Medicine and Department of Infectious Diseases and Immunity; Imperial College London Hammersmith Hospital Campus, London, United Kingdom

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Richard A. Oberhelman Asociación Benéfica Prisma, Lima, Perú; Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Perú; Johns Hopkins Bloomberg School of Public Health, Baltimore; Faculty of Medicine, Universidad de Concepción, Concepción, Chile; Tulane School of Public Health and Tropical Medicine, Tulane, Louisiana; Wellcome Centre for Clinical Tropical Medicine and Department of Infectious Diseases and Immunity; Imperial College London Hammersmith Hospital Campus, London, United Kingdom

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Carlton A. Evans Asociación Benéfica Prisma, Lima, Perú; Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Perú; Johns Hopkins Bloomberg School of Public Health, Baltimore; Faculty of Medicine, Universidad de Concepción, Concepción, Chile; Tulane School of Public Health and Tropical Medicine, Tulane, Louisiana; Wellcome Centre for Clinical Tropical Medicine and Department of Infectious Diseases and Immunity; Imperial College London Hammersmith Hospital Campus, London, United Kingdom

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Pediatric pulmonary tuberculosis diagnosis is difficult because young children are unable to expectorate sputum samples. Testing stool for tuberculosis DNA from swallowed sputum may diagnose pulmonary tuberculosis. Hospitalized children with suspected tuberculosis had stool, nasopharyngeal, and gastric aspirates cultured that confirmed pulmonary tuberculosis in 16/236 patients. Twenty-eight stored stools from these 16 children were used to evaluate stool polymerase chain reaction (PCR) for tuberculosis diagnosis compared with 28 stool samples from 23 healthy control children. Two DNA extraction techniques were used: fast-DNA mechanical homogenization and Chelex-resin chemical extraction. DNA was tested for tuberculosis DNA with a hemi-nested IS6110 PCR. PCR after Fast-DNA processing was positive for 6/16 culture-proven tuberculosis patients versus 5/16 after Chelex extraction (sensitivity 38% and 31%, respectively). All controls were negative (specificity 100%). If sensitivity can be increased, stool PCR would be a rapid, non-invasive, and relatively bio-secure initial test for children with suspected pulmonary tuberculosis.

Author Notes

Reprint requests: Carlton A Evans, Asociación Benefica PRISMA, Av Carlos Gonzales Nro 251, Urb. Maranga, San Miguel, Lima 32, Peru, E-mail: CarltonEvans@yahoo.com.
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