EBUS-TBNA in a paediatric population in London

Tuberculosis (TB) is a leading cause of death and morbidity worldwide. Of the 10 million incidence cases of TB estimated in 2017, 10% were in children.The diagnosis of TB in the paediatric population remains challenging due to the paucibacillary nature of the disease. Culture confirmation is low for both pulmonary and extrapulmonary disease; 30.3% and 19.4% respectively resulting in empiric treatment for presumed TB. Mediastinal TB is a common presentation of TB in children but difficult to access for sampling.A retrospective case review of all children (<16 years) with mediastinal/hilar lymphadenopathy who underwent an EBUS-TBNA between January 2010-2018 with a potential diagnosis of TB in a London TB centre were reviewed. There were 8 cases in total all performed under sedation with no reported complications. 75% cases showing granulomas on rapid on-site histological evaluation. All 8 cases were confirmed to have mycobacterium tuberculosis from EBUS samples. 7/8 cases were culture positive with a mean time for culture results at 13.3 days. 4/7 culture positive cases were smear positive. TB PCR picked up 1 further case where microscopy and culture remained negative. 1 case had multidrug resistant TB which was immediately identified on TB PCR allowing early initiation of correct drug therapy.In our cohort we show EBUS-TBNA is a safe and effective way of investigating TB lymphadenitis in children. It is essential that in a high resource setting we approach childhood TB with...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Tuberculosis Source Type: research