La cuerda dulce - a tolerability and acceptability study of a novel approach to specimen collection for diagnosis of paediatric pulmonary tuberculosis
Author(s)
Type
Journal Article
Abstract
Background: Recent data demonstrate the utility of the string test for the diagnosis of sputumscarce
HIV-associated TB in adults. We hypothesized that, if well-tolerated by children, this simple
tool might offer a breakthrough in paediatric TB diagnosis. Thus the objective of this study,
undertaken in the paediatric service of the Hospital Nacional Dos de Mayo, Lima, Perú, was to
determine the tolerability and acceptability of the string test to paediatric TB suspects, their
parents and nursing staff.
Methods: 22 paediatric subjects aged 3–14 years (median 8) under investigation for TB were
invited to undergo 2 string tests (four-hour downtime each). Subjective and objective pain and
discomfort rating scales were used to assess the perception of the subject, parent and attending
nurse.
Results: Patients as young as 4 years tolerated the procedure extremely well with 84% willing to
undergo a second procedure. Peak discomfort at the time of swallowing and of string retrieval was
mild (30% of maximum possible score) and brief as judged by visual analogue ratings and objective
indicators. Good concordance of parent/child and objective/subjective ratings strengthened the
validity of these findings.
Conclusion: The string test is well tolerated and achievable for most paediatric TB suspects as
young as 4 years. A formal prospective paediatric efficacy study is now needed.
HIV-associated TB in adults. We hypothesized that, if well-tolerated by children, this simple
tool might offer a breakthrough in paediatric TB diagnosis. Thus the objective of this study,
undertaken in the paediatric service of the Hospital Nacional Dos de Mayo, Lima, Perú, was to
determine the tolerability and acceptability of the string test to paediatric TB suspects, their
parents and nursing staff.
Methods: 22 paediatric subjects aged 3–14 years (median 8) under investigation for TB were
invited to undergo 2 string tests (four-hour downtime each). Subjective and objective pain and
discomfort rating scales were used to assess the perception of the subject, parent and attending
nurse.
Results: Patients as young as 4 years tolerated the procedure extremely well with 84% willing to
undergo a second procedure. Peak discomfort at the time of swallowing and of string retrieval was
mild (30% of maximum possible score) and brief as judged by visual analogue ratings and objective
indicators. Good concordance of parent/child and objective/subjective ratings strengthened the
validity of these findings.
Conclusion: The string test is well tolerated and achievable for most paediatric TB suspects as
young as 4 years. A formal prospective paediatric efficacy study is now needed.
Date Issued
2006-04-04
Date Acceptance
2006-04-04
Citation
BMC Infectious Diseases, 2006, 6
ISSN
1471-2334
Publisher
BioMed Central
Journal / Book Title
BMC Infectious Diseases
Volume
6
Copyright Statement
© 2006 Chow et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Subjects
Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
INFECTIOUS DISEASES
DRUG SUSCEPTIBILITY ASSAY
MYCOBACTERIUM-TUBERCULOSIS
STRING TEST
MICROSCOPIC OBSERVATION
BRONCHOALVEOLAR LAVAGE
CHILDHOOD TUBERCULOSIS
GASTRIC LAVAGE
TYPHOID-FEVER
CHILDREN
SPUTUM
Publication Status
Published
Article Number
67