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Journal of Tropical Pediatrics Advance Access published online on July 26, 2006
Journal of Tropical Pediatrics, doi:10.1093/tropej/fml022
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© The Author [2006]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Original Papers

Role of Naso-Gastric Aspirate in HIV-Positive Children Presenting with Respiratory Symptoms

Talib Y. Surve 1 * and Ashok D. Rathod 1

1 The Department of Pediatrics, Grant Medical College and J.J. Hospital, Byculla, Mumbai - 400 008, India

* To whom correspondence should be addressed.
Talib Y. Surve, E-mail: talibsurve{at}rediffmail.com


  Abstract

Background: Human immunodeficiency virus (HIV) infection predisposes to various opportunistic infections like tuberculosis, Pneumocystis carinii (P. carinii) pneumonia, toxoplasmosis and fungal infections. Naso-gastric aspirate (NGA) is utilized to demonstrate acid-fast-bacilli (AFB); similarly P. carinii was isolated with the help of naso-gastric aspirate in HIV positive children.

Design: Prospective study.

Setting: Tertiary care center.

Objective: To study the role of naso-gastric aspirate in HIV positive patients presenting with respiratory symptoms.

Methods: HIV positive patients less than 5 years age (n = 35) presenting with respiratory symptoms of cough, breathlessness, feeding difficulties and/or tachypnoea were studied. Gastric aspirate was obtained on three consecutive mornings after overnight fasting. 1 volume of dithiotretiol (mucolytic agent) was added to 2 volumes of gastric aspirate. The mixture was incubated for 15 min followed by centrifugation at 1500 r.p.m. for 5 min; the supernatant was decanted. The sediment was re-suspended in phosphate buffer saline with pH of 6.8 and re-centrifuged at 1500 r.p.m. for 5 min. The final sediment was again suspended in phosphate buffer saline followed by addition of 6 drops of 30% bovine serum albumin. Smears were prepared from the sample followed by Zeihl-Neelsen stain for AFB; toluidine blue, Giemsa stain and Gomori's methenamine stain for identification of trophozoite and cyst forms of P. carinii.

Results: P. carinii organism was identified in 17 patients (48.57%) with 11 patients having only P. carinii while 6 patients having isolated both P. carinii and AFB. 1 patient had isolated only AFB. The total number of AFB isolated was 7 patients (20.0%). Pulmonary Koch was identified in 17 patients; however AFB was identified in 7 cases (a yield of 41.18%). No complications as a result of the procedure were identified in any of the patients.

Conclusion: Naso-gastric aspirate is a simple, convenient, relatively non-invasive and economical technique for identification of AFB and/or P. carinii organisms in HIV-positive patients presenting with respiratory symptoms.


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