@article{daa7e1015a004e73a4857a2e41accd2e,
title = "Microscopic analysis and quality assessment of induced sputum from children with pneumonia in the PERCH study",
abstract = "Background. It is standard practice for laboratories to assess the cellular quality of expectorated sputum specimens to check that they originated from the lower respiratory tract. The presence of low numbers of squamous epithelial cells (SECs) and high numbers of polymorphonuclear (PMN) cells are regarded as indicative of a lower respiratory tract specimen. However, these quality ratings have never been evaluated for induced sputum specimens from children with suspected pneumonia. Methods. We evaluated induced sputum Gram stain smears and cultures from hospitalized children aged 1-59 months enrolled in a large study of community-acquired pneumonia. We hypothesized that a specimen representative of the lower respiratory tract will contain smaller quantities of oropharyngeal flora and be more likely to have a predominance of potential pathogens compared to a specimen containing mainly saliva. The prevalence of potential pathogens cultured from induced sputum specimens and quantity of oropharyngeal flora were compared for different quantities of SECs and PMNs. Results. Of 3772 induced sputum specimens, 2608 (69%) had <10 SECs per low-power field (LPF) and 2350 (62%) had >25 PMNs per LPF, measures traditionally associated with specimens from the lower respiratory tract in adults. Using isolation of low quantities of oropharyngeal flora and higher prevalence of potential pathogens as markers of higher quality, <10 SECs per LPF (but not >25 PMNs per LPF) was the microscopic variable most associated with high quality of induced sputum. Conclusions. Quantity of SECs may be a useful quality measure of induced sputum from young children with pneumonia.",
keywords = "Children, Induced sputum, Pneumonia, Quality",
author = "{PERCH Study Group} and Murdoch, {David R.} and Morpeth, {Susan C.} and Hammitt, {Laura L.} and Driscoll, {Amanda J.} and Watson, {Nora L.} and Baggett, {Henry C.} and Brooks, {W. Abdullah} and Knoll, {Maria Deloria} and Feikin, {Daniel R.} and Kotloff, {Karen L.} and Levine, {Orin S.} and Madhi, {Shabir A.} and O'Brien, {Katherine L.} and Scott, {J. Anthony G.} and Thea, {Donald M.} and Dilruba Ahmed and Awori, {Juliet O.} and DeLuca, {Andrea N.} and Ebruke, {Bernard E.} and Higdon, {Melissa M.} and Possawat Jorakate and Karron, {Ruth A.} and Sidi Kazungu and Geoffrey Kwenda and Lokman Hossain and Sirirat Makprasert and Moore, {David P.} and Azwifarwi Mudau and John Mwaba and Sandra Panchalingam and Park, {Daniel E.} and Christine Prosperi and Rasheed Salaudeen and Aliou Toure and Zeger, {Scott L.} and Howie, {Stephen R.C.} and Nicholas Fancourt and Wei Fu and Kagucia, {E. Wangeci} and Mengying Li and Zhenke Wu and Jane Crawley and Endtz, {Hubert P.} and Khalequ Zaman and Doli Goswami and Yasmin Jahan and Hasan Ashraf and Martin Antonio and Jessica McLellan and Eunice Machuka",
note = "Funding Information: Supplement sponsorship. This article appears as part of the supplement “Pneumonia Etiology Research for Child Health (PERCH): Foundational Basis for the Primary Etiology Results,” sponsored by a grant from the Bill & Melinda Gates Foundation to the PERCH study of Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Funding Information: Financial support. PERCH was supported by the Bill & Melinda Gates Foundation (grant number 48968 to the International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health). J. A. G. S. was supported by a clinical fellowship from The Wellcome Trust of Great Britain (award number 098532). Publisher Copyright: {\textcopyright} The Author 2017.",
year = "2017",
doi = "10.1093/cid/cix083",
language = "English (US)",
volume = "64",
pages = "S271--S279",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
}