Given the importance of trying to obtain confirmation of disease in areas of high drug-resistant TB prevalence or in contact cases of MDR-TB, optimizing the collection of appropriate specimens is critical.
Children < 6 years old, and some as old as 10 years old, may be unable or unwilling to spontaneously expectorate. Explanation and encouragement are important. Chest clapping is a simple, yet, often effective measure to help expectoration.
If these measures fail, sputum specimen can be obtained by sputum induction or gastric aspiration (Appendix 1). Given the distress caused to the child and the generally low yield on smear microscopy, these procedures should only be done if culture or Xpert MTB/RIF is available.