Abstract
BackgroundTuberculous lymphadenitis (TBLN) diagnosis has been a true challenge solely by clinical evidence in developing countries, due to limited the diagnostic facility on hand. However, the availability and affordability of available diagnostic tools in resource-limited settings like Ethiopia necessitates the quest for other techniques with added value over direct Z-N microscopy. Therefore, we aimed at to assess whether the concentration of lymph node aspirate similarly improves the detection rate of tuberculous lymphadenitis or not.Materials and methodsA cross-sectional study design was conducted on 132 individual subjects presumptive for tuberculous lymphadenitis from February to October 2013 in Addis Ababa, Ethiopia. Fine needle aspirate (FNA) samples were collected from the cases and cultured on Löwenstein-Jensen (LJ) slants. Identification of species and strains of mycobacteria was made by region of difference (RD) based polymerase chain reaction (PCR). Data entry and statistical analyses were performed by SPSS version 20. The confidence level of 95% was used for statistical significance.ResultA total of 132 study subjects were included in our study. Of these 56.1% (74/132) were positive for M. tuberculosis on culture. The detection rate of direct smear microscopy and the concentration method were 29.5 and 65.2% respectively. The sensitivity of direct smear microscopy was 43.2%, for concentrated smear microscopy 94.5%, for PCR 93.2% and for cytomorphology 95.4%. The level of agreement of concentrated ZN smear microscopy was 0.62 which was very similar with kappa of 0.58 of molecular (PCR) technique. AFB positivity by the concentration method and molecular method was increased in caseous aspirates as compared to purulent and hemorrhagic aspirates though it was not statistically significant (p-value = 0.18) and (p = 0.62) respectively.ConclusionThe concentration of FNA (Fine Needle Aspirate) aspirates for acid-fast smear microscopy similarly improves the sensitivity of acid fast bacilli in diagnosing of TBLN.
Highlights
Tuberculous lymphadenitis (TBLN) diagnosis has been a true challenge solely by clinical evidence in developing countries, due to limited the diagnostic facility on hand
The concentration of Fine needle aspirate (FNA) (Fine Needle Aspirate) aspirates for acid-fast smear microscopy improves the sensitivity of acid fast bacilli in diagnosing of TBLN
The challenges are due to the significant proportion of clinical samples, a low number of bacilli in extra pulmonary tuberculosis (EPTB) specimens and their slow growth rate which reduce the sensitivity of conventional diagnostic methods [5]
Summary
Tuberculous lymphadenitis (TBLN) diagnosis has been a true challenge solely by clinical evidence in developing countries, due to limited the diagnostic facility on hand. Tuberculosis is a major public health problem in Ethiopia which ranks 7th among the 22 High Burden Tuberculosis Countries (HBTCs) and ranks 2nd EPTB cases globally [2]. In Ethiopia, extra pulmonary tuberculosis (EPTB) accounted for 34.8% of TB cases with more than 80% of cases presenting as Tuberculosis lymphadenitis cases [4]. Even though early case detection and treatment is one of the pillars of the TB control program, extra pulmonary tuberculosis is a significant true challenge in its different clinical presentation. The challenges are due to the significant proportion of clinical samples, a low number of bacilli in EPTB specimens and their slow growth rate which reduce the sensitivity of conventional diagnostic methods [5]
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