Diagnosis of clinically suspected and unsuspected tubercular lymphadenopathy by cytology, culture, and smear microscopy

Abstract

BackgroundTubercular lymphadenopathy (TBLN) accounts for 20–40% cases of extrapulmonary tuberculosis. But the common presenting symptoms of tuberculosis like fever, cough, weight loss, fatigue, and night sweats are not always associated with tuberculosis lymphadenopathy, thereby, making its diagnosis difficult. Our aim was to study if Fine Needle Aspiration Cytology (FNAC) combined with Zeihl Neelsen stain and culture for Mycobacterium tuberculosis bacilli could improve the diagnostic accuracy in patients clinically suspected and unsuspected for tubercular lymphadenitis. MethodsThe study was conducted at Department of Pathology, Acharya Vinoba Bhave Rural Hospital, Jawaharlal Nehru medical College, Wardha, India. One hundred and twenty-nine patients with enlarged lymph node for more than two weeks duration were evaluated. All the patients were subjected to cytology, smear, and culture examination of their lymph node aspirate. ResultsAge range for the patients was from 1 to 74 years (mean 30.49±16.69) and F:M ratio was 1:1.18. Most common site of involvement was cervical lymph node. 48 patients were diagnosed as TBLN, out of which 19 patients had no associated symptoms and 28 patients had one or more presenting symptoms of tuberculosis. Fever was the most common presenting symptoms. Pediatric age group patients were more commonly associated with symptoms than adults (p value=0.000). Culture and ZN stain were positive in 32 and 10 cases respectively among TBLN. Additionally, culture was positive in 20 patients diagnosed as reactive lymphoid hyperplasia. ConclusionCytology combined with culture improves the diagnostic accuracy in cases with enlarged lymph nodes, suspected or unsuspected for tuberculosis.