Abstract
BackgroundTuberculosis (TB) is a major cause of childhood morbidity and mortality in developing countries. One of the main difficulties is obtaining adequate specimens for bacteriological confirmation of the disease in children.The aim of this study is to evaluate the adequacy of fine-needle aspiration (FNA) for the diagnosis of TB.MethodsIn a prospective study conducted at the paediatric hospital in Bangui in 2007–2009, we used fine-needle aspiration to obtain samples for diagnosis of TB from 131 children aged 0–17 years with persistent lymphadenitis.ResultsFine-needle aspiration provided samples that could be used for bacteriological confirmation of TB. Ziehl-Neelsen staining for acid-fast bacilli was positive in 42.7% of samples, and culture identified TB in 67.2% of cases. Of 75 samples that were stain-negative, 49 (65.3%) were culture-positive, while 12 stain-positive samples remained culture-negative. Ten of the 12 stain-positive, culture-negative samples were from patients who had received previous antimicrobial therapy. With regard to phenotypic drug susceptibility, 81/88 strains (91.1%) were fully susceptible to isoniazid, rifampicin, ethambutol and streptomycin, six (6.8%) were resistant to one drug, and one multidrug-resistant strain was found.ConclusionsFine-needle aspiration is simple, cost-effective and non-invasive and can be performed by trained staff. Combined with rapid molecular diagnostic tests, fine-needle aspirates could improve the diagnosis of TB and provide valuable information for appropriate treatment and drug resistance.
Highlights
Tuberculosis (TB) is a major cause of childhood morbidity and mortality in developing countries
The World Health Organization (WHO) estimates of TB incidence are based on sputum smear-positive cases, but more than 80% of children with TB are sputum smear-negative, and extrapulmonary
Fine-needle aspirates showed that lymphadenitis was common among cases of extrapulmonary TB
Summary
Tuberculosis (TB) is a major cause of childhood morbidity and mortality in developing countries. The aim of this study is to evaluate the adequacy of fine-needle aspiration (FNA) for the diagnosis of TB. Accurate figures on the prevalence of paediatric TB are not available because the health information systems in endemic countries are inadequate and limited attention is paid to children, who contribute little to TB transmission in affected communities. The World Health Organization (WHO) estimates of TB incidence are based on sputum smear-positive cases, but more than 80% of children with TB are sputum smear-negative, and extrapulmonary. Like most sub-Saharan countries, the Central African Republic (CAR) pays a heavy price in terms of TB morbidity and mortality, with an annual incidence of all forms of TB estimated in 2009 at 345 per 100 000 [4] and a death rate of 113 per 100 000 inhabitants [5]. Fine-needle aspirates showed that lymphadenitis was common among cases of extrapulmonary TB
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