Cases Of Tubercular Lymphadenitis Research Articles

ENT manifestation CCs in tuberculosis: a descriptive study

BackgroundAn attempt was made to study ENT manifestations in tuberculosis.Material and methodsA descriptive study was carried out among 200 patients with ENT manifestations of tuberculosis attending various departments at a government medical college hospital. Patients will be evaluated and followed up according to protocol. All patients diagnosed with tuberculosis were treated, according to the recent RNTCP guidelines using the CBNAAT testing.ResultsIn the present study, 66% of patients with tuberculosis of the ear, nose, and throat region were females. Seventy-five percent of patients with tuberculosis of ENT and neck region were between the age group of 11 and 40 years. Cases of tubercular lymphadenitis (89.5%), tubercular laryngitis (4.5%), tubercular otitis media (3%), TB of the oral cavity (2%), and TB of the nose (1%) were seen. Painless lymph node enlargement was found in 91.62% of cases. Lymph node enlargement, hoarseness of voice, painless profuse otorrhoea, hearing loss, nasal obstruction, rhinorrhea, odynophagia, ulcers in the oral cavity, and tonsil enlargement were seen in patients of respective ENT tuberculosis. Concomitant pulmonary TB was found in 8.37% of cases of cervical TB, 100% of cases of laryngeal TB, 50% of cases of TB otitis media, 75% of cases of oral TB, and 50% of cases of nasal TB. Biopsy and CBNAAT have a promising role in tuberculosis management.ConclusionEarly diagnosis of tuberculosis in ENT requires a high index of suspicion for patients non-responding to routine treatment

Association of Serum Adenosine Deaminase Levels in Cytologically Suggested Cases of Tubercular Lymphadenitis: The Experience of a Tertiary Care Centre

Background: Tuberculosis (TB), a communicable disease, caused by Mycobacterium tuberculosis requires a simple, rapid test, which can be easily carried out in a laboratory. Unfortunately, despite a battery of investigations, no definite test is available till date. Adenosine deaminase (ADA), a biochemical marker has been proposed as a useful surrogate marker for TB as its levels can be measured in body fluids.
 Methods: A one-and-a-half-year prospective study of 154 cases presenting with lymphadenitis from January 2019 to June 2020 was undertaken. Using cytology, lymphadenitis subjects were divided into two groups: Tubercular (104 patients) as a case group and Reactive (50 patients) as a control group. All cases were followed by serum ADA assay by colorimetric method. Nonparametric tests were performed to compare the two groups.
 Results: The mean age of the participants was 28.99 ± 13.26 years with a F:M ratio of 1.81:1. Involvement of cervical lymph nodes was most frequent (89.42% cases). The mean S.ADA level for tubercular and reactive lymphadenitis was 41.71 ± 11.53 U/L and 21.16 ± 4.16 U/L, respectively (P-value < 0.05). The cut-off value calculated was 32.6 U/L. The sensitivity, specificity, PPV, NPV, and accuracy were calculated as 79.81%, 100%, 100%, 70.42%, and 86.36%, respectively.
 Conclusion: A statistically significant increase was found in serum ADA levels in tubercular lymphadenitis cases compared to reactive lymphadenitis. Hence, it can be used as an adjunct to FNAC and is a fairly sensitive and specific test. Since it is difficult to always demonstrate AFB in FNAC smears, ADA can be helpful in establishing a definite diagnosis despite smear negativity.
 Keywords: adenosine deaminase, lymphadenitis, tuberculosis

All necrotizing nodes are not tuberculosis – A report of two cases

IntroductionKikuchi-Fujimoto disease is a benign and self-limiting systemic disorder of unknown aetiology characterised by fever, superficial lymphadenopathy and leukopenia. In highly endemic & low-resource country like India, it is frequently misdiagnosed as tuberculosis. Case reportBoth the cases were diagnosed as necrotizing lymphadenitis by fine-needle aspiration cytology. Tuberculin skin prick test (TST) was positive for one case and negative for the other case. Cartridge based nucleic acid amplification test (CBNAAT) from lymph node aspirate was negative for mycobacterium tuberculosis in both the cases, later on histopathology of lymph node showed diagnosis of Kikuchi-Fujimoto disease. ConclusionKikuchi Fujimoto is a self-limiting disease systemic disease of unknown aetiology. A definite diagnosis can be established by incisional/excisional biopsy of the lymph node. When dealing with cases of tubercular lymphadenitis, Kikuchi-Fujimoto disease should be kept as differential diagnosis.

2156. To Evaluate the Role of Kit-Based Loop-Mediated Isothermal Amplification (TB-LAMP) Assay in the Diagnosis of Tubercular Lymphadenitis

BackgroundTuberculosis (TB) is the leading cause of death as a single infectious agent worldwide. In 2017, there were an estimated 1.3 million TB deaths among HIV-negative people and 300,000 deaths among HIV-positive people. The rapid and accurate diagnosis of TB in lymphnode specimens remains a challenging task today. In 2016, World Health Organization endorsed a commercial molecular assay, the LoopAMP™ Mycobacterium tuberculosis complex (MTBC) detection kit (Eiken Chemical Company, Tokyo, Japan), which uses loop-mediated isothermal amplification (LAMP) for sputum samples only. No prospective studies on LAMP in diagnosis of Tubercular Lymphadenitis in adults have been done yet.MethodsA prospective observational study with a total of 70 lymph-node aspirate specimens from suspected cases of Tubercular Lymphadenitis with age >18 years were selected and subjected to Ziehl–Neelsen staining, LAMP and culture in mycobacterial growth indicator tube (MGIT960). The immunochromatographic test was used to confirm MTB complex (MTBC) in culture positive samples and phenotypic drug susceptibility testing was done using MGIT-960. The composite reference standard (CRS) used in the study includes symptoms, radiological evidence and follow-up of 2 months. 2 × 2 tables were made and Sensitivity, Specificity, PPV, NPV of TB-LAMP were calculated with respect to AFB smear and composite reference standard (CRS).ResultsLAMP assay was able to detect MTBC in 34.3% (24/70) of lymph-node specimens. Sensitivity and specificity of the assay were 100% and 69.7%, respectively, considering smear as gold standard. On comparing with CRS, the assay showed 100% sensitivity and 100% specificity in the diagnosis of MTBC.ConclusionIn our study, LAMP assay was found to be a promising tool for the diagnosis of Tubercular Lymphadenitis and could be used for rapid and cost-effective diagnosis of Tubercular Lymphadenitis in resource-limited settings. Disclosures All authors: No reported disclosures.

Cytopathological spectrum of cervical lymphadenopathy in a tertiary care centre of Western Uttar Pradesh

Introduction: Cervical lymphadenopathy is common in India and may present as a diagnostic problem to the clinicians. Diseases affecting cervical lymph nodes are of varying severity starting from simple infectionto malignant pathology. Objective: The purpose of this study was to observe the various clinical presentations of cervical lymphadenopathy and correlate the cytological and histopathological findings to estimate its efficacy. Materials and Methods: A prospective study of 290 cases of Fine needle aspiration cytology (FNAC) of cervical lymphadenopathy was conducted and studied. Histopathological correlation was done in all the cases that were biopsied. The study was carried out over a period of one year in thedepartment of Pathology, Rohilkhand Medical College & Hospital, Bareilly in Western Uttar Pradesh. The clinical and pathological findings were studied and their importance in reaching towards a diagnosis was also evaluated. Result: Out of 290 cases, the most common diagnosiswas reactive lymphadenitisin 78 cases followed second in line by 74 cases of granulomatous lymphadenitis. The average median age of study population was 40 years. 56 study subjects presented with Reactive lymphadenitis and 36 cases of granulomatous lymphadenitis. 289 had the size of lymph node less than 3 cm. Reactive and tubercular lymphadenitis cases were observed more on the left side and malignant cases more on the right side. Conclusion: The present study highlights the role of cytopathology in theearly diagnosis and effective management of cervical lymphadenopathy. Keywords: Cervical, Lymphadenopathy, FNAC, Biopsy, Tubercular.

The role of repeated aspirations in the treatment of tubercular cervical lymphadenitis

Introduction: Tubercular lymphadenitis is the most common form of extrapulmonary tuberculosis. Tubercular lymphadenopathy can progress to abscess and fistula formation. Further during the course of treatment paradoxical upgrading reaction of lymphnodes like appearance of new lymphnodes and sinus formation can occur. Objective: The aim of the study was to evaluate the role of repeated aspirations as an adjunct to ATT in the treatment of tubercular lymphadenitis presenting with abscess. Material and Methods: The study involved 180 cases of cervical lymphadenopathy who presented in the ENToutpatient Department of Bundelkhand Medical College Sagar between Jan 2016 to Sep 2017. 102 cases were diagnosed by FNAC and 3 cases were diagnosed by excision biopsy as tubercular lymphadenitis. Only new cases of were included Out of the 105 cases of diagnosed with tubercular lymphadenitis 15 cases presented with cold abscess initially. All thepatients were started onanti-tubercular treatment. 10 cases developed abscess during the course of treatment. All cases presenting with abscess were subjected to repeated aspiration biweekly. Results: All cases of tubercular lymphadenitis and abscess showed complete recovery with 6 months of treatment. Conclusion:Repeated aspirations in cold abscess as an adjuvant to ATT is a less invasive procedure than surgical excision and reduces the complications like sinus formation. Close supervision by the ENT specialist is mandatory during the course of medical treatment to combat paradoxical upgrading reactions especially abscess formation.

Age and gender wise distribution of cases presenting with cervical lymphadenopathy: A retrospective study

Introduction: Cervical lymphadenopathy is a common clinical presentation of various diseases its FNAC serves as an excellent clue to the underlying disease. The presentation of cervical lymphadenopathy varies in different age groups and in both the both the gender as well. Objective: To analyze the spectrum of lesions causing cervical lymphadenopathy as well as to see the age and gender wise distribution of cases of tubercular lymphadenitis. Materials and Methods: It is a retrospective study and included three years data. A total of 222 cases that underwent FNA for cervical lymphadenopathy were recorded with their clinical history. For all cases, MGG, Pap and AFB slides were re evaluated and results were recorded. Epidemiological variables were analyzed by cross tabulation to assess their relationship. Result: Out of 222 cases 117 cases were of Tubercular lymphadenitis followed by 81 cases of reactive lymphadenitis, 10 cases presented as metastatic deposit of squamous cell carcinoma, 9 with Lymphoma (NHL) followed by 5 cases of adenocarcinoma deposits. Females to males ratio in Tuberculosis lesions was 1.3:1. Conclusion: In both pediatric and adult population Tuberculosis was an important cause of cervical lymphadenopathy while in children less than two years reactive lymphadenitis was more common. Tuberculosis was more common in females as compared to males and here FNAC is an inexpensive and valuable fist line tool in assessing cervical lymphadenopathies. Keywords: Cervical lymphadenopathy, Tuberculosis, FNAC, Age and gender.

ETIOLOGICAL FACTORS, CLINICAL PRESENTATIONS AND TREATMENT OUTCOME OF CERVICAL LYMPHADENOPATHY: AN OBSERVATIONAL DESCRIPTIVE STUDY

Aim: To study various etiological factors, clinical presentations of cervical lymphadenopathy. To study the management and outcome of cervical lymphadenopathy Method: Proper clinical history was first noted, local and systemic examination was performed and a clinical diagnosis was made. Gender wise distribution, presenting symptoms, site distribution, and treatment outcome were noted. Result: Gender wise distribution of male and female was 52%, and 48%, commonest site of primary in cases of metastatic Secondaries was tongue followed by oesophagus and thyroid. After proper diagnosis confirmed by Histopathology (biopsy), treatment constituted properly- Cases of Tubercular Lymphadenitis (49 cases) were Started on Anti-tubercular treatment, all were showed improvement in symptoms. Cases of Reactive lymphadenitis (26 cases) started on antibiotics, all recovered well. Among 14 Cases of Metastatic secondaries, 5 cases were given Chemotherapy/Radiotherapy after expert oncologist opinion out of which 3 showed improved symptoms and 2 were expired, 6 cases were operated out of which 5 showed improved symptoms and 1 expired post operatively, 3 cases were referred to specialized oncological and oncosurgical center for further management. All 6 Lymphoma cases were started on chemotherapy after expert oncologist opinion showed improvement in symptoms. Conclusion: Commonest site of primary in cases of metastatic Secondaries was tongue followed by oesophagus and thyroid. Anti-tubercular treatment for tubercular lymphadenitis was highly satisfactory with improvement in almost all patients. Surgery was restricted as an adjuvant to chemotherapy, as diagnostic biopsy, for treatment of abscess/sinuses and for a lymph nodes that do not resolve with chemotherapy. Non-tuberculous non-neoplastic lesions can be best managed by conservatively. Keywords: Cervical lymphadenopathy; Clinical presentations; Treatment outcome.

Assessment of Clinically Suspected Tubercular Lymphadenopathy by Real-Time PCR Compared to Non-Molecular Methods on Lymph Node Aspirates

Background: The diagnosis of tubercular lymphadenitis (TBLN) is challenging. This study assesses the role of diagnostic intervention with real-time PCR in clinically suspected tubercular lymphadenopathy in relation to cytology and microbiological methods. Methods: The cross-sectional study involved 214 patients, and PCR, cytology, and Ziehl-Neelsen (ZN) staining was performed on aspirates. The findings were compared with culture on Lowenstein-Jensen medium. The overall concordance of cytology and PCR, both individually and combined, was calculated. χ² and Phi values were assessed between cytology, PCR, and culture. Results: A cytological diagnosis of tuberculosis (TB), reactive lymphoid hyperplasia, and suppurative lymphadenitis was made in 71, 112, and 6 patients, respectively. PCR and culture were positive in 40% of the cases. Among the TBLN patients, PCR showed higher positivity in necrosis and culture showed higher positivity in necrotizing granuloma. Positive ZN staining was observed in 29.6% of the TBLN cases, with an overall positivity of 11%. PCR could additionally detect 82 cases missed by ZN staining. The overall concordance rate for either diagnostic modality, i.e., PCR or cytology, was highest (75%), and for PCR alone was 74%. Phi values were observed to be 0.47 between PCR and culture. Conclusion: Real-time PCR for Mycobacterium tuberculosis complex on aspirates offers a definitive and comparable diagnosis of TBLN. Including this approach as the primary investigation in the work-up of TBLN could reduce the burden of TB.

Role of 18F-FDG PET/CT in patients with pyrexia of unknown origin

ObjectivesThis paper is a prospective observational study to assess the role of 18F-FDG PET/CT in evaluation of pyrexia of unknown origin (PUO) in a hospital based population in a tertiary level referral center in an Indian metropolitan city. Materials and methodsMedical records of 25 patients who underwent 18FDG PET/CT as a part of investigative work up of PUO were analyzed. A diagnostic CT scan was performed from the level of clavicle to the pubic symphysis in arterial and venous phases of contrast administration. Equilibrium phase images were obtained from vertex to mid-thigh without breath hold instructions with subsequent PET acquisition from vertex to mid-thigh, and these two sets of images were fused to obtain PET/CT fused images. Two radiologists with considerable PET-CT experience evaluated the contrast enhanced CT and 18-FDG PET-CT images separately and tried to identify the probable cause of fever in the 25 patients. ResultsRecords of 25 patients (13 Females, 12 Males) were evaluated. Abnormal focal FDG uptake was found in 21 patients and contributed to final diagnosis (TP) in 20 patients with 1 false positive results (FP). In the rest of the 4 patients with negative PET/CT final specific diagnosis (FN) was made only in 2 patients (2/4-50%) and in 2 patients no diagnosis was made (TN). The PET/CT had a sensitivity of 90.91%, specificity of 66.67%, positive predictive value (PPV) of 95.24% and negative predictive value (NPV-50%). TP cases included 8 cases of Kochs (2 cases of tubercular lymphadenitis, 1 case of tubercular pleural effusion, 1 case of spinal kochs, 1 case of genitourinary kochs, 1 case of Cutaneous Koch, 1 case of splenic Koch; 1 case of abdominal Koch); 4 cases of focal infections/abscesses, 1 cases of lymphoma, 2 cases of Sarcoidosis, 1 case of Kikuchi Fusimoto, 1 case of aortoarteritis, 1 case of Castleman's disease, 1 case of Rosai Dorfman and 1 case of thyroiditis. FN negative cases included one case of meningitis and one case of giant cell arteritis. One false positive case was due to focal hyper metabolism on PET in the caecum.In comparison, on CECT, probable etiology was suspected in 11 patients, out of which 8 cases were true positive (TP), 3 cases were false positive and 12 were false negative. In 2 patients no diagnosis was made (TN). CECT had a sensitivity of 42.86%, specificity of 50% positive predictive value (PPV) of 84% and negative predictive value (NPV-14.29%). Thus 18F-FDG PET/CT improved the sensitivity (90.91% vs 42.86%), specificity (66.67% vs 50%), Positive predicate value (95.24% vs 84%) and Negative predicate value (50% vs 14.29%) as compared CECT alone. ConclusionsFDG PET/CT is better than CECT in making a specific diagnosis in the evaluation of PUO. It also helps in deciding the best possible site for biopsy.

Molecular biology technique combined with Fine needle aspiration cytology revealing the diagnostic dilemma in tubercular lymphadenitis cases

Background: Extra-pulmonary Tuberculosis in the form of tubercular lymphadenitis (TBLN) accounts for 30-40% of Tuberculosis cases. Tuberculosis lymphadenitis is not always associated with the clinical symptoms like fever, cough, weight loss etc which makes its diagnosis difficult. Moreover, conventional investigations like culture and Ziehl Neelsen staining (ZN) used for providing the bacteriological evidence of TBLN have their own limitations. These cases therefore remain undiagnosed and become worse when left untreated. Such cases have potential to spread tuberculosis and thus are problem areas to the public health. We aim to reveal the diagnostic dilemma by molecular biology technique based on real-time Polymerase chain reaction (PCR) with the hypothesis that Real-time PCR performed on lymph node aspirates will be able to diagnose tubercular lymphadenitis cases which lack clinical and bacteriological evidence of tuberculosis on conventional methods. Research problem with aproach Methods & Materials: Cross sectional study: Fifty patients with enlarged lymph node, enrolled in this study were taken for cytological evaluation to Department of Pathology, Jawaharlal Nehru Medical College, Wardha, India. Informed consent was taken. Lymph nodes were subjected to Fine needle aspiration cytology (FNAC); aspirates obtained were used for studying morphology, ZN staining, culture and TaqMan based real time PCR on target insertion sequence IS6110. The results were recorded and data analyzed in Software package for statistical analysis.Inclusion and exclusion criteria and study process Results: Female to male ratio was 1.3:1. Most common site among lymph nodes was cervical in 72%, cases. Morphologically necrotizing granuloma was seen in 20/30 cases diagnosed TBLN on Fine needle aspiration cytology, ZN staining was positive only in 15 cases, culture was positive only in 20 cases and TaqMan based real-time PCR findings were positive in 35 cases. Ten cases missed for TBLN on conventional methods (culture and ZN stain) were diagnosed by FNAC and PCR. Five cases missed for TBLN on FNAC were diagnosed by PCR. Diagnostic accuracy of real-time PCR was found to be 100%. Results Conclusion: A positive real-time PCR finding on aspirates of lymph nodes reveals the diagnostic dilemma in tubercular lymphadenitis cases where there was no clinical suspicion and bacteriological proof was lacking. In addition real time PCR helps to diagnose the cases missed on morphology.

Chronic cervical lymphadenopathy in children: Role of ultrasonography

Aim:To assess the usefulness of ultrasonography in the differentiation of causes of chronic cervical lymphadenopathy in children.Materials and Methods:Children with palpable cervical lymph nodes were included. An ultrasonographic examination was performed to delineate multiple lymph nodes, irregular margins, tendency towards fusion, internal echos, the presence of strong echoes and echogenic thin layer.Results:The total number of patients was 120. Echogenic thin layer and strong internal echoes were specific for tuberculosis. Long axis to short axis (L/S) ratio was more than 2 in most of the tubercular nodes (85.71%). Hilus was present in 50 (73.53%) tubercular lymphadenitis, 12 (40%) lymphoma and 10 (62.5%) cases with metastatic lymph nodes. Hypoechoic center was present in 60 (88.24%) tubercular lymphadenitis cases followed by 62.5% metastatic and 60% malignant lymphoma cases.Conclusions:Ultrasonography is a non-invasive tool for lymph nodal evaluation in children. It may be used to differentiate cervical lymphadenopathy with different etiologies in children. When correlated clinically, it may avoid biopsy in a patient.

Homeopathy in the treatment of tubercular lymphadenitis (TBLN) – An Indian experience

Tuberculosis (TB) has been known since antiquity. In spite of effective antibiotic treatment, it is still a major worldwide public health problem. Endogenous factors are important in the development of active disease. Homeopathic medicines have the potential for immune-modulation and hence to influence endogenous factors in disease. In India, patients with tubercular lymphadenitis (TBLN) often consult homeopaths but such cases are seldom documented. The objective of the present study is to document such experience. A retrospective exploratory study of 25 positively diagnosed cases of TBLN has lead to the development of a homeopathic regime consisting of a patient specific constitutional medicine, one disease specific biotherapy (Tuberculinum) and Silicea 6x as supportive medicine. Homeopathy can be used as a complement to conventional anti tubercular treatment (ATT) with beneficial results. Further validation in controlled trials with immunological markers is required.