Cases Of Tuberculous Lymphadenitis Research Articles

Comparative whole genome sequence analysis of mycobacterium tuberculosis isolated from pulmonary tuberculosis and tuberculous lymphadenitis cases in northwest ethiopia: Genomic diversity, transmission dynamics and in-silico molecular drug resistance

Comparative whole genome sequence analysis of mycobacterium tuberculosis isolated from pulmonary tuberculosis and tuberculous lymphadenitis cases in northwest ethiopia: Genomic diversity, transmission dynamics and in-silico molecular drug resistance

Transbronchial lymph node forceps biopsy as a novel tool in diagnosis of mediastinal lymphadenopathy: a pilot study

BackgroundDifferential diagnosis of mediastinal lymphadenopathy is an issue of debate. Lymph nodes may be enlarged due to a variety of inflammatory, infectious, or malignant reasons. Therefore, obtaining samples from the affected nodes is crucial for the diagnosis. Usually, these patients are subjected to TBNA (EBUS or conventional) or mediastinoscopy if TBNA is not conclusive. This study evaluated the safety and feasibility of this new technique of transbronchial forceps biopsy for the diagnosis of mediastinal lymphadenopathy.MethodsThe study included 18 patients with confirmed mediastinal lymphadenopathy who were admitted in Chest Department, Cairo University in the period from December 2019 to December 2020. All patients were subjected to flexible bronchoscopy with conventional transbronchial needle aspiration (C-TBNA) and transbronchial forceps biopsy (LN-TBFB) from the enlarged mediastinal lymph node in the same procedure.Resultswe found the technique of LN-TBFB safe with no serious complications. We were able to reach a diagnosis in 7/7 (100%) cases of sarcoidosis, 6/7 (85.7%) cases of malignant lymph nodes. We had three cases where the histopathology showed hyperactive follicular hyperplasia, and a single case of tuberculous lymphadenitis. C-TBNA was diagnostic in 71.4% of sarcoidosis cases, 42.9% of malignant cases, but failed to diagnose the one patient with tuberculous lymphadenitis.ConclusionLymph node transbronchial forceps biopsy (LN-TBFB) was found to be safe and effective in the diagnosis of mediastinal lymphadenopathy. We strongly advocate the use of this minimally invasive technique for diagnosing pathologically enlarged mediastinal lymph nodes, as a last step before mediastinoscopy.

Utility of Conventional ZN Staining and Modified Bleach Techniques in Detection of Acid Fast Bacilli from Aspirates of Suspected Cases of Tuberculous Lymphadenitis

Introduction: Tuberculosis (TB) is a significant public health problem in many developing countries, including India. Diagnosing tuberculous lymphadenitis, in particular, poses challenges as it requires the demonstration of Acid-Fast Bacilli (AFB) using the conventional Ziehl-Neelsen (ZN) technique. The Modified Bleach Technique, which involves liquefying the aspirated specimen with sodium hypochlorite followed by centrifugation, has been described to enhance the yield of AFB, improving sensitivity and diagnostic accuracy. Aim: To highlight the role of the bleach concentration method compared to conventional ZN staining in detecting AFB in Fine-Needle Aspiration (FNA) material from clinically suspected cases of tuberculous lymphadenitis. Materials and Methods: A prospective cross-sectional study was conducted at the Department of Pathology, MVJ Medical College and Research Hospital, Bengaluru, Karnataka, India from November 2020 to December 2022. Fine needle aspiration material from 100 cases of clinically suspected tuberculous lymphadenitis was included. In each case, part of the aspirate was processed for ZN staining, while the remaining material was used for modified bleach staining and Cartridge Based Nucleic Acid Amplification Test (CBNAAT). Patient data, including age, sex, duration and site of swelling, nature of aspirate, and cytomorphological diagnosis, were documented. The data was entered into a Microsoft excel spreadsheet and analysed using the Chi-square test, with a p-value<0.05 considered statistically significant. Results: The age range of the study participants was 1-80 years. Out of 100 cases, 13 were excluded due to inadequate material. The most common lymph node site was cervical 69 (79.3%), followed by axillary 8 (9.1%) and supraclavicular 6 (6.89%). Among the 87 cases, reactive lymphadenitis was diagnosed in 36 (41.3%), suppurative lymphadenitis in 12 (13.8%), necrotising granulomatous lymphadenitis in 12 (13.8%), granulomatous lymphadenitis in 15 (17.3%), and necrotising lymphadenitis in 12 (13.8%). Out of the 100 cases included in the study, 32 cases were confirmed as tubercular lymphadenitis by CBNAAT. Among these 32 cases, conventional ZN stain was positive for AFB in only 3 cases (9%), whereas the Modified bleach stain was positive in 16 cases (50%). The results were compared with CBNAAT findings, and the modified bleach technique showed sensitivity (59.4%), specificity (100%), Positive Predictive Value (PPV) (100%), Negative Predictive Value (NPV) (80%), and Accuracy (85%). Conclusion: The Modified bleach method of ZN staining is a simple, safe, inexpensive, and easy-to-perform technique. With the bleach method, AFB was easily visible and detectable in the majority of AFB-positive cases. Additionally, the bleach method preserved the morphology of AFB better. It improves the microscopic detection of AFB, leading to a definitive diagnosis of TB on cytology.

Impact of fine needle aspiration cytology strategy implemented at the microscopy center level for diagnosis of tuberculous lymphadenitis

IntroductionIn India, EPTB accounts for about 50% of TB cases especially in people living with HIV/AIDS. Microbiological confirmation is present in only about 15% of EPTB cases. Tuberculous Lymphadenitis is the most common form of EPTB in India, accounting for around 35% of EPTB cases. Fine needle aspiration cytology has been found to be highly sensitive and specific in the diagnosis of tuberculous lymphadenitis with 83–94% accuracy. The procedure of AFB detection is exactly the same for the FNAC obtained smears as for the presently examined sputum smears at the DMCs. The aim of the present study was to determine the feasibility and effectiveness of FNAC strategy implemented at DMC level for detection of tuberculous lymphadenitis cases. MethodsThe present study was a randomized cluster trial with one control and one intervention arm. At the intervention units (DMCs) all suspected tuberculous lymphadenitis cases was subjected to FNAC of the suspected superficial lymph nodes by the trained Medical Officers. The control group was free from any such intervention. Effectiveness and feasibility of FNAC strategy in the intervention group was determined by relevant indicators. ResultsAt the seven intervention DMCs, FNAC was performed on a total number of 1298 suspected cases of Tuberculous Lymphadenitis. Among them 294 cases were selected in the intervention arm and 196 cases in the control arm. Intervals between advice of FNAC and performance of FNAC as well as start of therapy was significantly low in the intervention arm. Complication was insignificant. The concordance between FNAC reports generated at the DMCs and that at Medical College estimated by agreement measurement kappa (0.970) suggested a high level of agreement. ConclusionImplementation of FNAC strategy at the DMC level for detection of tuberculous lymphadenitis cases was found to be feasible as well as effective.

Demographic and microbiological characteristics of tuberculous lymphadenitis and other extrapulmonary tuberculosis cases

Objective: Tuberculosis (TB) is a significant public health problem that remains important worldwide. This study aimed to examine the demographic characteristics and clinical features of patients with extrapulmonary tuberculosis (EPTB) and also identify the comorbidities of EPTB. Our secondary aim was to compare tuberculous lymphadenitis (TBL) with other forms of EPTB. Patients and Methods: This single-center, retrospective, observational study was conducted on patients diagnosed with EPTB in a training hospital in Turkey between January 1, 2011 and December 31, 2020. The demographic characteristics and clinical features of the patients were examined. TBL cases were compared with other forms of EPTB cases. Results: The most common clinical form was TBL. Fever, night sweats, and accelerated erythrocyte sedimentation rate were significantly more common in the other forms of the EPTB group compared to TBL. The rate of tuberculin skin test positivity was significantly higher in patients with TBL. The complication rate was 3%, and mortality rate was 4% among all patients. Conclusions: Extrapulmonary tuberculosis should be considered in the differential diagnosis by evaluating the medical history of patients who present with organ-specific symptoms, especially in TB endemic countries. The clinic may differ according to the organ involvement. TBL may be seen with milder symptoms compared to other clinical forms.

A cytological study on peripheral lymphadenopathy in a tertiary care center with special reference to tuberculous lymphadenitis

Background: Fine-needle aspiration cytology (FNAC) is the most common, cost-effective, and time-efficient cytological diagnostic procedure and is used routinely in cases of swelling or lymph node enlargement at accessible sites. FNAC plays an important role in diagnosing benign and malignant lesions of peripheral lymphadenopathy cases and also provides a valuable screening test. Aims and Objectives: In this study, we aimed to evaluate various cytomorphological manifestations of lymphadenopathies and the suggestive cases of tuberculous lymphadenitis were divided based on their cytomorphological patterns. Materials and Methods: The current prospective study was conducted in the Department of Pathology, SSMC, Rewa, M.P. A total of 150 cases of peripheral lymphadenopathy were subjected to FNAC and were categorized based on their cytological findings. The cases which showed features suggestive of tuberculous lymphadenitis were further categorized into four distinct cytological patterns (I to IV). Results: Out of 150 cases of peripheral lymphadenopathies, the most common lesion diagnosed cytologically was reactive lymphadenitis (41.3%) followed by tuberculous lymphadenitis in 38.7% cases. The different patterns of tuberculous lymphadenitis on microscopy were divided into four categories from I to IV with pattern I being the most frequently seen (53.5%). Conclusion: Our study highlighted the various morphological patterns of lymphadenopathy and the most common lesion diagnosed was reactive lymphadenitis. The present study found that FNAC is an effective screening tool for diagnosing benign and malignant lymphadenopathies and also to study the cytomorphological patterns in cases of tuberculous lymphadenitis. It reduces the need for surgical intervention and for the early diagnosis and management of patients with peripheral lymphadenopathy.

Concurrence of cat-scratch disease and paradoxical tuberculosis-IRIS lymphadenopathy: a case report

BackgroundMycobacterial infections can cause significant morbidity when cellular immunity is compromised. Patients with AIDS can be affected directly from infection or through mycobacterial IRIS, especially if they are previously untreated for HIV. Herein a case of tuberculous lymphadenitis is reported, which primarily responded to antimicrobials but complicated by IRIS and cat-scratch disease at a later course.Case presentationA 23-year-old man, intravenous drug user with untreated HIV and HCV infection presented with fever and painful cervical lymphadenopathy. Mycobacterium tuberculosis was isolated from PCR and culture of ultrasound-guided lymph node aspirate and a four-drug anti-TB regimen was subsequently administered, leading to complete resolution of clinical and laboratory abnormalities. Given the patient’s CD4 count (67 cells per mm3), antiretroviral treatment started seven weeks after TB treatment initiation. Within the first month of ART fever recurred along with cervical lymph node inflammation. Paradoxical IRIS was considered as the most probable diagnosis but workup expanded, revealing acute Bartonella infection. A posteriori, the patient remembered being scratched by a stray cat two weeks before his new symptoms started. Doxycycline and corticosteroid monotherapy failed to resolve symptoms, whereas a combination of doxycycline for 3 months and methylprednisolone with long-term tapering led to negative follow-up Bartonella antibodies and complete clinical and biochemical response, without recurrence.ConclusionsCo-infection with TB and Bartonella presenting with lymphadenitis is unusual. Cat-scratch disease can be a rare clinical presentation of Bartonella infection in patients with AIDS, but coexistence of bartonellosis and paradoxical IRIS has never been reported before. However, physicians treating people living with HIV should be aware of this potential concurrence. Early testing for Bartonella infection could be offered in patients with TB and HIV co-infection in case of acute deterioration or partial response to treatment, especially if they have a history of cat exposure, since clinical picture can be indistinguishable.

Tuberculous Lymphadenitis in Immunocompromised Patients: A Case Report

Introduction: Tuberculous lymphadenitis (TBLN) is a form of extra-pulmonary TB with clinical features ranging from lumps to abscesses. Human Immunodeficiency Virus (HIV) co-infection and diabetes mellitus alongside TBLN made the diagnosis and management exceptionally challenging. We reported 3 cases of TBLN, 2 among them had an existing HIV co-infection, and 1 had preexisting diabetes mellitus.Case: The first case, a 28-year-old man, previously diagnosed with HIV, complained of a lump in the neck; biopsy results suggested TBLN. The second case was a 36-year-old man with a neck abscess and HIV co-infection. Acid Fast Bacilli (AFB) pus was positive & Human Immunodeficiency Virus Enzyme-Linked Immunosorbent Assay (HIV ELISA) was reactive. The third case was a patient with a neck abscess with preexisting diabetes mellitus (DM) underwent wound debridement and was given anti-tuberculosis drugs.Conclusion: TBLN with HIV co-infection or diabetes had clinical features ranging from a painful lump to an abscess. The definitive diagnosis was taken by examining AFB from pus. If the abscess was more extensive than or equal to 3 cm, wound debridement was necessary. The primary treatment for TBLN was anti-tuberculosis drugs and required even greater attention if a patient had any preexisting comorbidities such as HIV and diabetes.

A Case of Tuberculous Lymphadenitis with a Young Man from Indonesian

A Case of Tuberculous Lymphadenitis with a Young Man from Indonesian

Kikuchi disease: An unusual cause of cervical lymphadenopathy in a young female

Kikuchi-Fujimoto disease (KD), also known as histiocytic necrotizing lymphadenitis, is a rare cause of unilateral cervical lymphadenopathy usually described in adolescents and young adults with female preponderance. Clinically patients present with palpable lymphadenopathy, fever, and loss of weight. Hence, it should be differentiated from other causes of lymphadenopathy such as tuberculosis, lymphoma, or malignancy. Although the majority resolve spontaneously without treatment some may require non-steroidal anti-inflammatory drug or steroids. It may also be associated with systemic lupus erythematosus. Hence early detection, prompt diagnosis, and follow-up of the patient are essential in all cases of unilateral cervical lymphadenopathy in young adults. Here, we describe a 22-year old female who presented with unilateral neck swelling and was clinically diagnosed initially as a case of tuberculous lymphadenitis which on biopsy turned out to be KD.

SCROFULA: ANALYZING THE ASPIRATE TO AID IN EARLY DIAGNOSIS

<h3>Background</h3> Tuberculosis is a commonly occurring mycobacterial pulmonary infection that can lead to chronic lymph node enlargement. Scrofula is cervical lymphadenopathy due to tuberculosis. Conventional methods are used to detect the active pulmonary component of the disease. However, tuberculous lymphadenopathy is often difficult to establish routinely; hence, fine-needle aspiration cytology (FNAC) can prove to be a useful aid in diagnosing tuberculous lymphadenopathy. <h3>Objective</h3> To analyze cytomorphological patterns of tuberculous lymphadenopathy by using FNAC and to analyze the presence of acid-fast bacilli (AFB) in different patterns of tuberculous lymphadenopathy by using Ziehl-Neelsen staining. <h3>Methods</h3> One hundred cases of cytologically proven cases of tuberculous lymphadenitis were analyzed, first using Giemsa staining to evaluate and categorize the cytomorphological patterns, then using Ziehl-Neelsen staining to screen of AFB in lymph node aspirate. <h3>Results</h3> Four cytomorphological patterns were seen, which were described as type 1 (primary), presence of neutrophils and suppuration (15%); type 2 (secondary), presence of necrosis, scattered lymphocytes, and degenerated cells (46%); type 3 (tertiary), presence of necrosis, epithelioid cells, and lymphocytes (30%); and type 4 (quaternary), presence of epithelioid granuloma, necrosis, with or without giant cells. AFB positivity was seen in 76% of cases: type 1 (10%), type 2 (39%), type 3 (25%), and type 4 (2%). <h3>Conclusions</h3> FNAC is a quick and economical aid in clinical diagnosis for lymphadenopathies. The cytomorphological pattern for tuberculous lymphadenopathy in the initial phases of the disease shows a reactive response; hence, in cases of suspicion, it is highly advisable for detecting AFB in order to diagnose the cervical lymphadenopathy as scrofula.

Factors associated with localization of tuberculosis disease among patients in a high burden country: A health facility-based comparative study in Ethiopia

IntroductionIn contrast to most tuberculosis (TB) high burden countries, Ethiopia has for a long time reported a very high percentage of extra pulmonary TB (EPTB), which is also reflected in population based estimations reported by the World Health Organization (WHO). Particularly a steadily higher proportion of cervical tuberculous lymphadenitis (TBLN) has been described. Here we identify clinical and demographic factors associated with anatomic site of the TB disease. MethodA health facility based comparative study was conducted among TBLN and PTB patients who visited selected health facilities in Ethiopia during 2016 and 2017. Associated risk factors were identified through a multivariate logistic regression model using R-studio. ResultA total of 1,890 study participants, 427 TBLN and 1,463 PTB patients, were included. The mean age of TBLN patients (29 years ± 14.4 SD) was lower than that of PTB cases (36 years ± 15.0 SD). There were slightly more women diagnosed with TBLN (51.1%) while nearly 6 out of 10 male patients were diagnosed with PTB (58.9%). Most significantly, younger age groups (<15 Years) were more likely to develop cervical TBLN than older people (>56 years), with an AOR of 9.76 (95% CI: 4.87, 19.56). The odds of cervical TBLN among women [1.69 (1.30, 2.20)] was higher than that for men. In addition, adjusted estimates suggested that, compared with PTB, renal diseases [3.41 (1.29, 9.02)] and the presence of other concomitant chronic illness [1.61 (1.23, 2.09)] had a significant association with TBLN. ConclusionGenerally, the risk of developing a particular form of TB disease is usually associated with demographic and medical history of an infected individual. Hence, the current symptom based screening, which primarily rely on chronic cough in many countries, may lead to missing significant portions of TBLN cases.

Interleukin-4 Cytokine as an Indicator of the Severity of Tuberculous Lymphadenitis

BACKGROUND: Interleukin-4 (IL-4) is a cytokine of Th2 response and plays a role as a reducer or silencer of Th1 work. It is more related to allergic processes, with consequent loss of control of the disease (i.e., tuberculosis). Interferon gamma (IFN-γ) is a Type II interferon that inhibits Th2 immune response and inducts Th1 immune response to inhibit tuberculous and viral replication, and any immunostimulatory and immunomodulatory effects. Dark specks (DS) are in the background of eosinophilic granular material seen in aspirations of tuberculous lymphadenitis stained with May–Grunwald Giemsa (MGG). A lesion with DS festers and the disease worsens.&#x0D; AIM: This study determines whether the expression of IL-4 is associated with disease severity and compares incidences of expression of IL-4 and IFN-γ in DS lesions.&#x0D; MATERIALS AND METHODS: This study includes 100 diagnostic cases of tuberculous lymphadenitis, which were not successfully treated with common antibiotics, but responded to anti-tuberculous drugs (ex juvantibus diagnosis). Out of the 100 cases, 59 cases were with DS and 41 cases were without DS. Out of the 59 cases with DS, 49 cases were IL-4 positive (+) and 10 cases IL-4 negative (–). Of the 41 cases without DS, 10 cases were IL-4 (+) and 31 cases were IL-4 (–). Out of the 59 cases of DS, there were 31 cases with expressions of IL-4 (+) and IFN-γ (–); zero case with IL-4 (–) and IFN-γ (+); 18 cases with IL-4 (+) and IFN-γ (+); and 10 cases with IL-4 (–) and IFN-γ (–). Antigen expressions were determined using rabbit polyclonal to IL-4 (IL-4, ab9622) and rabbit polyclonal to IFN-γ (IFN-γ, ab9657), Abcam. Statistical evaluations were performed using the Chi-square test and Fisher’s exact test. Any p &lt; 0.05 was statistically significant.&#x0D; RESULTS: Expression of IL-4 significantly associated with disease severity, compared to IFN-γ expression (p &lt; 0.05). In lesions with DS, IL-4 is more frequently expressed compared with IFN-γ.&#x0D; CONCLUSION: IL-4 can be a beneficial indicator of the severity of tuberculous lymphadenitis.

Cytological evaluation of lymphadenopathy in HIV seropositive patients

Cytological evaluation of lymphadenopathy in HIV seropositive patients - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2020.002, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Datia Langhans cells as tuberculous lymphadenitis diagnose parameter based on chemical reaction

The incidence of tuberculosis in Indonesia increases every year, resulted in increased cases of tuberculous lymphadenitis. The histopathological picture is often similar to other types of lymphadenitis. This study was an in-depth exploration of the anatomical pathology of Langhans datia cells and necrosis in tuberculous lymphadenitis. This research used secondary data from medical record of the lymph node paraffin blocks in the Anatomical Pathology Department of Sadikin Hasan General Hospital Bandung from January to December 2017. There are 322 medical records of tuberculosis lymphadenitis patients, consisting of 179 types of tuberculous lymphadenitis, 144 types of non-lymphadenitis specific, and nine types of granulomatous lymphadenitis. In all kinds of lymphadenitis, necrosis shows a general picture, whereas datia Langhans are more dominant in the tuberculous and granulomatous lymphadenitis type. The description of necrosing in lymphadenitis is tuberculous type 176(98.3%), non-specific type 120(83.3%), and granulomatous type 7(77.8%), while datia Langhans cells are more common in 132(73.7%) tuberculosis lymphadenitis, and granulomatous lymphadenitis 7(77.8%), compared with non-specific lymphadenitis 42(29.2%). This study concludes that there is necrosis in almost every type of lymphadenitis, whereas datia Langhans cells are lower in the tuberculous and granulomatous lymphadenitis.

Treatment Failure in a Case of Fully Susceptible Tuberculous Lymphadenitis; Time to Consider Dual Pathology

Background The clinical presentation of tuberculous lymphadenitis (TBL) can mimic that of other pathologies; obtaining a tissue diagnosis is therefore essential. Dual pathology can manifest as apparent treatment failure and rare cases of coexistent lymphoma have been reported. Case description A 54-year-old fit and well man of African-Caribbean origin presented with an 8-week history of dysphagia, breathlessness and weight loss. He was tachypnoeic and thin with right supraclavicular and axillary lymphadenopathy. An HIV test was negative. A CT thorax demonstrated clear lung fields and a 7.2cm mediastinal soft tissue mass compressing the oesophagus and trachea. US-guided core biopsies of a supraclavicular lymph node showed necrotising granulomatous inflammation. There was no evidence of lymphoma on immunohistochemistry. An acid-fast bacillus was seen on Wade-Fite staining. Voractiv was commenced for suspected TBL. Tissue culture subsequently grew Mycobacterium tuberculosis. Susceptibility to treatment was confirmed by whole genome sequencing. After two months of treatment he remained symptomatic with continued weight loss. The possibility of dual pathology was considered, and the index biopsy revisited. Steroids were commenced for a possible paradoxical reaction, resulting in some initial clinical improvement. Ten weeks into treatment, he further deteriorated requiring artificial nutrition and tracheal stenting. Repeat CT imaging showed enlargement of the mediastinal mass, now extending into the oesophageal lumen. Oesophageal biopsy demonstrated adenocarcinoma. Conclusions We report a case of TBL with coexistent adenocarcinoma, which whilst rare highlights the importance of reassessment for dual pathology in cases of biopsy proven TBL that fails to respond to appropriate anti-tuberculous therapy.

Cytomorphology of lymphadenopathy with a report on patterns of tuberculous lymphadenitis in a resource-limited setting

Context: Lymphadenopathy is one of most common clinical presentations, for which fine-needle aspiration (FNA) is indicated as the first-line investigation since it is a reliable, rapid, simple, cost-effective procedure done in the outpatient department. Aims: The study was performed to assess the various cytomorphological patterns of the lymph node aspirates in patients presenting with peripheral lymphadenopathy. Subjects and Methods: The prospective study included 81 patients with complaints of peripheral lymphadenopathy on whom FNA was done in the Department of Pathology at our hospital. The smears were analyzed and categorized according to their cytomorphological patterns. Results: Of 81 patients, 30 were male and 51 were female. The male:female ratio was 1:1.7. The age of the patients ranged from 3 to 83 years, with a mean age of 35.2 years. Reactive lymphadenitis (48.15%) was the most common lesion followed by tuberculous lymphadenitis (33.33%). Acid–fast bacilli (AFB) positivity was noted in 13 out of 27 cases (48.15%) with tuberculous lymphadenitis. The cases of tuberculous lymphadenitis were further divided into three groups based on cytomorphology, of which Group 2 lesions (epithelioid granulomas with necrosis) were most common and Group 1 lesions (epithelioid granulomas without necrosis) were least reported. Group 3 lesions (necrosis without epithelioid granulomas) were all positive for AFB. There were nine cases (11.11%) of acute suppurative lymphadenitis and six cases (7.41%) of metastatic squamous cell carcinoma to the lymph nodes. Conclusions: FNA is an ideal tool which can be used as a basic investigation for the evaluation of lymphadenopathy. Reactive lymphadenitis followed by tuberculosis was the major cause of lymph node enlargement in our setup. Epithelioid granulomas with or without necrosis and/or AFB positivity on the cytological smears and with associated clinical symptoms should be considered as tuberculosis in our clinical setup unless proven otherwise.

Comparison of routine cytology findings with conventional ziehl-neelsen method and fluorescent method for detection of acid fast bacilli in fine needle aspirates from suspected cases of tuberculous lymphadenitis

Objective: This study aimed to correlate the modified fluorescence stain method and conventional ZN method with routine cytology findings on lymph node aspirates for the detection of AFB in suspected cases of tuberculous lymphadenitis. Material and Methods: After adequate fine needle aspiration, aspirates were examined for cytology diagnosis, studied with Ziehl-Neelsen and Auramine-rhodamine Fluorescent stain. Cytological findings, ZN stain observations and grading were compared with fluorescent stain grading. Result: In our study, 36 cases were reported positive by fluorescent staining method for M. tuberculosis. Out of 43 granulomatous lymphadenitis cases diagnosed by FNAC, 29 cases were reported positive for acid fast bacilli by Z-N staining. 11 cases were found as false negative (22%). Sensitivity and specificity of Z-N method was found to be 70.27% and 76.92% respectively. And for cytological method it was 96.77% and 31.57% respectively. Conclusion: There are problems in arriving at an absolute diagnosis in certain cases of tuberculous lymphadenitis when the aspirate shows polymorphous picture with occasional epithelioid cells and absence of typical Langhans giant cell or caseous necrosis. Microscopy has many advantages when it comes to speed & feasibility, its sensitivity could be improved by adjuvant methods.

Comparative Study of Ziehl-Neelsen Stain versus Fluorescent Microscopy in Diagnosis of Tuberculous Lymphadenitis on FNAC at A Tertiary Care Centre

Introduction: Worldwide, TB is one of the top 10 causes of death and the leading cause from a single infectious agent. Lymph nodes tuberculosis is considered the most common form of extrapulmonary tuberculosis and most common cause of lymphadenopathy in developing countries like India.Conventional Ziehl-Neelsen (ZN) method & Fluorescent microscopy (FM) plays an important role for detection of Acid fast bacilli (AFB). Objectives: This study is an attempt to find out cost effective, rapid and sensitive technique for early diagnosis of tuberculous lymphadenitis. To study incidence, age, sex and site wise distribution of tuberculous lymphadenitis in this area. Material Methods: The prospective observational study was carried out in the Department of Pathology, S.R.T.R. Govt. Medical College, Ambajogai in year 2017. All 247 aspirated samples from Lymph node swellings were subjected to ZN stain, Fluorescent stain, MGG & PAP stain and 52 cases of tuberculous lymphadenitis were subjected for further analysis, Results: Out of 247 samples aspirated from lymph node lesions 52 were of tuberculous lymphadenitis (21.05%). For tuberculous lymphadenitis, age ranged from 7 months to 77 years. Female predominance was noted with Female to male ratio 1.17:1. Half of the cases were in the range of 21-40 years of age. Cervical region was the commonest siteinvolved with 51.92%. Of 52 aspirates, smear positivity of AFB on ZN stain method was 78.84%, while positivity of Auramine fluorescent stain method was 90.38%. Conclusion: In developing countries with high prevalence of tuberculosis, Fine needle aspiration cytology (FNAC) coupled with fluorescent stain & ZN stain could distinctively improve diagnosis of tuberculous lymphadenitis in patients presenting with superficial lymphadenopathy.

Two Cases of Tuberculous Lymphadenitis of the Supraclavicular Lymph Nodes Suspected of being Breast Cancer Metastasis

Two Cases of Tuberculous Lymphadenitis of the Supraclavicular Lymph Nodes Suspected of being Breast Cancer Metastasis