Diagnosis Of Tuberculosis Lymphadenitis Research Articles

Integration of cytopathology with molecular tests to improve the lab diagnosis for TBLN suspected patients.

BackgroundTuberculosis lymphadenitis (TBLN) diagnosis is often challenging in most resource poor settings. Often cytopathologic diagnosis of TBLN suspected patients is inconclusive impeding timely clinical management of TBLN suspected patients, further exposing suspected patients either for unnecessary use of antibiotics or empirical treatment. This may lead to inappropriate treatment outcome or more suffering of suspected patients from the disease. In this study, an integrated diagnostic approach has been evaluated to elucidate its utility in the identification of TBLN suspected patients.MethodsA cross-sectional study was conducted on 96 clinically diagnosed TBLN suspected patients, where fine needle aspirate (FNA) samples were collected at the time of diagnosis. FNA cytology, Ziehl-Neelsen (ZN), Auramine O (AO) staining, GeneXpert MTB/RIF and Real time PCR (RT-PCR) were performed on concentrated FNA samples. Considering culture as a gold standard, the sensitivity, specificity, positive and negative predictive values were calculated. Cohen’s Kappa value was used to measure interrater variability and level of agreement and a P-value of <0.05 was considered as statistically significant.ResultOut of the 96 FNA sample, 12 (12.5%) were identified to have Mycobacterium tuberculosis (Mtb) using ZN staining, 27 (28.1%) using AO staining, 51 (53.2%) using FNAC, 43 (44.7%) using GeneXpert MTB/RIF, 51 (53.1%) using Real time PCR (RT-PCR) and 36 (37.5%) using Lowenstein-Jensen (LJ) culture. Compared to LJ culture, the sensitivities of GeneXpert MTB/RIF, RT-PCR, and FNAC were 91.7%, 97.2%, and 97.2%, respectively and the specificities were 83.3%, 73.3%, and 68.3%, respectively. GeneXpert MTB/RIF and RT-PCR when combined with FNAC detected 61 (63.5%) cases as having Mtb, and the sensitivity and specificity was 100% and 58.3%, respectively.ConclusionFNA cytology and RT-PCR detected more TBLN cases compared to other Mtb detection tools and the detection sensitivity even improved when FNA cytology was combined with GeneXpert MTB/RIF, performed on concentrated FNA sample, suggesting the combined tests as an alternative approach for improved diagnosis of TBLN.

Contribution of fine needle aspiration and auramine tests in diagnosis of Tuberculosis lymphadenitis at Kigali University Teaching Hospital (CHUK), Rwanda

Background&#x0D; Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis. Tuberculosis affects mainly the lungs but other organs of the body are involved. TB lymphadenitis is most common in extrapulmonary TB. Lymphadenitis is the infection or inflammation of the lymph nodes which are essential in immune response of the body.&#x0D; Objective&#x0D; To evaluate the contribution of fine needle aspiration (FNA) and auramine tests in the diagnosis of TB lymphadenitis.&#x0D; Methods&#x0D; Smears from lymph node aspirates were prepared. Air-dried smears were stained by auramine staining for AFB examination and Diff-Quick staining cytological technique to detect malignant cells and other pathology. The slides were examined by laboratory technologists and the pathologist.&#x0D; Results&#x0D; Results are based on a total number of 137 samples; 58 (42.33%) cases were auramine positive for TB lymphadenitis while other 79 (57.67%) suspected cases were non TB lymphadenitis. Necrotizing lymphadenitis, granulomatous lymphadenitis, chronic lymphadenitis, acute lymphadenitis and reactive lymphadenitis represented 21.19%; 13.14%; 1.42%; 2.19%; and 19.71% respectively.&#x0D; Conclusion&#x0D; The use of auramine test and FNA cytology should be considered as useful in the diagnosis of tuberculosis lymphadenitis. These techniques are less expensive, quick, safe and show low complication rate.&#x0D; Keywords: TB lymphadenitis; fine needle aspiration; auramine test

Pattern of tuberculosis lymphadenitis diagnosed by fine needle aspiration cytology in Gondar University Hospital

<h3>Introduction</h3> Tuberculosis lymphadenitis is the most common extrapulmonary tuberculosis. Fine needle aspiration cytology (FNAC) provides a cheap and rapid diagnostic means in resource poor setting. <h3>Objectives</h3> The purpose of this study is to assess the pattern of tuberculosis lymphadenitis in Gondar university hospital. Prevalence, age, sex and site distribution is determined in this study. <h3>Method</h3> This is a retrospective descriptive study conducted by reviewing FNAC record done in one year in Gondar university hospital. <h3>Result</h3> There was a total of 1884 patients on whom FNAC was done in the pathology department over period of one year. Of these, 600 (32%) were LN aspirates. Of these 600 cases, 321 (53%) showed cytological features of tuberculosis lymphadenitis. Females accounted for 55% of patients with the diagnosis of tuberculosis lymphadenitis. Patients' ages ranged from 3 to 78 years. The most commonly involved lymph nodes were the cervical group of lymph nodes (46%). Two were from intra-abdominal lymph nodes. <h3>Conclusion</h3> Prevalence of tuberculosis lymphadenitis is high in Gondar. Immediate public health measures to treat, prevent and control this disease should be put in action as soon as possible.

Tuberculosis Lymphadenitis in Northwest Ethiopia: Implications for Public Health

Objective: In Ethiopia where there are limited diagnostic facilities, the actual burden of tuberculosis (TB) lymphadenitis is not well known. Therefore, we conducted this study to determine the proportion of TB lymphadenitis (TBL) in childhood and adults in Northwest Ethiopia. Materials and Methods: A prospective cross sectional study was conducted from April to May 2012. Fine needle aspiration cytology (FNAC) for cytological diagnosis of TBL was used. The diagnosis of TBL was established when cytological features from lymph node aspirates are strongly suggestive of TB. Descriptive and multivariate analysis was done using SPSS version 16. Results: Out of 1070 patients attending the cytological diagnosis in the study sites 437 (41%) were positive for TBL. Of the 437 registered TBL, 59 (13.5%) were pediatric patients and 378 (86.5%) were adults. There were more females than males with a male to female ratio of 0.8:1. The cervical region had the most common group of TBL with 321 (73.2%) patients. Most of all these patients 314 (75.3%), were matted with a majority of (250/314) being in the cervical region. Individuals who had contact history with TB patients (P = 0.046) were more likely to have TBL. Conclusions: In the studied region high prevalence of TBL was documented. Screening of TBL particularly for those who had contact with TB patients is recommended. Most patients in our study presented with matted lymph nodes, indicating that late arrival of patients to health institutions. Thus continuous and intensified public health strategies on health education and early referral system have to be done in order to link them to health institutions earlier than at present.

Tuberculosis lymphadenitis in Southwest Ethiopia: a community based cross-sectional study

BackgroundIn Ethiopia where there is no strong surveillance system and diagnostic facilities are limited, the real burden of tuberculosis (TB) lymphadenitis is not well known. Therefore, we conducted a study to estimate the prevalence of TB lymphadenitis in Southwest Ethiopia.MethodsA community based cross-sectional study was conducted from February to March 2009 in the Gilgel Gibe field research area. A total of 30,040 individuals 15 years or older in 10,882 households were screened for TB lymphadenitis. Any individual 15 years or older with lumps in the neck, armpits or groin up on interview were considered TB lymphadenitis suspect. The diagnosis of TB lymphadenitis was established when acid fast bacilli (AFB) smear microscopy of fine needle aspiration (FNA) sample, culture or cytology suggested TB. HIV counseling and testing was offered to all TB lymphadenitis suspects. Descriptive and bivariate analysis was done using SPSS version 15.ResultsComplete data were available for 27,597 individuals. A total of 87 TB lymphadenitis suspects were identified. Most of the TB lymphadenitis suspects were females (72.4%). Sixteen cases of TB lymphadenitis were confirmed. The prevalence of TB lymphadenitis was thus 58.0 per 100,000 people (16/27,597) (95% CI 35.7-94.2). Individuals who had a contact history with chronic coughers (OR 5.58, 95% CI 1.23-25.43) were more likely to have TB lymphadenitis. Lymph nodes with caseous FNA were more likely to be positive for TB lymphadenitis (OR 5.46, 95% CI 1.69-17.61).ConclusionThe prevalence of TB lymphadenitis in Gilgel Gibe is similar with the WHO estimates for Ethiopia. Screening of TB lymphadenitis particularly for family members who have contact with chronic coughers is recommended. Health extension workers could be trained to screen and refer TB lymphadenitis suspects using simple methods.

Comparison of PCR with standard culture of fine needle aspiration samples in the diagnosis of tuberculosis lymphadenitis

Lymphadenopathy is the commonest form of extrapulmonary tuberculosis (TB) Clinical diagnosis of TB in lymph nodes requires aspiration of the material and isolation of mycobacteria. Bacterial culture is the gold standard for detection of tubercle bacilli, but it is time-consuming and requires specialized safety procedures and a BSL3 laboratory. However, PCR is a rapid method which requires small volumes of samples and can also be performed on killed bacilli to ensure safety. This project was designed to compare direct fine needle aspirate (FNA) PCR with culture in the diagnosis of tuberculosis lymphadenitis. Direct examination of samples with EZN staining, culture, cytology and PCR was performed on previously collected FNA from the patients with suspected tuberculosis lymphadenitis. In total, 38% of the samples were positive for TB by culture, 11.8% by EZN staining, 23.4% by PCR, and 59.8% by cytology. Cytology had the highest sensitivity (81%) and EZN stain the least (22.9%). The specificity of EZN stain was the highest (92.4%) while cytology was the lowest (50%). In this study, out of 50 culture-positive samples, 21 (42%) were positive by PCR while 8 (10.8%) out of 74 culture-negative samples were positive by PCR. Although PCR is a sensitive diagnostic method, its sensitivity was shown to be low in this study. Therefore, we recommend that further studies should be conducted on fresh aspirate samples to investigate for possible PCR inhibitors which may limit the sensitivity of PCR diagnosis.

Tuberculous osteomyelitis of the foot in a haemodialysis patient.

A 64-year-old woman with end-stage renal disease secondary to hypertension undergoing haemodialysis for 2 years was admitted with a history of fever, pain and swollen left foot lasting for 1 year. Clinical examination demonstrated localized erythema, warmness and swelling (Figure ​(Figure1).1). The erythrocyte sedimentation rate was 122 mm/h and C-reactive protein was 12.6 mg/dL (normal <0.5 mg/dL). The tuberculin skin test revealed 26 mm enduration with bullous oedema. Thoracic computed tomography indicated only calcified lymph nodes in the left hilar region. Magnetic resonance imaging showed destruction in the navicular bone and widespread oedema in the adjacent bones and fluid collection (Figure ​(Figure2).2). After surgical intervention, a diagnosis of tuberculosis (TB) was established with the histopathological examination of the tissue. Growth of mycobacterium tuberculosis complex was found in the culture obtained at the time of bone debridement. However, she was lost to follow-up without anti-TB treatment. After 10 months, she presented with fever, swelling and drainage in the left inguinal region. Ultrasonographic examination revealed enlarged inguinal lymph nodes. The diagnosis of TB lymphadenitis was made by demonstrating positive acid-fast bacilli in the drainage fluid. She was cured with standard anti-TB drugs for 9 months. Fig. 1 Swollen left foot in the lateral position. Fig. 2 The MRI of the patient showed a diffuse low-intensity signal on T1-weighted sagittal image in the left navicular bone. TB osteomyelitis is one of the unusual manifestations of osteoarticular TB and comprises 2–3% of all cases [1]. Due to nonspecific presentation, symptoms together with frequent extrapulmonary localization, this rare condition is often misdiagnosed or the true nature of the lesion is identified late in the diagnostic process as in our case.

Chylothorax due to tuberculosis lymphadenopathy: Report of a case

While pulmonary tuberculosis is a very frequent infection, chylothorax is an unusual manifestation of tuberculous disease. A 71-year-old woman with chylothorax is herein presented. The ductus thoracicus was ligated and lymphadenomegaly, which was adjacent to diaphragm, was resected. Based on the findings of various tests, a diagnosis of tuberculosis lymphadenitis was made. The patient was administered antituberculosis chemotherapy and has since remained asymptomatic for 1 year after the operation. In conclusion, tuberculosis lymphadenomegaly may lead to the development of chylothorax. The combination of appropriate surgical and medical treatment is an effective therapeutic strategy for this pathology.