Tubercular Lymph Nodes Research Articles

Efficacy of cartridge-based nucleic acid amplification test (CBNAAT) in comparison with line probe assay and liquid culture in the evaluation of tubercular lymph node abscess.

Tuberculosis (TB) remains the number one cause of adult deaths by a curable infectious disease. Mycobacterium tuberculosis bacilli (MTB) is the most common causative organism isolated from mycobacterial lymphadenitis. Accurate and speedy diagnosis is required, especially in paucibacillary extrapulmonary TB. In this study, we compared the efficacy of CBNAAT with line probe assay and liquid culture in the evaluation of tubercular lymph node abscesses. This is a hospital-based observational cross-sectional study conducted at Gandhi Medical College and Hospital, Secunderabad, TS, in patients who presented with lymph node abscesses over a period of 18 months after obtaining clearance from the ethics committee and obtaining informed consent. Each sample was evaluated and analyzed in association with the clinical findings, AFB staining, CBNAAT, LPA, and AFB culture, and the results were compared. Fifty patients with TB lymph node abscess diagnosed through FNAC were included in the present study. AFB smear was positive in 29 samples, CBNAAT was positive in 43 samples, LPA was positive in 44 samples, and liquid culture was positive in 39 samples. CBNAAT could detect TB in 16 smear-negative cases, 10 liquid culture-negative cases, and one LPA-negative case. In our study, CBNAAT was more effective in diagnosing TB lymph node abscess than AFB smear. No significant results were obtained when comparing CBNAAT with LPA and liquid culture. This study demonstrates excellent diagnostic accuracy of the Xpert MTB/RIF test in patients with tuberculous lymphadenitis, with a sensitivity of 86%, specificity of 83.33%, negative predictive value of 95.56%, and positive predictive value of 58.82%. Thus, it can be a rule in testing for lymph node TB. These efforts will contribute to the attainment of the TB elimination goal.

Outcome of Surgical Treatment in the Management of Tubercular Cervical Lymphadenopathy: An Experience in NIENT, Dhaka

Objectives: To observe the necessity and effectiveness of the surgical intervention as a last measure in management of tubercular cervical lymphadenopathy. Another objectives are to identity the various presentation of extra pulmonary cervical tuberculosis in our country, patterns as well as causes of recurrence and resistance, type of surgery done in tubercular cervical lymphadenopathy and complications after surgery.
 Materials and Methods: This prospective observational study was carried among 52 patients of tubercular cervical lymphadenopathy attended in the outpatient department (OPD) and admitted into the inpatient department (IPD) of National Institute of ENT, Dhaka during the period of January 2017 to June 2018 of which first 12 months for treatment and follow up; and next 06 months exclusively for follow up, where patients of tubercular cervical lymphadenopathy were surgically treated along with standard antitubercular drugs.
 Results: Most of the patients 71.16% had fever and weight loss, 51.93% patients had multiple nodes at one level, 48.08% abscess and 9.62% sinus, most tubercular lymph nodes were present at level V 73.07% and in the left side 57.69% , 60% were Gene -Xpert positive. All patients were cured who had underwent surgery with no recurrence.
 Conclusion: A good number of patients of tubercular cervical lymphadenopathy necessitated neck dissection but patient compliance is a must in the management of the disease.
 Bangladesh J Otorhinolaryngol 2022; 28(1): 84-90

Utility of cartridge based nucleic acid amplification test in diagnosis of tubercular lymph nodes on fine needle aspiration and its comparison with zeihl-neelsen staining and concentration bleach method

Tuberculosis (TB) is one of the oldest disease known to humanity and among the deadliest epidemics and is in the top 10 causes of death worldwide. The incidence of tuberculosis in India has dramatically increased and contributing to it is Human Immunodeficiency Virus (HIV). Various diagnostic methods are available for detection of tubercular bacilli. Only full proof criteria for diagnosis of TB is to demonstrate the bacilli from affected tissue. This study was planned in extra pulmonary tuberculosis cases to evaluate different staining methods for demonstration of mycobacterium on FNAC material. To evaluate efficacy of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) in the initial cytodiagnosis of Tubercular Lymphadenitis 147 clinically suspected cases of extra pulmonary tuberculosis mainly TB lymphadenitis who attended cytology OPD were selected irrespective of age and sex. FNAC was performed. Slides stained for PAP, ZN and concentration bleach. Material remained in hub was sent for CBNAAT. PAP stained slides were observed for various morphological pattern.Six morphological patterns were observed. Positivity for acid fast bacilli by ZN staining, concentration bleach method and CBNAAT were compared. Detection of acid-fast bacilli by CBNATT was found more as compared to ZN and Concentration bleach method.

Periampullary Tuberculosis-obstructive Jaundice - A Rare Case Report

Obstructive jaundice rare variant caused by abdominal tuberculosis specially due to involvement of peripotal lymph node. Abdominal tuberculosis (TB) commonly affects the intestinal tract, lymph nodes, peritoneum and solid organs in varying combinations. I will describe a patient with biliary obstruction caused by enlarged tubercular lymph nodes.

Mediastinal tubercular lymph nodes completely encasing aorta in a child- A rare complication

Mediastinal tubercular lymph nodes completely encasing aorta in a child- A rare complication

Contrast-enhanced endoscopic ultrasound features of tubercular lymphadenopathy.

There is lack of data on the contrast-enhanced endoscopic ultrasound features of tubercular lymph node; our retrospective analysis of 37 patients with enlarged mediastinal and abdominal lymph nodes showed heterogeneous enhancement in the great majority (70%).

English

BACKGROUND Neck swellings consists of a wide spectrum of pathological entities. These swelling can occur due to a variety of aetiologies consisting of congenital, acquired inflammatory, neoplastic, or vascular origin. It is essential to have an extensive knowledge of the anatomy and contents of each cervical compartment to achieve a diagnosis. The age of presentation and clinical findings often narrows down the differential diagnosis. Ultrasonography (USG) is helpful in differentiating the nature of the lesions and differentiating solid from cystic neck lesions. Ultrasound is often used as an initial modality for pre-treatment assessment of any neck swelling. METHODS Patients with clinically palpable / non-palpable neck swellings were scanned using 7.5 - 11 MHz transducers, excluding patients with diagnosed thyroid swellings. RESULTS In total 120 cases were studied; the mean age of patients was 34 years with a male to female ratio of 1.1:1. The age wise categorisation included paediatric population (34.2 %) and adult population (65.8 %). 96 (80 %) cases presented with painless neck swelling, 76 (63.3 %) cases were non-neoplastic and 44 (36.7 %) cases were neoplastic in nature. Cervical lymphadenopathy being the most common ultrasound finding in both paediatric and adult population. Malignant lesions were most common in adult age group. Heterogeneous echotexture, rounded nodes, intranodal necrosis, loss of echogenic hila, peripheral nodal blood flow and increased pulsatility index (PI) and resistive index (RI) were important features of malignant lymph nodes. Sensitivity and specificity of USG and Doppler in differentiating neoplastic from non-neoplastic lesions were 97.7 % and 98.3 % respectively and for differentiating benign from metastatic nodes were 97.7 % and 98.3 % respectively. CONCLUSIONS Considering the study results and observations, USG is the best initial investigation for the evaluation of inflammatory, cystic and neoplastic swellings in various age groups. It is non-invasive, cost effective readily available and repeatable technique. It is relatively easier to use and does not involve radiation hazards. Colour Doppler can evaluate the vascularity of the lesions and provide details of any vascular invasion of metastatic lesions. Ultrasound can differentiate aetiology of lymph node enlargement to a significant extent. KEYWORDS High Resolution Ultrasound, Paediatric Neck Mass, Metastatic Lymph Node, Histopathology, FNAC, Tubercular Lymph Nodes, Colour Doppler, Non-Thyroidal

18F FDG PET-CT Imaging in the Evaluation of Diagnosed Extra Pulmonary Tuberculosis

Objectives: Extra Pulmonary Tuberculosis (EPTB) presents with atypical symptoms and heterogeneous clinical features. Management of EPTB including diagnosis, localization, extension and monitoring treatment response of active disease is quite challenging. Moreover, localization of active disease, differentiation between active and latent disease by conventional methods is troublesome. So this study was done to evaluate the metabolic activity of active disease by 18F Flurodeoxyglucose (FDG) PET-CT in diagnosed cases of EPTB patients.
 Patients and methods: A total of 17 patients with EPTB were included in this study. FDG PET-CT scan was performed to evaluate the metabolic activity of tubercular lesions before anti-TB treatment. Clinical features, biochemical changes including ESR, WBC count, CRP, MT test and maximum standardized uptake value (SUVmax) of most intense FDG avid lesions and sizes were recorded in 18F FDG PET-CT scan.
 Results: All 17 patients (09 female, 08 male) had lymph node involvement, two had bone TB and two had abdominal TB. Active TB lesions showed increased FDG uptake in extra-pulmonary tubercular lesions in 16 patients. The mean SUVmax value of the involved lymph nodes were 9.4 ± 6.0 and the mean size (maximum diameter) 19.8 ± 10.4 mm (mean ± SD). One histologically proven EPTB patient had non avid lesions in FDG PET-CT scan.
 Conclusion: 18F FDG PET-CT scan plays an important role in the localization, extension and differentiation between active and latent TB. In this study, the metabolic activity and size of the involved tubercular lymph nodes were increased in active lesions. Increased FDG uptake in active tubercular lesions may help in treatment monitoring of EPTB. Non avid lesions in EPTB patients revealed suggested latent TB which can change further management plan. Although PET-CT is an expensive technology, application of this sophisticated imaging technique in atypical or doubtful cases of EPTB might modify the treatment plan significantly after proper evaluation of the disease status. , 18F FDG PET-CT scan will be helpful to evaluate the disease status and modification of treatment regime in non-responders cost-effectively. A nationwide large-scale study would be the better way for clinical validation.
 Bangladesh J. Nuclear Med. 22(1): 9-14, Jan 2019

Tubercular lymphadenitis presenting with facial palsy: a rare case report

<p class="abstract"><span lang="EN-IN">India has a very high prevalence of tuberculosis (TB). Incidence of extrapulmonary tuberculosis is on the rise and at times it presents with uncommon features. We reported a case of 27 year old female presented with an irregular scar mark in the submandibular region along with an asymmetric smile. She was on treatment for tuberculosis as diagnosed by an earlier aspiration cytology report. Examination showed irregular non tender scar along with an underlying 2×2 cms swelling. Repeat fine needle aspiration was inconclusive and the patient was thus taken up for excision biopsy. Final report turned out to be tubercular lymphadenopathy and treatment was thus started accordingly. We conclude that tubercular lymph nodes presenting with facial nerve paresis are extremely rare entity. A high degree of suspicion should be maintained in a country like India where prevalence of TB is significantly high.</span></p><p class="abstract"> </p>

Evaluation of fine needle aspiration cytology among lymphadenopathy patients in Ambedkarnagar, Uttar Pradesh, India

Background: Surgical fine needle aspiration cytology is most popular diagnostic aid in patients with lymphadenopathy.Methods: This one year observational study comprised of aspirate collected from lymph nodes of patients attending Mahamaya Rajkiya Allopathic Medical College and Hospital, Ambedkarnagar, Uttar Pradesh, India. Fine needle aspiration was performed in all the patients and slides were stained with H and E, PAP and Ziehl Neelsen stains. SPSS was used for data analysis. Fischer’s Exact test was applied.Results: Out of the 51 patients, the most common site of lymph node aspirated was cervical (72.5%). A higher proportion of cases were diagnosed as chronic nonspecific lymphadenitis (23.5%) followed by granulomatous abscess (23.5%), tubercular lymph node (21.6%) and reactive (17.6%). A significant association found between FNAC diagnosis and age was found (p≤ 0.05).Conclusions: FNAC is a simple and useful procedure in patients with lymphadenopathy.

FNAC of tubercular lymph node-An alternative to excision biopsy

Background: Tuberculosis is a major health problem in our country, India. Tuberculer involvement of cervical lymph node is very common. Diagnosis of tubercular lymphadenitis can be made by using various biochemical, micro bacteriological laboratory methods. Above all these methods stands Fine needle aspiration cytology (FNAC) of affected lymph node which is simple, quick, easy and effective method to diagnose tubercular lymphadenopathy. Aim: This study is done to 1. Study various cytological patterns of tubercular lymphadenitis & find out the AFB positivity of such cases. 2. To find out how far it can obviate the biopsy of tubercular lymph nodes for diagnosis. Material and Methods: Total 465 suspected cervical tubercular lymphadenopathy patients of were included in study. Detailed clinical history regarding duration of swelling, sites, size, consistency, and mobility were taken into account. Fine needle aspirations were done and the smears were air-dried and stained with May- Grunwald Giemsa (MGG) and Ziehl-Neelsen (ZN) stain for acid fast bacilli (AFB). Result: During this period of five years 465 patients of cervical lymphadenopathy were diagnosed as tubercular lymphadenitis. AFB positivity was 55.2%. Conclusion: FNAC can be used as diagnostic tool alone in case of tubercular lymphadenitis. Keywords: FNAC, Z-N staining, Tubercular

English

AIMS AND OBJECTIVES: To study and differentiate neoplastic (Malignant) and nonneoplastic (Reactive and tubercular)cervical lymph nodes by High resolution ultrasonography. To correlate the diagnostic accuracy of ultrasound with FNAC in differentiating neoplastic (malignant) and nonneoplastic (reactive and tubercular) cervical lymphadenopathy. MATERIAL AND METHODS: Data was collected from a total of 100 cases referred for ultrasound of neck to the Department of Radiodiagnosis, Sri R. L. Jalappa Hospital and Research Center over a period of 24 months from January 2012 to January 2014, with 5-10 MH linear transducer using SEIMENS G 40/G 50/ Acuson Ax 300 ultrasound equipment. Lymph nodes were assessed using grey scale and colour Doppler parameters like: nodal level and site, size, shape, L/S ratio, border, hilum, echotexture, necrosis, matting and angioarchitecture (hilar vessels, capsular vessels (peripheral) and mixed flow). A provisional diagnosis was suggested after the ultrasound examination and these findings were correlated with Fine Needle Aspiration Cytology/ Histopathological findings. RESULTS: In our study out of 45 non neoplastic nodes (reactive and tubercular) only 41 nodes were identified as non- neoplastic (reactive/ tubercular) on ultrasound prior to FNAC/ histopathology. Out of 55 possible neoplastic (malignant nodes) detected on ultrasound only 46 lymph nodes turned out to be neoplastic on FNAC/ histopathology. Lymph node with oval shape (L/S ratio > 2) echogenic hilum, homogenous echotexture and hilar vascularity were considered as significant parameters in detecting non-neoplastic (reactive) lymph nodes, which showed matting with soft tissue edema were considered nonneoplastic lymphnodes (Tubercular lymphnodes). Nodes which were Round shape (L/S ratio < 2), absent hilum, heterogeneous echotexture, hilar, capsular vessels and mixed vascularity were considered as significant parameters in detecting neoplastic (malignant) lymph nodes. Correlation of sonographic findings with Fine Needle Aspiration Cytology/ Histopathological findings was performed. Sensitivity and Specificity of ultrasound in differentiating neoplastic from non-neoplastic cervical lymphadenopathy was found to be 90% and 74% respectively. CONCLUSIONS: This study concludes that: 1) High resolution ultrasonographic examination proved as a valuable primary investigation to identify lymph nodes and differentiate nonneoplastic and neoplastic lymphadenopathy. 2) Combination of ultrasonographic features with vascular pattern of the lymph nodes have a high sensitivity, specificity in differentiating neoplastic and non-neoplastic

Metabolic profiling of cervical tubercular lymphadenitis tissues by proton HR-MAS NMR spectroscopy

Proton metabolic profiling of incisional biopsied cervical lymph node tissue specimens of 109 patients suffering from tubercular (CTBL) and non-specific (NSCLA) lymphadenitis were analyzed by high resolution magic angle spinning (HR-MAS) NMR spectroscopy. In the present study, 40 endogenous metabolites namely, myo-inositol (m-Ins), branched chain amino acids (BCAA), glutamate, serine, taurine (Tau) aromatic amino acids, choline (Cho) containing compounds and glucose were characterized. To the best of our knowledge, this is the first report on metabolic profiling of cervical tubercular lymph node tissues using HR-MAS NMR spectroscopy. The principal component analysis revealed a clear discrimination between CTBL and NSCLA tissues. Increase in the concentration of mobile poly unsaturated fatty acids, BCAA, Cho, Tau, glycine and a decrease in the concentration of lactate, phosphocholine and m-Ins was observed in CTBL cases. The partial least square discriminant analysis (PLS-DA) with R 2 = 0.95 and Q 2 = 0.92 provided >98 % of correct classification between the two groups. A PLS-DA training set model of 75 % (CTBL = 54, NSCLA = 27) of the subjects when subjected for prediction of 25 % cases (CTBL = 18, NSCLA = 10) as an unknown dataset provided more than 98 % of diagnostic accuracy in their respective histological categories. The receiver operator characteristic curve was generated from PLS-DA factor-1 projected an area under the curve of 0.962. The metabolic profile obtained from HR-MAS NMR spectroscopy may be used as surrogate markers in vivo MRS for differentiating between CTBL and NSCLA cases non-invasively.

Mediastinal tubercular lymph node eroding into pericardium causing acute pyopericardium and cardiac tamponade

Cardiac tamponade due to tuberculosis is a well-known complication. However, acute erosion of TB lymphadenitis and its caseous material into the pericardium causing pericardial tamponade is rare. We describe a case of extensive mediastinal tubercular lymph node mass in which the caseous necrotic material found its way into pericardial sac causing acute pyopericardium and cardiac tamponade.

Subcutaneous emphysema as the first relevant clinical sign of complicated tubercular lymph node disease in a child

BackgroundChildren make up a significant proportion of the global tuberculosis (TB) caseload, and experience considerable TB-related morbidity and mortality. Unfortunately, it is not easy to diagnose TB in the first years of life because of the diversity of its clinical presentation and the non-specific nature of most of its symptoms.Case presentationA 26-month-old male child was admitted to hospital because of the sudden onset of rapidly increasing swelling of the neck, face and upper trunk a few hours before. Upon admission, his temperature was 36.5°C, pulse rate 120/min, respiratory rate 36/min, and O2 saturation 97% in air. Palpation revealed subcutaneous emphysema (SE) over the swollen skin areas, and an examination of the respiratory system revealed crepitations in the left part of the chest without any significant suggestion of mediastinal shift. Chest radiography showed enlargement of the left lung hilum with pneumomediastinum and diffuse SE. Bronchoscopy was carried out because of the suspicion that the SE may have been due to the inhalation of a peanut. This excluded the presence of a foreign body but showed that the left main bronchus was partially obstructed with caseous material and showed significant signs of granulomatous inflammation on the wall. Contrast-enhanced computed tomography of the lungs confirmed the SE and pneumomediastinum, and revealed bilateral hilum lymph node disease with infiltration of the adjacent anatomical structure and a considerable breach in the left primary bronchus wall conditioning the passage of air in the mediastinum and subcutaneous tissue. As a tuberculin skin test and polymerase chain reaction for Mycobacterium tuberculosis on bronchial material and gastric aspirate were positive, a diagnosis of TB was made and oral anti-TB therapy was started, which led to the elimination of M. tuberculosis and a positive clinical outcome.ConclusionsThis is the first case in which SE was the first relevant clinical manifestation of TB and arose from infiltration of the bronchial wall secondary to caseous necrosis of the hilum lymph nodes. Physicians should be aware of the fact that SE is one of the possible initial signs and symptoms of early TB infection, and act accordingly.

Enigma unraveled: Role of Ultrasonography in Tuberculous Lymphadenopathy

Lymphadenopathy is the most common form of extrapulmonary tuberculosis; cervical region being the frequent affected site. Ultrasound is a useful noninvasive imaging modality in the assessment of cervical lymph nodes. The morphology of lymph nodes is evaluated by grey-scale sonography and the power Doppler sonography helps in the assessment the vasculature of lymph nodes. Tuberculous lymphadenitis exhibits distinctive features like presence of adjacent soft tissue edema and matting of nodes. This article highlights the use of ultrasonographic as a diagnostic approach, by comparing and differentiating the features of tubercular lymph nodes in a 10-year-old female patient.

A study of tubercular lymphadenitis: A comparison of various laboratory diagnostic modalities with a special reference to tubercular polymerase chain reaction

Objective: The purpose of our study was to compare various laboratory diagnostic methods, namely histopathological examination, Ziehl-Neelsen (ZN) stain, AFB culture by conventional Lowenstein–Jensen (LJ) method and fluorescence-based mycobacterial growth indicator tube (MGIT) technique and polymerase chain reaction (PCR) in clinically suspected cases of tubercular lymphadenitis. Materials and Methods: A total of 65 lymph nodes biopsied from patients clinically suspected of having tubercular lymph nodes were included. Specimens were processed for AFB culture after NaOH-NALC concentration and inoculation on LJ medium and using the MGIT system. PCR was performed on all specimens using a commercial nested PCR kit targeting IS6110 insertion element of Mycobacterium tuberculosis complex. All lymph node specimens were subjected to histopathological examination. Results: Of the 65 lymph nodes, 37 (56.9%) were positive on MGIT culture and 45 (69.2%) were positive by PCR. Histopathology showed maximum sensitivity (96%) but with compromised specificity (78.5%). PCR showed 90.1% sensitivity and 100% specificity. The mean turnaround time for mycobacterial growth in smear negative specimens was 30 days determined by LJ and 20 days by MGIT techniques. Conclusion: PCR is a rapid and useful method for diagnosis of TB lymphadenitis and definitely increases the positive predictive value of a positive histopathology report. MGIT is better than LJ culture as regards time to positivity and higher yield.

Usefulness of ultrasonography for the evaluation of cervical lymphadenopathy

AimTo evaluate the role of ultrasonography for differentiating cervical lymphadenopathy due to tuberculosis, metastasis and lymphoma.MethodsUltrasonography of the neck nodes was carried out prior to FNAC in 192 patients using a 10 mHz linear transducer. The sonographic findings were then correlated with the definitive tissue diagnosis obtained by FNAC or lymph node biopsy.ResultsThe most significant distinguishing feature was strong internal echoes seen in 84% of tubercular lymph nodes. This finding was found in only 11% of metastatic nodes and absent in lymphomatous nodes. The other findings such as L/S ratio, irregular margins, hypoechoic center, fusion tendency, peripheral halo and absent hilus were helpful in differentiating reactive from diseased nodes but showed considerable overlap in the 3 groups of tubercular, metastatic and lymphoma lymph nodes.ConclusionUltrasonography is noninvasive and can give useful clues in the diagnosis of cervical lymphadenopathy. It should be interpreted in conjunction with FNAC result. Ideally ultra-sonographic guided FNAC should be obtained from the sonographically most representative node. In FNAC indeterminate cases, sonographic features may obviate the need for an invasive lymph node biopsy.

Tubercular mediastinal lymphadenopathy: An unusual cause of failed decannulation and tracheostomy

Literature has described many causes of failed decannulation and weaning. However, failed decannulation and weaning from ventilator due to a hilar lymph node compressing upon a bronchus has not been described. We report a case of a 30-year-old man with Guillain-Barré syndrome who had quadriparesis and respiratory distress. After 1 year of intensive care unit admission, he was ambulatory, haemodynamically stable, devoid of sepsis, had effective cough with tracheostomy in situ. Every attempt of decannulation led to pooling of secretions in left side of chest, hypercarbia and altered sensorium. This was followed by re-institution of ventilator support. Chest x-ray was unremarkable, but computed tomography (CT) chest done during this time showed a mass compressing upon left lower lobe bronchus. Flexible fibre-optic bronchoscopy and transbronchial biopsy confirmed the diagnosis to be tubercular lymph node. After 1 month of starting of anti-tubercular treatment, there was resolution of the mass with relief of the bronchial compression and a successful decannulation thereafter. Role of CT in difficult cases of weaning is emphasized, and role of bronchoscopy is highlighted in difficult cases of weaning and decannulation.

Assessment of possible tuberculous lymphadenopathy by PCR compared to non-molecular methods

Tuberculosis is a major public health problem in India and other developing countries and has formed a lethal partnership with AIDS. It often presents a diagnostic challenge especially when clinical presentation is suggestive but bacteriological proof is lacking. The objective of this study was to compare the various diagnostic techniques in clinically suspected cases of tubercular lymph nodes and to find a suitable, cost-effective but sensitive and specific method for diagnosis. A total of 100 cases were recruited for the study. Fine needle aspiration cytology was done in all cases and the smears prepared were processed for Giemsa, Ziehl-Neelsen's, Kinyoun and Papanicolaou stains. Parts of the aspirated materials were assessed by fluorescent staining, culture and PCR. Seventy-four percent of aspirates were positive by fluorescent stain while only 22% were positive by culture. PCR could be performed in 55 cases, out of which 22 (40%) were positive. When compared to culture, the sensitivity and specificity of PCR were found to be 89.5% and 86.1%, respectively. Fluorescent stain was found to be the most sensitive (81.8%) of the conventional methods but showed poor specificity (28.2%). Interestingly, PCR detected 80% of smear-negative but culture-positive cases.