Tuberculosis Lymphadenitis Research Articles

ULTRASONOGRAPHY EVALUATION OF PEDIATRIC NECK MASSES

Background: Neck masses are a frequent discovery in children and pose challenges in diagnosis. These masses can stem from congenital, inflammatory, neoplastic, or vascular origins. Understanding the cervical anatomy and compartments is crucial for differential diagnosis. There are different cystic lesions like ranula, thyroglossal cyst, brachial cyst, lymphangioma and vascular malformation and solid lesions like reactive lymph nodes,thyroid lesions,ectopic thymus etc.Rare lesions like teratoma,rhabdomyosarcoma,neurofibroma also exists. Aims: To assess congenital and acquired neck masses in children using ultrasonography (USG) and correlate imaging findings with pathology. Materials and Methods: This prospective observational study involved 30 pediatric patients with clinically palpable neck swellings referred for USG. Imaging was followed by necessary USG-guided procedures, and radiological findings were compared with histopathology. Results: Among 30 patients, 68% were male and 32% female. Most patients (53%) were aged 1-10 years. Right-sided lesions were most common (41.15%), with bilateral (17.25%) and midline (11.5%) presentations noted. Inflammatory causes were predominant (76.1%), followed by congenital (16.3%) and neoplastic (7.5%). USG revealed features such as reactive lymphadenitis (14 cases), TB lymphadenitis (6 cases), abscesses (2 cases, confirmed by aspiration), thyroglossal cysts (3 cases), lipomas (2 cases, confirmed by histopathology), malignancies (2 cases, confirmed by biopsy), and a branchial cyst (1 case). Conclusion: Pediatric neck masses are common and diagnostically challenging. Detailed clinical history, physical examination, and knowledge of cervical anatomy are crucial for accurate diagnosis. Utilizing neck compartments and multimodality imaging aids in precise diagnosis and appropriate management.

The value of nomogram model combined with contrast-enhanced ultrasound in the differential diagnosis of cervical tuberculosis lymphadenitis and metastatic lymph node.

This study aimed to construct an effective Nomogram for the differential diagnosis of cervical tuberculosis lymphadenitis (CTBL) and cervical metastatic lymph node (CMLN) based on ultrasound (US). Retrospectively analyzed 227 patients with CTBL and CMLN who attended Hangzhou Red Cross Hospital from January 2020 to October 2022, and were divided into a training set (n = 163) and a validation set (n = 64) according to the clinical data, US, and CEUS qualitative and quantitative analysis data were recorded to establish the prediction model and perform validation. The area under curve (AUC) of the receiver operating characteristic curve (ROC) was used to assess the discrimination of the model; the calibration curve and brier coefficient were used to assess the calibration of the model; and a Nomogram prediction model was constructed to visualize the results nomogram prediction model was constructed to visualize the results. Gender (OR = 0.200, 95% CI:0.090-0.470, P < 0.001), age (OR = 0.170, 95% CI:0.070-0.410, P < 0.001), liquefaction necrosis (OR = 2.560, 95% CI:1.080-6.040, P = 0.033), perfusion defect (OR = 2.570, 95% CI:1.010-6.580, P = 0.048), and Standard deviation (StdDev) (OR = 3.040, 95% CI:1.220-7.570, P = 0.017) were the independent predictors of the constructed model. The AUCs of the constructed predictive model in the training set and validation set were 0.844 and 0.927, respectively; from the calibration curves, it was observed that the predicted values of the model and the actual observed values fell near the 45° diagonal, and the brier scores were 0.145 and 0.109 in the training set and validation set, respectively. StdDev combined with Gender, age, and the presence of liquefaction necrosis and perfusion defects are important features to identify CTBL and CMLN, and the constructed visual nomogram is intuitive and convenient to improve the efficiency of clinical work.

Persistently high plasma procalcitonin levels despite successful treatment of tuberculous pleuritis and tuberculous lymphadenitis patients

In a prospective cohort study, we evaluated plasma PCT levels in 48 TB lymphadenitis (TBLN) and 41 TB pleuritis (TBPE) patients. Measurements of PCT were done in unstimulated plasma of microbiologically and clinically confirmed TBLN and TBPE patients registered for anti-TB treatment at a tertiary care hospital in Lahore, Pakistan. Plasma levels of PCT were found to be raised in 89% of the patients at baseline with a median of 1.5 ng/ml. Levels were higher (p = 0.001) in TBLN as compared to TBPE (2.69, 0.96 ng/ml). PCT levels were not related to the bacterial burden depicted by culture positivity in these patients. PCT showed a negative correlation with the severity of constitutional symptoms (rho = − 0.238, p = 0.034), and inflammatory biomarkers; ferritin (rho = − 0.43, p < 0.001), INF-γ (rho = − 0.314, p = 0.003), TNF-α (rho = − 0.220, p = 0.039), IL-6 (rho = − 0.224, p = 0.035), and several chemokines of CCL and CCXL group. Raised plasma levels of PCT did not decrease with anti-TB treatment, indicating it is not a good biomarker to monitor treatment response in TBLN and TBPE patients. More studies with a larger number of confirmed EPTB cases are needed to define the role of PCT and its interaction with other biomarkers in EPTB.

Efficacy and tolerability of a 4-month ofloxacin-containing regimen compared to a 6-month regimen in the treatment of patients with superficial lymph node tuberculosis: a randomized trial

BackgroundTuberculosis (TB) lymphadenitis is the most common form of extra-pulmonary TB, and the treatment duration is six months. This non-inferiority based randomized clinical trial in South India evaluated the efficacy and safety of a four-month ofloxacin containing regimen in tuberculosis lymphadenitis (TBL) patients.MethodsNew, adult, HIV-negative, microbiologically and or histopathologically confirmed superficial lymph node TB patients were randomized to either four-month oflaxacin containing test regimen [ofloxacin (O), isoniazid (H), rifampicin (R), pyrazinamide (Z) -2RHZO daily/ 2RHO thrice-weekly] or a six-month thrice-weekly control regimen (2HRZ, ethambutol/4RH). The treatment was directly observed. Clinical progress was monitored monthly during and up to 12 months post-treatment, and thereafter every three months up to 24 months. The primary outcome was determined by response at the end of treatment and TB recurrence during the 24 months post-treatment.ResultsOf the 302 patients randomized, 298 (98.7%) were eligible for modified intention-to-treat (ITT) analysis and 294 (97%) for per-protocol (PP) analysis. The TB recurrence-free favourable response in the PP analysis was 94.0% (95% CI: 90.1–97.8) and 94.5% (95% CI: 90.8–98.2) in the test and control regimen respectively, while in the ITT analysis, it was 92.7% and 93.2%. The TB recurrence-free favourable response in the test regimen was non-inferior to the control regimen 0.5% (95% CI: -4.8-5.9) in the PP analysis based on the 6% non-inferiority margin. Treatment was modified for drug toxicity in two patients in the test regimen, while one patient had a paradoxical reaction.ConclusionThe 4-month ofloxacin containing regimen was found to be non-inferior and as safe as the 6-month thrice-weekly control regimen.

Blood RNA signatures outperform CRP triage of tuberculosis lymphadenitis and pericarditis.

Limited data are available on the diagnostic accuracy of blood RNA biomarker signatures for extrapulmonary TB (EPTB). We addressed this question among people investigated for TB lymphadenitis and TB pericarditis, in Cape Town, South Africa. We enrolled 440 consecutive adults referred to a hospital for invasive sampling for presumptive TB lymphadenitis (n=300) or presumptive TB pericarditis (n=140). Samples from the site of disease underwent culture and/or molecular testing for Mycobacterium tuberculosis complex (Mtb). Discrimination of patients with and without TB defined by microbiology or cytology reference standards was evaluated using seven previously reported blood RNA signatures by area under the receiver-operating characteristic curve (AUROC) and sensitivity/specificity at predefined thresholds, benchmarked against blood C-reactive protein (CRP) and the World Health Organization (WHO) target product profile (TPP) for a TB triage test. Decision curve analysis (DCA) was used to evaluate the clinical utility of the best performing blood RNA signature and CRP. Data from 374 patients for whom results were available from at least one microbiological test from the site of disease, and blood CRP and RNA measurements, were included. Using microbiological results as the reference standard in the primary analysis (N=204 with TB), performance was similar across lymphadenitis and pericarditis patients. In the pooled analysis of both cohorts, all RNA signatures had comparable discrimination with AUROC point estimates ranging 0.77-0.82, superior to that of CRP (0.61, 95% confidence interval 0.56-0.67). The best performing signature (Roe3) achieved an AUROC of 0.82 (0.77-0.86). At a predefined threshold of 2 standard deviations (Z2) above the mean of a healthy reference control group, this signature achieved 78% (72-83%) sensitivity and 69% (62-75%) specificity. In this setting, DCA revealed that Roe3 offered greater net benefit than other approaches for services aiming to reduce the number needed to investigate with confirmatory testing to <4 to identify each case of TB. RNA biomarkers show better accuracy and clinical utility than CRP to trigger confirmatory TB testing in patients with TB lymphadenitis and TB pericarditis, but still fall short of the WHO TPP for TB triage tests. South African MRC, EDCTP2, NIH/NIAID, Wellcome Trust, NIHR, Royal College of Physicians London. Evidence before this study: Blood RNA biomarker signatures and CRP measurements have emerged as potential triage tests for TB, but evidence is mostly limited to their performance in pulmonary TB. Microbiological diagnosis of extrapulmonary TB (EPTB) is made challenging by the need for invasive sampling to obtain tissue from the site of disease. This is compounded by lower sensitivity of confirmatory molecular tests for EPTB compared to their performance in pulmonary disease. We performed a systematic review of diagnostic accuracy studies of blood RNA biomarkers or CRP measurements for EPTB, which could mitigate the need for site-of-disease sampling for the diagnosis of TB. We searched PubMed up to 1 st August 2023, using the following criteria: "extrapulmonary [title/abstract] AND tuberculosis [title/abstract] AND biomarker [title/abstract]". Although extrapulmonary TB was included in several studies, none focused specifically on EPTB or included an adequate number of EPTB cases to provide precise estimates of test accuracy. Added value of this study: To the best of our knowledge, we report the first diagnostic accuracy study of blood RNA biomarkers and CRP for TB among people with EPTB syndromes. We examined the performance of seven previously identified blood RNA biomarkers as triage tests for TB lymphadenitis and TB pericarditis compared to a microbiology reference standard among people referred to hospital for invasive sampling in a high TB and HIV prevalence setting. Multiple blood RNA biomarkers showed comparable diagnostic accuracy to that previously reported for pulmonary TB in both EPTB disease cohorts, irrespective of HIV status. All seven blood RNA biomarkers showed superior diagnostic accuracy to CRP for both lymphadenitis and pericarditis, but failed to meet the combined >90% sensitivity and >70% specificity recommended for a blood-based diagnostic triage test by WHO. Nonetheless, in decision curve analysis, an approach of using the best performing blood RNA biomarker to trigger confirmatory microbiological testing showed superior clinical utility in clinical services seeking to reduce the number needed to test (using invasive confirmatory testing) to less than 4 for each EPTB case detected. If acceptable to undertake invasive testing in more than 4 people for each true case detected, then a test-all approach will provide greater net benefit in this TB/HIV hyperendemic setting.Implications of all the available evidence: Blood RNA biomarkers show some potential as diagnostic triage tests for TB lymphadenitis and TB pericarditis, but do not provide the level of accuracy for blood-based triage tests recommended by WHO for community-based tests. CRP has inferior diagnostic accuracy to blood RNA biomarkers and cannot be recommended for diagnostic triage among people with EPTB syndromes referred for invasive sampling.

Evaluation of the GeneXpert MTB/RIF Assay for Rapid Diagnosis of Tuberculosis and Detection of Rifampin Resistance in Tuberculous Patients Admitted to Abbassia Chest Hospital

Abstract Background Tuberculosis is considered one of the major infectious diseases especially in the developing countries and a significant diagnostic and therapeutic challenge worldwide. Gene Xpert MTB/RIF assay is a diagnostic test which depends on a real-time polymerase chain reaction for rapid diagnosis of Mycobacterium Tuberculosis and rifampicin resistance in a single test. Aim To evaluate the diagnostic utility of Gene Xpert MTB/RIF assay for rapid diagnosis of pulmonary and extrapulmonary tuberculosis as well as the detection of rifampin resistance in specimens obtained from suspected tuberculous patients in Abbassia Chest Hospital. Patients and Methods Pulmonary and extrapulmonary samples from 77 cases with suspected TB were collected. All retrieved samples were examined with: direct smear microscopy for AFB, culture for Mycobacterium tuberculosis (L.J. media) along with Drug susceptibility testing (D.S.T.) for positive cultures. As well as the gene Xpert MTB/RIF assay and their results were compared to those of both culture and D.S.T. (as gold standard reference methods). Results Gene Xpert MTB/RIF assay showed the highest sensitivity, negative predictive value (NPV) and diagnostic accuracy in detection of pulmonary TB (96.4, 96.4 and 93.1% respectively), with 90%specificity. Xpert MTB/RIF assay showed the lowest sensitivity in diagnosing TB pleural effusion (66.6%) but with the highest specificity and positive predictive value (PPV) (100% for both). As regards diagnosing TB lymphadenitis, gene Xpert MTB/RIF assay showed 75% sensitivity and the lowest specificity (33.3%). Considering rifampin resistance, gene Xpert MTB/RIF assay showed 100% specificity in detection of RIF- Resistance with variable sensitivity according to the type of TB, being the highest in pulmonary TB (90.9% sensitivity). Conclusion Gene Xpert MTB/RIF assay could be used as the first line diagnostic tool for diagnosis of pulmonary TB because of its high diagnostic yield. Yet, it’s not recommended to replace the culture for diagnosing extrapulmonary TB especially in diagnosing tuberculous pleural effusion (pauci-bacillary specimens) which has limited diagnostic utility. Also, the assay showed 100% specificity in diagnosing rifampicin resistance guiding physicians to justifiably starting second line anti-TB treatment.

Performance of fine needle aspiration cytology and Ziehl-Neelsen staining technique in the diagnosis of tuberculosis lymphadenitis

IntroductionProper diagnosis of tuberculosis (TB) lymphadenitis is critical for its treatment and prevention. Fine needle aspirate cytology (FNAC) is the mainstay method for the diagnosis of TB lymphadenitis in Ethiopia; however, the performance of FNAC has not been evaluated in the Eastern Region of Ethiopia. This study aimed to evaluate the performance of FNAC and Ziehl-Neelsen (ZN) staining compared with that of GeneXpert for the diagnosis of TB lymphadenitis.MethodsFine needle aspiration (FNA) specimens collected from 291 patients suspected of having TB lymphadenitis were examined using FNAC, ZN, and GeneXpert to diagnose TB lymphadenitis. Gene-Xpert was considered the reference standard method for comparison. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficient were determined using SPSS version 25.ResultsThe sensitivity, specificity, PPV, and NPV of ZN for diagnosing TB lymphadenitis were 73.2%, 97.4%, 96.2%, and 80.1% respectively. There was poor agreement between ZN and GeneXpert (Kappa=-0.253). The sensitivity, specificity, PPV, and NPV of FNAC were 83.3%, 94.8%, 93.5%, and 86.3% respectively. There was moderate agreement between the FNAC and GeneXpert (Kappa = 0.785).ConclusionThe fine needle aspiration cytology (FNAC) is a more sensitive test for the diagnosis of TB lymphadenitis than ZN. The FNAC showed a moderate agreement with the GeneXpert assay. This study recommends the FNA GeneXpert MTB/RIF test in preference to FNAC for the diagnosis of TB lymphadenitis to avoid a missed diagnosis of smear-negative TB lymphadenitis.

Clincal characteristics and outcome of tuberculosis lymphadenitis in a tertiary center from Saudi Arabia

Clincal characteristics and outcome of tuberculosis lymphadenitis in a tertiary center from Saudi Arabia

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

Clinical characteristic, common sites, and geographical distribution of pediatric tuberculosis patients in Southwest China.

The data report of a large sample, dynamic epidemiology, and characteristic analysis of pediatric tuberculosis (TB) in Southwest China is not clear. Herein, we conducted descriptive dynamic epidemiology, characteristic analysis and geographical distribution study of pediatric TB inpatients in Southwest China for more than 20 years. Patients with pediatric TB were recruited from October 2002 to September 2022 in Southwest of China based on etiology or clinical confirmation. Extract hospitalization medical record information for each patient. The geographical distribution chart of cases is used to display the trend of case flow segmented every 5 years. Among 3,024 pediatric TB patients with an average age of 9.11 ± 4.39, 17.49% (529) had pulmonary tuberculosis (PTB), 9.06% (274) had extrapulmonary tuberculosis (EPTB), and 73.45% (2,221) had combined TB. The most common form of EPTB is disseminated TB (28.98%), followed by TB lymphadenitis (20.56%), pleural TB (19.72%), and TB meningitis (19.68%). Children aged 0-4 years had a high risk of TB meningitis and a severe symptoms, while children in the elderly age group had a high risk of pleural TB. In the past 20 years, hospitalized TB pediatric cases mainly came from Sichuan, Tibet, Qinghai, Yunnan and other places. The number of patients from ethnic minorities, especially Tibetans, showed an upward trend on a yearly basis (χ2 = 401.43, P < 0.001). Public health investment and effective management in pediatric TB should be further strengthened.

Histopathological Review of Granuloma in Diagnosis of Tuberculosis Lymphadenitis (TBL)

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and is the second leading cause of death from an infectious disease. Indonesia has the highest TB cases in West Java, East Java, and Central Java. Tuberculosis lymphadenitis (TBL) represents about 30–40% of cases of extrapulmonary tuberculosis. The study aimed to study the clinical and histopathological characteristics of TBL patients. The research design in this study used an exploratory, descriptive method. Data was taken from Al Islam Hospital Bandung as medical records from January 2019 to December 2020. The result showed that TBL primarily affects patients aged 6–11 years (28%), male gender (57%), patients not working (25%), and those residing in the East Bandung area (34%). Histopathological appearance showed granulomas of caseous necrosis, epithelioid cells, and Langhan's cells, indicated by types 1, 2, and 3. The most common type was type 1 (47%), which was more widely distributed in the right neck (46%) with size 1–3 cm. In conclusion, the frequency of TBL is higher in boys aged 6–11 years, residents of the East Bandung area, and patients who did not work. Well-formed granuloma of enlarged lymph nodes in the right neck with size 1–3 cm is most commonly found in TBL.

An overview of the prevalence of BCG lymphadenitis among infants registered in consulter clinic for chest and respiratory diseases, Kirkuk, Iraq

Abstract Background: Bacille Calmette-Guérin (BCG) lymphadenitis is one of the uncommon complications of BCG vaccination among infants, as it may lead to many serious problems as fistula or disseminated infection. Objectives: The study aimed to show the distribution of BCG lymphadenitis among vaccinated infants along the past 5 years who were diagnosed and managed in tuberculosis (TB) center. Materials and Methods: An observational study was carried out including 22 infants of both sexes who had BCG lymphadenitis. The diagnosis was made either clinically or it used polymerase chain reaction to examine the suppression, and biopsy was applied for indicated cases. All cases were managed by anti-TB and no death was reported. Results: The results showed male predominance ratio of 2:1. Regarding the latent period between the time of vaccination and appearance of the symptoms; the highest number was between 1 and 2 months (45.5%) whereas the lowest was in the group of 7–9 months following vaccination (4.5%). The results also found high incidence rate of BCG lymphadenitis (1.5%), among the infants. The high occurrence of TB lymphadenitis in the study may indicate many reasons, the most frequent being the dose of the vaccine and the wrong technique. Conclusion: It was concluded from results of the study that it is necessary to follow-up infants, and check for the appearance of lymphadenitis and to inform parents to present the baby to the TB center as soon as possible if any complications were observed.

Complex Case of Tuberculosis Lymphadenitis with Concurrent Takayasu Arteritis in a 14-Year-Old Girl from Ethiopia

Complex Case of Tuberculosis Lymphadenitis with Concurrent Takayasu Arteritis in a 14-Year-Old Girl from Ethiopia

Serum Adenosine Deaminase Levels in Tubercular Lymphadenitis: Correlation and Cutoff

Objectives: Tubercular lymphadenitis accounts for the large majority of extrapulmonary tuberculosis (TB) worldwide. The available means for their diagnosis are often time-consuming, tedious, and costly. Adenosine deaminase (ADA) level estimation in body fluids has emerged as a popular method of diagnosing tuberculous infection. Very few studies have examined serum ADA levels in TB lymphadenitis and fewer such studies have used controls. The objective of the present study was to find any correlation between serum ADA and fine-needle aspiration cytology-confirmed tubercular lymphadenitis and, if a correlation existed, whether there existed any diagnostic cutoff for clinical utility. Material and Methods: This prospective study was done over 2 years. The patients were grouped into tubercular lymphadenitis (group 1, cases) and non-tubercular lymphadenitis (group 2, controls). Serum ADA level was estimated using the spectrophotometric method. Statistical methods were employed to examine the intergroup differences in serum ADA levels. The receiver operating characteristic curve (ROC curve) was used to assess the overall accuracy and corresponding diagnostic accuracy at different cutoff values of serum ADA. Results: Tubercular lymphadenitis (Group I) has a strong female predilection (M: F = 0.56:1, P = 0.017), a significantly late clinical presentation (P = 0.002), and a significantly higher incidence of cervical lymph node involvement (P = 0.019). A positive treatment history was significantly and more commonly found in patients of group 1 (P &lt; 0.001) than patients of group 2. The mean serum ADA level was 43.14 IU/L. A significantly higher serum ADA level was detected in group 1 patients than in group 2 (56.81 ± 12.42 vs. 32.07 ± 6.84, P &lt; 0.001). On ROC, the area under the curve was 97.2%, indicating a very good discriminating capability of serum ADA levels between groups 1 and 2. A cutoff value of 41.90 IU/L had the best sensitivity and specificity (93.15% and 92.1%, respectively) for detecting a tubercular etiology. Conclusion: Serum ADA level of 41.90 U/L can differentiate tubercular from non-tubercular lymphadenitis with a very high sensitivity and specificity. Therefore, serum ADA estimation can facilitate an early clinical diagnosis and institution of treatment.

Approach to lymphadenopathy: how to diagnose tuberculosis lymphadenitis

lymphadenopathy is considered as abnormal finding local or generalized that can becaused by neoplasm or infection, as tuberculosis lymphadenitis. Cervical localization has prevalence&#x0D; in the variety of disorders, can has a similar kind of clinical presentation and to differentiate them be-comes extremely difficult. We provided a case report of the new onset of extrapulmonary tuberculosis&#x0D; lymphadenitis in 42-year-old Indian man. The patient complained of multiply enlarged painful lymphnodes on left anterior neck and was also concerned about sore throat persistent for a year. Objectiveexamination and analysis were without evident inflammatory signs. Previous ultrasound, pulmonaryand abdominal CT-scan investigations also revealed conglomerate of left mediastinal lymph nodes,moderate splenomegaly. The preliminary diagnosis of lymphoma was excluded due to confirmationof typical tuberculosis lymphadenitis with specific testing and morphological changes of the resected&#x0D; lymphatic node. Sputum microscopy was found to be negative, which meant that the patient was neg-ative for social transmission of tuberculosis. Affected lymph nodes resolved completely after appro-priate therapy during one-year treatment. This case report of extrapulmonary tuberculosis highlights&#x0D; the importance of tissue diagnosis in unclear situations. We used clinical protocol for unspecifiedlymph node enlargement as complete history taking and physical examination that is preliminary fordiagnosis, while laboratory tests, imaging diagnostic methods and tissue samplings are gold standardevaluation for definite lymphadenopathy. Tuberculosis lymphadenitis is popularly known as collarstud abscess and is the most common benign cause of cervical lymphadenopathy in endemic areas.This observation determined the details of the immunocompromised state of the patient, conclusionwas supported by the evidence of Pseudomonas putida associated pharyngitis. The main differentialsigns between lymphoma as immunoproliferative disorder and infectious tuberculosis lymphadenitiswere provided.

Disseminated tuberculosis: Clinical presentation, diagnosis, and outcomes in a tertiary-care hospital in Saudi Arabia.

Tuberculosis (TB) is the primary infectious cause of mortality worldwide. Although TB incidence and prevalence are declining, the use of immunosuppressive drugs and the growing prevalence of immunocompromising conditions such as comorbidities, malignancies, and the use of immunosuppressive agents are risk factors for disseminated TB (DTB). This study aims to identify the relevant clinical, laboratory, radiological, and histopathological features of DTB, as well as to assess the typical anatomical distributions and treatment outcomes of patients diagnosed with the disease at King Abdulaziz Medical City (KAMC). A retrospective chart review was conducted, including all patients diagnosed with miliary or DTB at KAMC with retrievable medical files. The study included 55 patients, of whom 35 (63.6%) were male and the median age was 64 years old. 35 (63.6%) of the infected patients were timely diagnosed and eventually cured from the illness. The most common comorbid conditions were diabetes, chronic kidney disease, and immunocompromising conditions, which were present in 37 (67.2%), 12 (21.8%), and 11 (20%) of the patients, respectively. The most common presenting symptoms were fever and cough, present in 31 (56.3%) and 26 (47.2%) of the patients, respectively, followed by weight loss in 25 (45.4%), night sweats in 15 (27.2%), and shortness of breath in 14 (25.4%). Approximately two-thirds of the patients had pulmonary miliary TB (MTB) (38; 69.1%), followed by TB lymphadenitis (21; 38.2%), central nervous system involvement (13; 23.6%), skeletal involvement (11; 20%), gastrointestinal involvement (5; 9.1%), pleural involvement (3; 5.5%), and urogenital TB (2; 3.6%). The mortality rate was 14 (25.5%) patients. MTB is challenging to diagnose due to nonspecific clinical, laboratory, and imaging findings. Clinicians dealing with patients who are at risk of developing DTB should be aware of the typical presentations and abnormal clinical findings. They should also have a low threshold to initiate specific investigations for the disease, as early diagnosis and effective treatment is critical in reducing morbidity and mortality rates.

Magnitude of tuberculosis lymphadenitis, risk factors, and rifampicin resistance at Adama city, Ethiopia: a cross-sectional study

Mycobacterium tuberculosis complex has an impact on public health and is responsible for over one million deaths per year. Substantial numbers of people infected with M. tuberculosis can develop tuberculosis lymphadenitis; however, there is a limited study in Adama, Ethiopia. The aim of this study was to determine the magnitude of Tuberculosis lymphadenitis, its predictors, and rifampicin-resistance gene-positive M. tuberculosis. A total of 291 patients with enlarged lymph nodes were recruited from May 2022 to August 30 at Adama Comprehensive Specialized Hospital Medical College (ACSHMC). GeneXpert, Ziehl–Neelsen staining, and cytology were used for the diagnosis of TB lymphadenitis from the Fine Needle Aspirate (FNA) specimen. Rifampicin-resistant gene was detected using GeneXpert. For data entry and analysis, Epi Data version 3.0 and SPSS version 25 were used respectively. A binary logistic regression model was used to identify predictors of TB lymphadenitis. A p < 0.05 with a 95% confidence interval (CI) was taken as a cut point to determine the significant association between dependent and independent variables. The prevalence of TB lymphadenitis using GeneXpert, Ziehl–Neelsen staining, and cytology were 138 (47.4%) (95% CI 41.70–53.10), 100 (34.4%) (95% CI 28.94–39.85), and 123 (42.3%) (95% CI 36.63–47.00) respectively. Nine (3.1%) participants were infected with rifampicin-resistant gene-positive M. tuberculosis. Out of the total M. tuberculosis detected by GeneXpert (n = 138), 9 (6.5%) were positive for rifampicin resistance-gene. Participants with a chronic cough had 2 times odds of developing TB lymphadenitis (AOR: 2.001, 95% CI 1.142–3.508). Close to half of patients with enlarged lymph nodes were positive for M. tuberculosis by the GeneXpert method in the study area. Chronic cough was significantly associated with TB lymphadenitis. Rifampicin-resistant gene-positive M. tuberculosis was relatively prevalent among patients with enlarged lymph node in the study area.

A rare case of Hermansky-Pudlak syndrome

Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder characterised by oculocutaneous albinism, a bleeding diathesis and platelet storage deficiency. Aim of this paper is to report a case of patient with HPS who was followed over a decade. A 2-and-a-half-year-old boy presented with recurrent respiratory tract infections and global developmental delay. On examination, he had light golden hair, grey iris with nystagmus, fundus hypo-pigmented fovea and white macules all over body. Also found to have neutropenia without granules on peripheral smear. HPS can often be diagnostic dilemma mimicking disorders like Chediak-Higashi syndrome (CHS), in this case diagnosis was made due to characteristic skin and hair hypopigmentation and ocular findings along with bleeding diathesis. Our patient categorised under HPS2 subtype which has mild immunodeficiency. HPS is usually associated with neutropenia and hence pyogenic infections, present case however was associated with advanced form of pulmonary tuberculosis-miliary TB and granulomatous TB lymphadenitis giving rise to the possibility of T-cell defect.

Zoonotic tuberculosis in a high bovine tuberculosis burden area of Ethiopia.

Tuberculosis (TB) is a major cause of ill health and one of the leading causes of death worldwide, caused by species of the Mycobacterium tuberculosis complex (MTBC), with Mycobacterium tuberculosis being the dominant pathogen in humans and Mycobacterium bovis in cattle. Zoonotic transmission of TB (zTB) to humans is frequent particularly where TB prevalence is high in cattle. In this study, we explored the prevalence of zTB in central Ethiopia, an area highly affected by bovine TB (bTB) in cattle. A convenient sample of 385 patients with pulmonary tuberculosis (PTB, N = 287) and tuberculous lymphadenitis (TBLN, N = 98) were included in this cross-sectional study in central Ethiopia. Sputum and fine needle aspirate (FNA) samples were obtained from patients with PTB and TBLN, respectively, and cultures were performed using BACTEC™ MGIT™ 960. All culture positive samples were subjected to quantitative PCR (qPCR) assays, targeting IS1081, RD9 and RD4 genomic regions for detection of MTBC, M. tuberculosis and M. bovis, respectively. Two hundred and fifty-five out of 385 sampled patients were culture positive and all were isolates identified as MTBC by being positive for the IS1081 assay. Among them, 249 (97.6%) samples had also a positive RD9 result (intact RD9 locus) and were consequently classified as M. tuberculosis. The remaining six (2.4%) isolates were RD4 deficient and thereby classified as M. bovis. Five out of these six M. bovis strains originated from PTB patients whereas one was isolated from a TBLN patient. Occupational risk and the widespread consumption of raw animal products were identified as potential sources of M. bovis infection in humans, and the isolation of M. bovis from PTB patients suggests the possibility of human-to-human transmission, particularly in patients with no known contact history with animals. The detected proportion of culture positive cases of 2.4% being M. bovis from this region was higher zTB rate than previously reported for the general population of Ethiopia. Patients with M. bovis infection are more likely to get less efficient TB treatment because M. bovis is inherently resistant to pyrazinamide. MTBC species identification should be performed where M. bovis is common in cattle, especially in patients who have a history of recurrence or treatment failure.

The role of systemic immune-inflammation index (SII) in the differential diagnosis of granulomatous and reactive LAP diagnosed by endobronchial ultrasonography.

Tuberculosis and sarcoidosis are the two most important granulomatous diseases that physicians have difficulty in differential diagnosis. In our study, we aimed to observe the place of systemic immune-inflammation index (SII) level in the differentiation of patients diagnosed with endoboronchial ultrasonography (EBUS). Our study included 494 patients who applied to our hospital's chest diseases outpatient clinic between 2015 and 2020 and underwent endobronchial ultrasonography (EBUS) for mediastinal lymphadenopathy (LAP). Patients' follow-up for at least 2 years after diagnosis and pre-procedural hematologic parameters were retrospectively recorded. In the comparison of SII between groups, it was observed that SII was statistically significantly higher in patients followed up for tuberculous lymphadenitis compared to patients with sarcoidosis and reactive LAP (p=0.01, <0.001). In sarcoidosis patients, SII levels were statistically significantly higher than in patients with reactive LAP (p=0.002). Platelet, sedimentation and SII levels were statistically significantly higher in stage 2 patients compared to stage 1 patients, while lymphocyte levels were lower (p=0.009, 0.001, 0.001, 0.001, 0.001 respectively). In the ROC curve analysis of the SII level of patients with sarcoidosis and tuberculosis LAP, the AUC was 0.668 and when the cut-off value for the SII level was 890.667, the sensitivity was 70% and the specificity was 66% in the differentiation of tuberculosis and sarcoidosis lymphadenitis. SII may be an easily applicable parameter in the differentiation of tuberculosis and sarcoidosis LAP with granuloma and in the differentiation of granulomatous diseases from reactive LAP.