Tuberculosis Lymphadenitis Research Articles

Childhood tuberculosis and factors associated with mortality and loss to follow-up at a major paediatric treatment centre in Southern Ghana.

tuberculosis (TB) is a major cause of morbidity and mortality in children in low- and middle-income countries. This study described the clinical presentation and identified factors contributing to poor outcome of childhood TB at Korle Bu Teaching Hospital (KBTH), Accra, Ghana. this was a retrospective cohort study of children aged ≤ 14 years with TB registered for treatment at KBTH from 2015 to 2019. Treatment outcomes were recorded as treatment success and unsuccessful outcomes (died and loss to follow-up). Multivariable logistics regression was conducted to assess factors associated with an unsuccessful outcome. of 407 children with TB registered during the period, 269 (66.1%) patients had pulmonary tuberculosis (PTB). Of the 138 patients with extra-pulmonary TB (EPTB), 68 (49.3%) had TB lymphadenitis. The TB/HIV coinfection rate was 42.8%. The overall treatment success rate was 68.3%, whilst 71(17.4%) died, and 58 (14.3%) were lost to follow-up. Factors associated with death were age below 1 year (AOR: 3.46, 95% CI: 1.48-8.10, p=0.004) and having HIV coinfection (AOR: 1.89, 95% CI: 1.04-3.43, p=0.037). Factors associated with loss to follow-up were age below 1 year (AOR: 2.91, 95% CI: 1.12-8.59, p=0.029) and having EPTB (AOR: 2.40, 95% CI: 1.24-4.65, p=0.009). childhood TB treatment success in our population was below the national target of 85%, with high mortality and loss to follow-up rates, especially in younger children and those with HIV coinfection or EPTB. Tailored treatment strategies may be needed for children at risk of unsuccessful treatment outcome, especially among infants.

The risk of tuberculosis bacilli seeding during mediastinoscopy in mediastinal tuberculosis: Is it clinically important?

Mediastinoscopy is the gold standard for diagnosis in the absence of parenchymal lesions in mediastinal tuberculosis lymphadenitis. During mediastinoscopy biopsy, tuberculous bacillus seeding into the mediastinum is a rare complication. This study aimed to test the safety of mediastinoscopy in terms of Mycobacterium tuberculosis seeding in the mediastinum by microbiologically evaluating mediastinal lavage samples taken before and after biopsy. Classical cervical mediastinoscopy was performed all of patients and who were reported as granulomatous inflammatory events results of histopathological examinations and who underwent mediastinal lavage before and after biopsy, were included in the study. All the lavage fluids were tested for AFB and subjected to Mycobacterium tuberculosis PCR DNA testing and standard tuberculosis culture. The patients were divided into two groups, Group 1: Necrotizing granulomatous inflammation, Group 2: non-necrotizing granulomatous inflammation. The microbiological tests of the patients in Group 1 were negative before biopsy. However, in two patients of Group 1, the results of cultures of lavage fluids that taken from after biopsy were positive for tuberculosis. In all patients in Group 2, all microbiological tests of the lavage fluids were negative (Power of the decision: 99.8%, with 5% error). All of patients in group 1, Antituberculosis treatment was initiated and continued for 6 months. There weren’t seen any serius complications due to treatment and recurrence during the follow-up period. Mediastinoscopy can be used safely, with low morbidity and mortality rates and a high success rate for the diagnosis of mediastinal tuberculosis.

Incidence and Mortality of Extrapulmonary Tuberculosis in Ukraine: Analysis of National Surveillance Data.

Improved understanding of the epidemiology and mortality risk factors of extrapulmonary tuberculosis (EPTB) may facilitate successful diagnosis and management. We analyzed national surveillance data from Ukraine to characterize EPTB subtypes (ie, localized in different anatomic sites). We calculated annual reported incidence, stratified by age, sex, and human immunodeficiency virus (HIV) status. Using Cox regression, we estimated mortality risk factors. Between January 2015 and November 2018, 14062 adults/adolescents (≥15 years) and 417 children (<15 years) had EPTB with or without concomitant pulmonary TB. The most commonly reported EPTB subtypes were pleural, peripheral lymph node, and osteoarticular. Most EPTB subtype notifications peaked at age 30-39 years and were higher in males. In adults/adolescents, most peripheral TB lymphadenitis, central nervous system (CNS) TB, and abdominal TB occurred in those with untreated HIV. CNS TB notifications in people without HIV peaked before age 5 years. Adults/adolescents with CNS TB (adjusted hazard ratio [aHR]: 3.22; 95% CI: 2.89-3.60) and abdominal TB (aHR: 1.83; 95% CI: 1.59-2.11) were more likely to die than those with pulmonary TB. Children with CNS TB were more likely to die (aHR: 88.25; 95% CI: 43.49-179.10) than those with non-CNS TB. Among adults/adolescents, older age and HIV were associated with death. Rifampicin resistance was associated with mortality in pleural, peripheral lymph node, and CNS TB. We identified the most common EPTB subtypes by age and sex, patterns of EPTB disease by HIV status, and mortality risk factors. These findings can inform diagnosis and care for people with EPTB.

Hobnail variant of papillary thyroid carcinoma with anaplastic dedifferentiation co-existent with tuberculosis lymphadenitis.

IntroductionThe current study aims to report a rare case of metastatic papillary thyroid carcinoma (PTC) of the cervical lymph nodes with hobnail variant and anaplastic de-differentiation. In addition to the primary disease, there was a second pathology which was caseating granulomatous lymph adenitis suggestive of tuberculosis.Case reportA 91-year-old female presented with a painful right sided neck swelling for two weeks, increased in size suddenly. On clinical examination, there was a well-defined firm painful right sided neck mass. On ultrasound examination, there was multiple well defined solid hypoechoic, hypervascular nodules. These resembled lymph nodes of variable size and shape, mostly in the right side. The patient underwent right lateral cervical lymph node dissection. After the operation, she was sent for radiotherapy.DiscussionThe hobnail variant of PTC is genetically identical to poorly differentiated thyroid carcinoma in that its mutations are in the p53 and TERT promoters are more common in this variant than in conventional PTCs. The proportion of hobnail features have no effect on the outcome. Additionally, 10% of tumor cells with hobnail features were previously linked to a more aggressive clinicopathological aspect.ConclusionAlthough it is rare, metastatic PTC with hobnail variant could undergo anaplastic dedifferentiation.

Conservative approach for treatment of Grisel's syndrome after resection of lympahadenitis tuberculosis of the neck: A rare case report.

IntroductionGrisel's syndrome is a rare condition characterized by nontraumatic rotatory subluxation of the atlantoaxial joint, which was caused by previous inflammation around the head and neck. It is usually seen in children and signed as torticollis. There was no consensus for management, yet early diagnosis and treatment is paramount.Presentation of caseA 5-year-old girl came to outpatient clinic complaining of wry neck 1 day after surgical excision of her TB lymphadenitis and got worsen by time. There was no history of trauma around the neck. Examination under general anesthesia and CT scan revealed acquired severe torticollis consistent with Grisel's Syndrome Fielding type 3 accompanied by TB lymphadenitis, and TB myositis of the neck. Manipulation under general anesthesia and immobilization using Minerva cast followed by Lerman Cervicothoracal Osthosis was conducted.DiscussionThis patient was diagnosed with Grisel's syndrome and underwent conservative treatment consisting of reduction under general anesthesia and immobilization using Minerva cast for 6 weeks. The patient was then applied Lherman Cervical Thoracic Orthosis (CTO) halo brace for another 3 months. Anti-tuberculous drug was given to control tuberculous infection. Eight months follow-up showed neither residual deformity, neck pain, nor movement limitation of the neck.ConclusionGrisel's syndrome has excellent result that is treated with conservative treatment using reduction under general anesthesia and Minerva cast.

Hematological and biochemical features with tuberculosis and bacterial lymphadenitis in children

Objective — to improve approaches to differential diagnosis of lymphadenitis by identifying features of hematological and biochemical parameters of blood of children with nonspecific bacterial and specific tuberculous lymphadenitis.&#x0D; Materials and methods. Under our supervision were 45 children aged 1 to 5 years with an increase in lymph nodes (LN), who were treated in the surgical department of the Odessa Regional Children’s Clinical Hospital for the period from 2017 to 2018. Patients were assessed for general condition and affected lymph node lesions, as well as blood sampling for general and biochemical studies. Additionally, the calculation of integrated hematological indices of immunological tolerance of the organism was performed, namely the index of neutrophils to lymphocytes ratio (NLR); lymphocyte to monocyte ratio (LMR); neutrophil to monocyte ratio (NMR); lymphocyte to eosinophil ratio (LER). For comparison with the norm used the data of these indicators, established in healthy children.&#x0D; Results and discussion. All patients were divided into 2 clinical groups. The first group (СG-1) included 25 children with lymphadenitis caused by BCG vaccination, the second (СG-2) — 20 patients with acute purulent lymphadenitis. The study found that the condition of most children (75 %) of the second group was more severe compared with patients with CG-1, which was manifested by more pronounced manifestations of intoxication and local condition of the affected LN.Evaluation of a general blood test showed that the average number of leukocytes with specific lymphadenitis in most (80.8 %) patients was within normal limits, with purulent; on the contrary, in 71.4 % of children there was a tendency to increase. The calculations of hematological indices revealed a decrease in NLR, and, with BCG lymphadenitis, it decreased by half (to 0.96) compared with bacterial lymphade­nit (to 1.88), which indicates an increase in specific immunological reactivity in children of CG-1. ISNM in most patients with lymphadenit remained low throughout the course of the disease. This indicates the timely activation of the macrophage defense system of the body. LMR with tuberculous lymphadenit grew, while with bacterial lymphadenit, on the contrary, it decreased by half, which indicates earlier mobilization of lymphocytes as an effector immunity in children with BCG lymphadenitis. LER in all forms of the disease tended to increase, which indicates the predominance of a delayed-type hypersensitivity reaction in children of both groups.Analysis of blood biochemical parameters in patients of both clinical groups did not reveal clear differences in children with bacterial and tuberculous lymphadenitis.&#x0D; Conclusions. At specific defeat of LN unlike nonspecific, the clinical and laboratory picture with lack of expressive leukocytes reaction is noted. Determining the indices of the ratio of blood leukocytes makes it possible to more deeply assess the level of immunological reactivity and the general condition of the child, which increases the informative value of clinical blood tests. Analysis of blood biochemical parameters in patients with specific and nonspecific lymphadenitis, although it has no specific differential diagnostic value, however, is an important component of assessing the quality of treatment and the patient’s condition as a whole.

Hematology Profile of Tuberculosis Lymphadenitis Patients at Siti Rahmah Hospital, Padang, Indonesia

Tuberculosis (TB) is a progressive granulomatous infectious disease caused by Gram-positive acid-resistant bacilli classified in the genus Mycobacterium. Tuberculosis in humans is caused by Mycobacterium tuberculosis (MTB) and it mainly infects the lungs, although it can also infect intestines, meninges, bones, lymph nodes, skin that cause extra-pulmonary TB. Tuberculous lymphadenitis is an inflammatory process in lymph nodes as a result of MTB activity. The inflammatory process caused by MTB activity is often associated with anemia as the most common complication. Anemia in TB is caused by an inflammatory process associated with bone marrow suppression due to pro-inflammatory cytokines, thus inhibiting the proliferation and differentiation of erythroid progenitor cells. This chronic TB infection also affects iron hemostasis, thus further affecting the hematological profile of TB patients. This study aimed to determine the hematology profile of TB lymphadenitis patients in the Siti Rahmah Hospital, Padang, Indonesia. This was a descriptive study, with a population of patients diagnosed with TB lymphadenitis based on the results of a fine needle biopsy in the Colli region. The samples of this study consisted of 24 patients who have tested the hematology profile. Tuberculosis lymphadenitis patients in females were higher than males, the mean age was 26.75±19.53 years old dominated by an adult (54%). The mean of 3 hemoglobin levels was 11.8±1.522 g/dL, with 62.5% anemia patients. The mean leukocyte count was 10400±3018.926/mm , 3 with 54.2% of patients had normal levels of leukocyte. The mean of thrombocyte count was 334750±74440.668/mm , with 83.3% in normal levels and the mean of Erythrocyte Sedimentation Rate (ESR) was 35.25±31.489 mm/h, with 54.2% patients in high ESR. Hematology profile in TB lymphadenitis patient was anemia, normal levels of leukocytes, thrombocyte, and increased levels of ESR.

Xpert MTB/RIF Ultra Is Highly Sensitive for the Diagnosis of Tuberculosis Lymphadenitis in a High-HIV Setting

ABSTRACTTuberculosis lymphadenitis (TBL) is the most common extrapulmonary tuberculosis (EPTB) manifestation. Xpert MTB/RIF Ultra (Ultra) is a World Health Organization-endorsed diagnostic test, but performance data for TBL, including on noninvasive specimens, are limited. Fine-needle aspiration biopsy specimens (FNABs) from outpatients (≥18 years) with presumptive TBL (n = 135) underwent (i) routine Xpert MTB/RIF testing (later with Ultra once programmatically available), (ii) MGIT 960 culture (if Xpert or Ultra negative or rifampicin resistant), and (iii) study Ultra testing. Concentrated paired urine specimens underwent Ultra testing. Primary analyses used a microbiological reference standard (MRS). In a head-to-head comparison (n = 92) of an FNAB study Ultra and Xpert, Ultra had increased sensitivity (91% [95% confidence interval: 79, 98] versus 72% [57, 84]; P = 0.016) and decreased specificity (76% [61, 87] versus 93% [82, 99]; P = 0.020) and diagnosed patients not on treatment. Neither HIV nor alternative reference standards affected sensitivity and specificity. In patients with both routine and study Ultra tests, the latter detected more cases (+20% [0, 42]; P = 0.034), and false-negative study Ultra results were more inhibited than true-positive results. Study Ultra false positives had less mycobacterial DNA than true positives (trace-positive proportions, 59% [13/22] versus 12% [5/51]; P < 0.001). “Trace” exclusion or recategorization removed potential benefits offered over Xpert. Urine Ultra tests had low sensitivity (18% [7, 35]). Ultra testing on FNABs is highly sensitive and detects more TBL than Xpert (Ultra still missed some cases due in part to inhibition). Patients with FNAB Ultra-positive “trace” results, most of whom will be culture negative, may require additional clinical investigation. Urine Ultra testing could reduce the number of patients needing invasive sampling.

Caseating Tuberculous Lymphadenitis- A Case Report

Introduction: Tuberculosis lymphadenitis (or tuberculous adenitis) is the most common type of infection with tuberculosis that occurs outside of the respiratory system. Tuberculosis lymphadenitis is a chronic condition caused by Mycobacterium tuberculosis in the granulomatous inflammation of the lymph node caused by caseated necrosis. The number of people who contact tuberculosis is estimated at 8 million per year, and about 3 million people die from tuberculosis in the world.&#x0D; Presentation of Case: In this case report we delineate the case of a female patient, 26-year-old, she had some pain and lymph node swelling in her right submandibular region since from 4 months and was diagnosed as right Caseating Tuberculous Lymphadenitis, associated with the cervical (neck) region, who was immunocompetent and HIV test negative, with a history of recurring fever, weight loss, loss of appetite for the last 4 months. On physical examination, she had swelling approximately 3×3 cm in the right submandibular region and a hard mass and painful sensation were noticed in her right submandibular region. On Fine needle aspiration cytology of submandibular lymph node reveals Caseating Tuberculous Lymphadenitis. this is extremely rare in immunocompetent individuals.

Epidemiology of childhood tuberculosis after ceasing universal Bacillus Calmette\u2013Gu\xe9rin vaccination

Universal Bacillus Calmette–Guérin (BCG) vaccination is recommended in countries with high tuberculosis (TB) burden. Nevertheless, several countries have ceased universal BCG vaccination over the past 40 years, with scarce comparative epidemiological analyses regarding childhood TB after the policy change. We analysed data on childhood TB in countries that ceased universal BCG vaccination. Data sources included national/international databases, published papers, annual TB reports, and public health authority websites. Childhood TB notification rate increased in one of seven countries with available data. Pulmonary TB and TB lymphadenitis were the main causes of increasing childhood cases, while changes in severe forms of TB cases were minor. Maintaining high vaccine coverage for the target group was a common challenge after shifting selective vaccination. In some countries showing no increase in childhood TB after a BCG policy change, the majority of childhood TB cases were patients from abroad or those with overseas parents; these countries had changed immigration policies during the same period. Heterogeneity in childhood TB epidemiology was observed after ceasing universal BCG vaccination; several factors might obscure the influence of vaccination policy change. Lessons learned from these countries may aid in the development of better BCG vaccination strategies.

TB or Not TB: Role of Interferon-Gamma Release Assays

Research Article| August 01 2021 TB or Not TB: Role of Interferon-Gamma Release Assays AAP Grand Rounds (2021) 46 (2): 19. https://doi.org/10.1542/gr.46-2-19 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation TB or Not TB: Role of Interferon-Gamma Release Assays. AAP Grand Rounds August 2021; 46 (2): 19. https://doi.org/10.1542/gr.46-2-19 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: interferon type ii, tuberculosis, interferon gamma release assay, lymphadenitis Source: Martínez-Planas A, Baquero-Artigao F, Santiago B, et al. On behalf of the Spanish Pediatric TB Research Network (pTBred) and the European NontuberculouS MycoBacterial Lymphadenitis in childrEn (ENSeMBLE) study. Interferon-gamma release assays differentiate between Mycobacterium avium complex and tuberculous lymphadenitis in children [published online ahead of print May 10, 2021]. J Pediatr. doi. https://doi.org/10.1016/j.jpeds.2021.05.008 Investigators from multiple institutions conducted a study to assess the utility of interferon-gamma release assays (IGRAs) to differentiate tuberculosis (TB) from Mycobacterium avium complex (MAC) as the etiology of subacute/chronic submandibular/cervical lymphadenitis in children. Patients <18 years old with TB lymphadenitis who were included in the Spanish Network for the Study of Pediatric TB (pTBred) database between 2013 and 2018 were eligible for the current study. pTBred is a collaborative network of healthcare professionals in Spain; a central database includes demographic, laboratory test, and clinical data on children with TB.... You do not currently have access to this content.

Epidemiology of Mycobacterium tuberculosis lineages and strain clustering within urban and peri-urban settings in Ethiopia.

Previous work has shown differential predominance of certain Mycobacterium tuberculosis (M. tb) lineages and sub-lineages among different human populations in diverse geographic regions of Ethiopia. Nevertheless, how strain diversity is evolving under the ongoing rapid socio-economic and environmental changes is poorly understood. The present study investigated factors associated with M. tb lineage predominance and rate of strain clustering within urban and peri-urban settings in Ethiopia. Pulmonary Tuberculosis (PTB) and Cervical tuberculous lymphadenitis (TBLN) patients who visited selected health facilities were recruited in the years of 2016 and 2017. A total of 258 M. tb isolates identified from 163 sputa and 95 fine-needle aspirates (FNA) were characterized by spoligotyping and compared with international M.tb spoligotyping patterns registered at the SITVIT2 databases. The molecular data were linked with clinical and demographic data of the patients for further statistical analysis. From a total of 258 M. tb isolates, 84 distinct spoligotype patterns that included 58 known Shared International Type (SIT) patterns and 26 new or orphan patterns were identified. The majority of strains belonged to two major M. tb lineages, L3 (35.7%) and L4 (61.6%). The observed high percentage of isolates with shared patterns (n = 200/258) suggested a substantial rate of overall clustering (77.5%). After adjusting for the effect of geographical variations, clustering rate was significantly lower among individuals co-infected with HIV and other concomitant chronic disease. Compared to L4, the adjusted odds ratio and 95% confidence interval (AOR; 95% CI) indicated that infections with L3 M. tb strains were more likely to be associated with TBLN [3.47 (1.45, 8.29)] and TB-HIV co-infection [2.84 (1.61, 5.55)]. Despite the observed difference in strain diversity and geographical distribution of M. tb lineages, compared to earlier studies in Ethiopia, the overall rate of strain clustering suggests higher transmission and warrant more detailed investigations into the molecular epidemiology of TB and related factors.

Review of Head and Neck Masses in the Indian Population Based on Prevalence and Etiology With an Emphasis on Primary Diagnostic Modalities.

Head and neck masses are classified as sebaceous cysts (epidermoid cysts), cervical lymphadenopathy, benign lipomas, lymph nodes, thyroid swellings, or tuberculosis lymphadenitis that may be painful or painless, adherent or fluctuant. In spite of this, they have distinct prognoses and pathological features. The anatomical location of the swelling and other demographic manifestations of the patient provide valuable information about the cause and type of swelling. Computed tomography (CT), magnetic resonance imaging, positron emission tomography-CT, and ultrasonography are the gold standard imaging methods for the head and neck examination. These methods are used according to the region considered for the study. Fine-needle aspiration cytology of lymph nodes is known to be effective, simple, and sometimes the only tool for the diagnosis of lymph node malignancies. This review highlights the epidemiological aspect of head and neck masses in the Indian population.

Spatiotemporal analysis and seasonality of tuberculosis in Algeria.

This study aimed to describe the spatiotemporal distribution, to build a forecasting model, and to determine the seasonal pattern of tuberculosis (TB) in Algeria. The Box-Jenkins methodology was used to develop predictive models and GeoDa software was used to perform spatial autocorrelation. Between 1982 and 2019, the notification rate per 100,000 population of smear-positive pulmonary TB (SPPTB) has dropped 62.2%, while that of extrapulmonary TB (EPTB) has risen 91.3%. For the last decade, the mean detection rate of PTB was 82.6%. At around, 2% of PTB cases were yearly reported in children under 15 years old, a peak in notification rate was observed in the elderly aged 65 and over, and the sex ratio was in favor of men. Between 52% and 59% of EPTB cases were lymphadenitis TB and between 15% and 23% were pleural TB. About two-third of EPTB cases were females and around 10% were children under the age of 15. The time series analysis showed that (1,1, 2) × (1, 1, 0)4 (respectively (0, 1, 2) × (1, 1, 0)4, (3, 1, 0) × (1, 1, 0)4) offered the best forecasting model to quarterly TB (respectively EPTB, SPPTB) surveillance data. The most hit part was the Tell followed by high plateaus which accounted for 96.6% of notifications in 2017. Significant hot spots were identified in the central part for EPTB notification rate and in the northwestern part for SPPTB. There is a need to reframe the set objectives in the state strategy to combat TB taking into account seasonality and spatial clustering to ensure improved TB management through targeted and effective interventions.

Synchronous breast carcinoma (with Paget’s disease) and renal cell carcinoma with tubercular axillary lymphadenitis: a rare presentation

Synchronous malignancy are defined as two primary malignancy of two different organs occurring concurrently or within 6 months duration. Reports of synchronous breast carcinoma with RCC (renal cell carcinoma) are very limited. We presented here the first case of non-metastatic synchronous RCC with breast carcinoma and Paget’s disease associated with tubercular axillary lymphadenitis in a 62 year old female for which she underwent right MRM and right partial nephrectomy. She received chemotherapy and anti-tubercular therapy post-surgery and currently on oral hormonal therapy. Follow up scans showed stable disease. There have been cases of breast cancer with TB lymphadenitis as well as of double synchronous malignancies involving breast carcinoma and RCC. Most of the multiple malignancies reported in literature are metastatic tumours or metachronous breast malignancy with RCC. A case of synchronous primary ca breast with pages disease coexisting with primary RCC along with tubercular lymphadenopathy is yet to be reported in literature. This might just be the first one.

Clinicopathological Study on TB Lymphadenopathy Case

Background: Tuberculosis in the form of pulmonary and extrapulmonary TB is common in developing countries like Bangladesh. Among extrapulmonary TB, lymphnode TB is still common in our setting. So, the objectives of the present study were to evaluate theclinicopathological findings among the lymphnode TB cases in our context.&#x0D; Materials and methods: This observational study was done from January 2017 to December 2019 among 300 lymphnode TB cases in a tertiary care hospital during a three-year study period. Patients were selected after obtaining informed written consent and clinical evaluation. Then enlarged lymphnodes were evaluated by FNAC or histopathology. If lymphnode TB features were found then the patients were included in our study.Other findings like metastasis, lymphoma or pyogenic lymphadenitis were excluded from this study. After collection, data was recorded and analyzed by Microsoft Excel.&#x0D; Results: Among 300 cases of TB lymphadenitis subjects were commonly within the age groups 11-20 years (Male 63 and female 51) and 21-30 years(male 45 and female 42) with amale: female ratioof 1.22:1. Regarding different clinical signs and symptoms,low grade fever was found in 21(7%) cases, local lymphnode pain and tenderness was found in 67 (22%) and 63(21%) of subjects. Discharging sinuses was present in 33(11%) patients, 35(12%) had history of weight loss, 39 (13%) had anorexia and 42(14%) had history of night sweats. Regarding locationof different lymph node areas, 125(41.67%) patients had deep cervical nodes, 65(21.67%) had supraclavicular lymph nodes, 60(20%) had lymph nodes in the posterior triangle 33 (11%) in jugulo-omohyoid and 17 (5.66%) in submandibular area. Among all cases, 83% cases showed bilateral and 17% showed unilateral involvement.Regarding nature of lymph nodes, firm, matted multiple lymphnodes were found in 130(43%) cases, single discrete nodes were found in 70(23.33%) cases, others were found as suppurative noded with single and multiple sinuses. Cytopathological and histopathological findings revealed caseating granuloma with epithelioid cell with Langerhans type giant cell was found in 220(73%) cases, caseating granuloma with epithelioid cell was found in 47(16%) epithelioid cell was found in 20(7%) cases and epitheliod cells with smear positive AFB was found in 13(4%) cases.&#x0D; Conclusion: TB lymphadenitis is still a common form of extrapulmonary tuberculosis and it has variable clinical and pathological presentations.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 77-80

Interferon-Gamma Release Assays Differentiate between Mycobacterium avium Complex and Tuberculous Lymphadenitis in Children

To assess the performance of interferon-gamma release assays (IGRAs) in the differential diagnosis between Mycobacterium avium complex (MAC) and tuberculosis (TB) in children affected with subacute/chronic submandibular/cervical lymphadenitis. Multicenter observational study comparing children with microbiologically confirmed MAC lymphadenitis from the European NontuberculouS MycoBacterial Lymphadenitis in childrEn study with children with TB lymphadenitis from the Spanish Network for the Study of Pediatric TB database. Overall, 78 patients with MAC and 34 with TB lymphadenitis were included. Among MAC cases, 44 out of 74 (59.5%) had positive tuberculin skin test (TST) results at the 5-mm cut-off, compared with 32 out of 33 (97%) TB cases (P<.001); at the 10-mm cut-off TST results were positive in 23 out of 74 (31.1%) vs 26 out of 31 (83.9%), respectively (P<.001). IGRA results were positive in only 1 out of 32 (3.1%) patients with MAC who had undergone IGRA testing, compared with 21 out of 23 (91.3%) TB cases (P<.001). Agreement between TST and IGRA results was poor in MAC (23.3%; κ=0.017), but good in TB cases (95.6%; κ=0.646). IGRAs had a specificity of 96.9% (95% CI 84.3%-99.8%), positive predictive value of 95.4% (95% CI 78.2%-99.8%), and negative predictive value of 93.9% (95% CI 80.4%-98.9%) for TB lymphadenitis. In contrast to TST, IGRAs have high specificity, negative predictive value, and positive predictive value for TB lymphadenitis in children with subacute/chronic lymphadenopathy, and consequently can help to discriminate between TB and MAC disease. Therefore, IGRAs are useful tools in the diagnostic work-up of children with lymphadenopathy, particularly when culture and polymerase chain reaction results are negative.

Tuberculosis Lymphadenitis and Human Immunodeficiency Virus Co-infections among Lymphadenitis Patients in Northwest Ethiopia

Tuberculosis and human immunodeficiency virus (HIV) are among the major health problems in Ethiopia. This study assessed the proportion of tuberculosis lymphadenitis (TBLN), HIV infection and their co-infection among TBLN presumptive individuals at the selected hospitals in Northwest Ethiopia. Institution based cross sectional study was carried out. Data on demographic and clinical variables were collected with standardized questionnaire. Microbiological culture was done on specimen obtained by fine needle aspirates. The HIV status was determined by rapid anti-HIV antibody test. Data was entered and scrutinized using SPSS version 20 statistical packages. A stepwise logistic regression model was used. The result was considered as statistically significant at P<0. 05. A total of 381 lymphadenitis patients were included in the study. The overall prevalence of TBLN and HIV were at 250(65.6%) and 9(2.4%), respectively and their co-infection was at 6(2.4%). Based on the cytological examination, 301(79.0%) of them were diagnosed as TBLN. The age group, (P=0.01) and residency, (P=0.01) were found significantly associated with TBLN. Similarly, unsafe sex was also statistically significant for HIV infection (P=0.007). Tuberculosis lymphadenitis is the leading cause of TB and lymphadenitis in the region. However, TBLN-HIV coinfection was promisingly low. High rate of discrepancy was noticed between cytological and culture results. Hence, the TBLN diagnostic criteria shall pursue revision.

Validity of Method for MTBC and NTM Detection in FNAB Specimens from Tuberculous Lymphadenitis Using Microscopy, XPERT MTB / RIF and Culture Method

Mycobacterium tuberculosis and Nontuberculous Mycobacteria usually cause infection in tuberculous lymphadenitis. To improve accuracy of the detection MTB and NTM bacteria it is necessary to select valid methods. This study aims to compare validity of diagnostic methods from FNAB specimens for determining tuberculous lymphadenitis patients. a descriptive observational laboratory study involved 35 samples were obtained from tuberculous lymphadenitis patients in Dr. Soetomo Hospital Surabaya East Java. All specimens examined Ziehl-Neelsen staining microscopy, Xpert MTB/RIF , culture method Middlebrook7H10 solid media and MGIT as Gold standard. Identification of MTB dan NTM with SD Bioline TB Ag MPT64 and niacin paper strip BD . Used diagnostic test 2x2 to analyze sensitivity, specificity, negative predictive value and positive predictive value. Ziehl-Neelsen staining microscopy Sensitivity 83,33 % and Specificity 95,65% of , PPV 90,91%and NPV 91,67%, Diagnostic Accuracy 91,43 % . Xpert MTB/RIF Sensitivity 75% and Specificity 95,65% , PPV 90 % and NPV 88 %, Diagnostic Accuracy 88,57 % with 95% CI (Confidence Interval ) . Characteristics female dominated 23/35 (65.7%) while Male numbered 12/35 (34.3%), age range distribution of TB lymphadenitis patients is highest in young adults 17 years to 25 years as many as 15/35 (42.9%) the second highest is the age group of 36 years to 45 years by 8/35 (22.9%), Clinicial presentation are mostly lymph node enlargement in cervical 37% patients other locations supraclavicular ,mamae. Clinical symptoms mostly lymphadenopathy 31,5% and other lymphadenopathy with fever. Microscopy method still have the good validity shoul be conjunction with the molecular rapid tests and culture as gold standard in determining the diagnosis of TB lymphadenitis.

Tubercular Lymphadenitis in the 21st Century

Tubercular lymphadenitis (TBLN) remains the most frequent manifestation for extrapulmonary TB despite advancements in diagnostics and management over the years. Our study intends to explore five-year trend of TBLN in a tertiary care centre from south India, and aims to study clinico-demographic and diagnostic factors in the management of TBLN. All the adult patients (≥18 years) diagnosed and confirmed for TB lymphadenitis between January 2015 to December 2019 were retrospectively evaluated. Demographic factors, clinical manifestations, and different diagnostic approaches used in the management of TBLN were analysed using SPSS ver. 16. A total of 164 patients with confirmed TBLN were included. Patients aged 18-45 years were the most affected (63.41%) with female dominancy. The most affected lymph nodes were cervical lymph nodes (84.1%) presenting with single palpable enlarged lymph node (80.5%). Majority (78.7%) of the lymph nodes were non-matted and 68.9% of enlarged lymph nodes were >3cm size. Excisional biopsy was performed for the majority of the patients 99 (60.4%) and 60.4% of the cases were managed with a combination of surgical excision and anti-tubercular treatment (ATT). The declining trend of TBLN observed in this study highlights the outcome of good public health policies; however, young females and high-risk groups like HIV infected or AIDS (affected more in the study) demand further attention. Overall, the advanced diagnostic tools along with surgical management and ATT can lead us to earlier diagnosis and successful treatment outcomes.