Tuberculous Lymphadenitis Patients Research Articles

Role of the Lymphocyte Profile in Mediastinal Lymph Nodes in the Differential Diagnosis of Sarcoidosis and Tuberculous Lymphadenitis Patients Undergoing EBUS-TBNA.

The value of lymphocyte profiling (LP) in mediastinal lymph nodes for the differential diagnosis of sarcoidosis has not been extensively studied, and existing literature presents mixed results. This was a prospective study of patients with intrathoracic lymphadenopathy who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). LP in lymph node puncture fluid (LNPF) was evaluated using flow cytometry. The results of LP in sarcoidosis patients were compared with tuberculous lymphadenitis (TBLA) patients. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-offs of the statistically significant parameters for screening for sarcoidosis. Based on the optimal cut-offs and the final diagnosis of sarcoidosis and TBLA, the sensitivity, specificity, and accuracy of every statistically significant parameter and different combinations of the above three parameters were calculated for the diagnosis of sarcoidosis. Forty-five cases of sarcoidosis and 33 cases of TBLA were enrolled in this study. Compared with the LP in TBLA patients, in sarcoidosis patients, the proportion of CD4 T cells and CD4/CD8 ratio increased, and the proportion of CD8 T cells and natural killer (NK) cells decreased. Among all single parameters, the CD4/CD8 ratio had high diagnostic sensitivity (84.4%), specificity (81.8%), and accuracy (83.3%) for sarcoidosis. Among all the combinations of three parameters, the combination of CD4, CD8, and NKT/NK ratio had high diagnostic sensitivity (91.1%), specificity (84.8%), and accuracy (87.2%) for sarcoidosis. Assessment of LP in LNPF may improve the differential diagnostic accuracy of sarcoidosis from TBLA and further strengthen the importance of LP in LNPF in the diagnostic workup of sarcoidosis.

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.

Evaluation of Recurrent Lymphadenitis after Six Months Anti-Tuberculous Therapy

Background: Recurrence or persistence of tuberculous lymphadenitis even after treatment occurs due to paradoxical immune response, non-tubercular mycobacterial (NTM) infection, drug resistance tuberculosis or because of misdiagnosis. In these situations sometimes the patients are asked to continue category-1 more than six months on the basis repeat fine needle aspiration cytology (FNAC) findings. This study evaluated the cause of persistence or appearance of new lymph node after anti-TB category-1. Methods: This observational study was done from January, 2013 to March, 2014 after getting ethical clearance from Bangabandhu Sheikh Mujib Medical University (BSMMU). Patients who had persistent or new lymphadenitis after completing anti-TB category-1 for six months were selected. After analysis of treatment records, patients were selected for either FNAC or biopsy with local surgical clearance. Cyto/histopathological analysis, AFB stain (LED fluorescent), AFB culture (MGIT and L-J media) and GeneXpert test was done. Follow-up of the patients were done after two weeks and six months of FNA/surgery. Results: Thirty-two patients (M/F=11/21) with mean age 25(±12) years were investigated. Altogether 26 cases (81.25%) Journal of Bangladesh College of Physicians and Surgeons Vol. 41, No. 4, October 2023 were confirmed as tuberculous lymphadenitis and six (18.75%) were non-tuberculous (03 lymphomas, 01 sarcoidosis, 01 reactive lymphadenitis and 01 pyogenic abscess). Among the TB patients, granuloma was present in 23 cases (88.46%) (FNA-07, biopsy-16). Twenty-three (88.46%) cases were GeneXpert positive, comprising 21 rifampicin sensitive and 02 rifampicin resistant. One rifampicin resistant case was confirmed by culture and the remaining 25 were culture negative. One case was AFB stain positive and no NTM was found in AFB culture. After surgery, rapid healing was observed within two weeks among tuberculous lymphadenitis patients. Conclusions: Persistent granuloma after anti-TB category-1 does not indicate active tuberculosis if it is culture negative. It may occur due to immunological reaction against dead bacilli in deep seated sinus. Local surgical clearance results rapid recovery and other diagnosis should be excluded without further continuation of anti-TB category-1. J Bangladesh Coll Phys Surg 2023; 41(4): 262-268

Pattern of Lymph Node Involvement and Clinical Presentations of Tuberculous Cervical Lymphadenitis in a Single Center Tertiary Level Hospital

Introduction: Tuberculous cervical lymphadenitis, also known as scrofula, is a common manifestation of extra pulmonary tuberculosis. It primarily affects the lymph nodes in the neck region and is caused by Mycobacterium tuberculosis. TCL presents with distinct clinical features and a characteristic pattern of lymph node involvement. This short overview aims to analyze the pattern of lymph node involvement and clinical presentations of TCL to improve diagnostic accuracy and patient care. Aim of the study: The aimed to analyze the pattern of lymph node involvement and clinical presentations of TCL. Methods: This prospective observational study was conducted at the Dhaka Medical College Hospital, Dhaka, Bangladesh, over a period of four years. A total of 189 TCL patients were included in the study, with data collected on socio-demographic characteristics, clinical presentations, neck swelling-related characteristics, and various laboratory findings. Result: The majority of the participants were between the ages of 15-30 years (71.43%) and were predominantly female (68.25%). Fever was the most common clinical presentation (66.67%), followed by abscess (49.21%) and cough (30.16%). Unilateral neck swelling on the right side was the most prevalent (41.27%). Swollen nodes were frequently observed, primarily at node levels II, III, IV, V, and VI. High ESR (58.73%) and positive CGD on FNAC (100%) were common laboratory findings. Gene-Xpert testing showed positive results in 87.50% of cases. During the follow-up period, fever, neck pain, and neck swelling gradually decreased, while new abscess occurrences decreased over time. Surgery was performed on 4.23% of participants with single-level swollen nodes and 19.10% with multi-level swollen nodes after 1 year. Conclusion: In summary, this study on tuberculous lymphadenitis (TCL) identified consistent patterns in lymph node involvement and clinical presentations. Fever, abscess formation, and cough were common symptoms, .......

Comparative whole-genome sequence analysis of Mycobacterium tuberculosis isolated from pulmonary tuberculosis and tuberculous lymphadenitis patients in Northwest Ethiopia.

Tuberculosis (TB), caused by the Mycobacterium tuberculosis complex (MTBC), is a chronic infectious disease with both pulmonary and extrapulmonary forms. This study set out to investigate and compare the genomic diversity and transmission dynamics of Mycobacterium tuberculosis (Mtb) isolates obtained from tuberculous lymphadenitis (TBLN) and pulmonary TB (PTB) cases in Northwest Ethiopia. A facility-based cross-sectional study was conducted using two groups of samples collected between February 2021 and June 2022 (Group 1) and between June 2020 and June 2022 (Group 2) in Northwest Ethiopia. Deoxyribonucleic acid (DNA) was extracted from 200 heat-inactivated Mtb isolates. Whole-genome sequencing (WGS) was performed from 161 isolates having ≥1 ng DNA/μl using Illumina NovaSeq 6000 technology. From the total 161 isolates sequenced, 146 Mtb isolates were successfully genotyped into three lineages (L) and 18 sub-lineages. The Euro-American (EA, L4) lineage was the prevailing (n = 100; 68.5%) followed by Central Asian (CAS, L3, n = 43; 25.3%) and then L7 (n = 3; 2.05%). The L4.2.2.ETH sub-lineage accounted for 19.9%, while Haarlem estimated at 13.7%. The phylogenetic tree revealed distinct Mtb clusters between PTB and TBLN isolates even though there was no difference at lineages and sub-lineages levels. The clustering rate (CR) and recent transmission index (RTI) for PTB were 30 and 15%, respectively. Similarly, the CR and RTI for TBLN were 31.1 and 18 %, respectively. PTB and TBLN isolates showed no Mtb lineages and sub-lineages difference. However, at the threshold of five allelic distances, Mtb isolates obtained from PTB and TBLN form distinct complexes in the phylogenetic tree, which indicates the presence of Mtb genomic variation among the two clinical forms. The high rate of clustering and RTI among TBLN implied that TBLN was likely the result of recent transmission and/or reactivation from short latency. Hence, the high incidence rate of TBLN in the Amhara region could be the result of Mtb genomic diversity and rapid clinical progression from primary infection and/or short latency. To validate this conclusion, a similar community-based study with a large sample size and better sampling technique is highly desirable. Additionally, analysis of genomic variants other than phylogenetic informative regions could give insightful information. Combined analysis of the host and the pathogen genome (GXG) together with environmental (GxGxE) factors could give comprehensive co-evolutionary information.

Significance of non-granulomatous cytomorphology on fine needle aspirate in lymphadenitis cases classified as tuberculous by using a composite reference standard.

Fine needle aspiration cytology (FNAC) is established as a first line investigation for tuberculous lymphadenitis (TBLA). We aimed to describe the various cytomorphologic features of tuberculosis (TB) on FNAC and their contribution in the diagnostic decision-making in suspected TBLA cases. Patients with presumptive TBLA were prospectively enrolled (n = 266) and subjected to routine diagnostic work-up for TB, including FNAC samples, and followed until the end of treatment. Patients were categorized as TB or non-TB cases based on a composite reference standard of which the various cytomorphologic patterns were compared. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy was calculated using cross-tabulation. Fifty-six patients were categorized as bacteriologically confirmed TB, 102 as clinically confirmed TB and 108 as non-TB. The most common cytomorphologic pattern among TB cases (59%) was granulomatous inflammation with necrosis, however, about one-third of tuberculous lymphadenitis patients presented with non-granulomatous inflammation, with 21% showing only necrosis and 13% presenting with a reactive pattern. The overall sensitivity and specificity of FNAC was 85% and 66%, respectively. We found that about one-third of TBLA patients presented without granulomas on FNA, highlighting the importance of considering TB in a wide spectrum of cytomorphology in a high TB burden setting. Our study supports the use of FNAC as a first-line investigation tool for diagnosing TBLA in a low-resource setting due to its relative simplicity and good sensitivity. However, the low specificity of FNAC, emphasizes the need for a second-tier confirmatory test with improved specificity.

Drug Resistance in Tuberculous Lymphadenitis: Molecular Characterization.

Drug-resistant tuberculosis (TB) epidemic in high-TB-incidence countries, particularly Ethiopia, remains a significant challenge. As a result, we investigated the drug resistance, common gene mutation, and molecular characterization of mycobacterial isolates from patients with suspected tuberculous lymphadenitis (TBLN). Methodology. A cross-sectional study of 218 FNA samples from TBLN patients inoculated on Lowenstein-Jensen media was carried out. The culture isolates were identified as MTB by polymerase chain reaction (PCR) and the difference-9 (RD9) test region. In addition, the GenoType MTBDRplus assay tested the first and second-line MTB drugs, and the spoligotyping strain-dependent polymorphism test was determined. Among the 50 culture-positive isolates, 14% (7/50) had drug resistance caused by a gene mutation. Out of these, 4 (8%) isolates were mono-resistant to isoniazid drug, which is caused by a gene mutation in katG in the region of interrogated at codon 315 in the amino acid sequence of S315T1, and 3 (6%) isolates were resistant to both rifampicin and isoniazid drugs. The mutation was observed for katG (at codon 315 with a change in the sequence of amino acid S315T) and rpoB (at codon 530-533 with a change in the sequence of amino acid S531L (S450L)) genes. The most prevalent spoligotypes were orphan and SIT53 strains. The predominance of INH mono-resistance poses a critical risk for the potential development of MDR-TB, as INH mono-resistance is a typical pathway to the occurrence of MDR-TB. The orphan and SIT53 (T) strains were the most common in the study area, and a drug-resistant strain caused by a common gene mutation could indicate the transmission of clonal-resistant strains in the community.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Diagnostic value of serum adenosine deaminase in tuberculous lymphadenitis

Background: Extra-pulmonary tuberculosis often requires FNAC or biopsy of lymph node to reach a final diagnosis of tuberculous lymphadenitis, which is invasive, expensive, and needs an advanced setting. Estimation of adenosine deaminase (ADA) in different body fluid and serum has been suggested as a quick, cheap, and reliable test for tuberculosis. Objective: The study was intended to assess the usefulness of serum ADA in the diagnosis of tuberculous lymphadenitis. Methods: This was a cross-sectional observational study, conducted in BSMMU over a two year period and included 68 participants, divided equally into two group e.g. tuberculous lymphadenitis and a healthy comparison group. As tuberculous lymphadenitis, only newly diagnosed cases, labeled on the basis of histopathological findings of epithelioid granuloma with caseation necrosis were included. Serum ADA concentrations were estimated by enzymatic method and compared between groups. Results: The mean serum ADA concentration was found to be 25.52±7.11 U/L in tuberculous lymphadenitis group, which was significantly higher (p=0.000) than that of the healthy comparison group (14.82±3.85 U/L). Three different cut-off values of serum ADA (18.25 U/L, 20.45 U/L, 22.15 U/L) were used to determine the best predictive value for the diagnosis of tuberculous lymphadenitis. Sensitivity and specificity of these cut off values were 91.2% and 82.4%, 79.4% and 88.2%, 67.6% and 97.1% respectively. Conclusion: It is clearly denoted by the study that, tuberculous lymphadenitis patients has significant higher serum ADA then the healthy comparison group. This result indicates that serum ADA can be used as a useful adjunct in the diagnosis of tuberculous lymphadenitis with conventional investigations. Bangladesh Med Res Counc Bull 2021; 47(2): 151-155

The Correlation between Tuberculous Lymphadenitis and Nutritional Status in Children

Tuberculous lymphadenitis may cause weight loss and lead to malnutrition in children.This study analyzes the correlation between tuberculous lymphadenitis and nutritionalstatus in children. It was an analytic observational study with a cross-sectional design.The population was pediatric patients under 18 years old with lymphadenitis, outpatientand inpatient admitted from January 2018 to December 2020 in dr. Soebandi publichospital, Jember, Indonesia. The samples were 76 respondents with total sampling. There were 52 tuberculosis lymphadenitis patients in the case group, while 24 were non-tuberculosis in the control group. The body weight data was from the medical record when the first diagnosis of lymphadenitis. Instruments were weight-for-age z-scorecurves (WHO, 2007) for under 60 months old children, while CDC Growth Charts 2000for more than five-year-old children. Then, data analysis used the Chi-square test.Mostly, tuberculous lymphadenitis patients were girls (65.4%), 12-17 years old (67.3%),not underweight (61.5%), and lived in rural areas (73%). Furthermore, all of them weregiven isoniazid, rifampicin, and pyrazinamide. In addition, 100% of them had successfultreatment. Meanwhile, most of the non-tuberculous lymphadenitis patients were boys(54.2%), 6-11 years old (58.3%), lived in the rural areas (79%), and were notunderweight (66.7%). Treatment of the non-tuberculous lymphadenitis group consistedof antibiotics, analgesics, vitamins, and symptomatic medicine. The Chi-square testresults obtained p=0.667 (p&gt;0.05). In conclusion, tuberculosis lymphadenitis in theearly incubation period

Diagnostic efficacy of Light-Emitting Diode (LED) Fluorescence based Microscope for the diagnosis of Tuberculous lymphadenitis.

BackgroundThe comparatively straightforward and cheaper light-emitting diode fluorescent microscope (LEDFM) was suggested by WHO to replace conventional microscope in tuberculosis (TB) laboratories. However, the comparable efficacy of each of those techniques differs from laboratory to laboratory. We investigated the efficacy of LEDFM for the diagnosis of tuberculous lymphadenitis (TBLN) patients.MethodsA cross-sectional study was conducted on 211 samples from clinically suspected tuberculous lymphadenitis patients. Three smears were prepared from FNA on microscope slides for cytomorphology study, Auramine O (AO), and for Ziehl-Neelsen (ZN) staining. The left-over samples were inoculated onto Lowenstein-Jensen (LJ) media. Statistical analysis was done using STATA version 11. The sensitivity, specificity, positive and negative predictive values were calculated by considering the culture results as the gold standard using a 95% confidence interval.ResultsAmong 211 samples 49.7% (105) were positive by cytomorphology, 32.7% (69) by LEDFM, 23.69% (50) by LJ culture, and 13.7% (29) by ZN. Compared to the gold standard sensitivity of ZN, LEDFM, and cytomorphology were 30% [95% CI: 17.9–44.6], 66% [95% CI: 51.2–78.8] 78% [95% CI: 64–88.5], respectively. The specificity of ZN, LEDFM, and cytomorphology was 91.3% [95% CI: 85.8–95.2], 77.6% [95% CI: 70.4–83.8], 58.8% [95% CI: 50.7–66.5], respectively.ConclusionLED fluorescence microscopy gives a legitimate option in contrast to conventional ZN techniques in terms of its higher sensitivity, a bit lower specificity, time-saving, and minimal effort.

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.

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.

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

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

Clinical performance of Xpert MTB/RIF on contrast-enhanced ultrasound-guided core biopsy specimens for rapid diagnosis of superficial tuberculous lymphadenitis in high TB burden settings.

The diagnosis of superficial tuberculous lymphadenitis (TBLN) remains difficult due to low detection rate of etiology. To increase the diagnostic value for TBLN, contrast-enhanced ultrasound (CEUS) guided core biopsy was introduced to obtain the specimen followed by Xpert MTB/RIF (Xpert) and other methods testing and to explore the optimum diagnostic pattern for TBLN in China. A prospective study was performed on patients with suspected superficial TBLN. All patients underwent CEUS-guided core biopsy from which specimens were tested by histopathology, Xpert, acid-fast bacilli (AFB), and MGIT960 culture (MGIT960), respectively. The diagnostic values were calculated and compared. A total of 328 patients were included the study, 272 were diagnosed as TBLN (254 definite TB, 18 probable TB) and 56 cases with Non-TBLN, and 100% (272/272) of TBLN patients obtained diagnosis sampled by CEUS-guided core biopsy. The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of comprehensive diagnosis on the specimens by CEUS-guided core biopsy for TBLN were 100% ( 272/272, 95% CI 98.26-100.00), 94.64% (53/56, 95% CI 84.20-98.61), 98.91% (272/275, 95% CI 96.58-99.72), and 100% (53/53, 95% CI 91.58-100%), respectively. Xpert obtained 93.31% (237/254) of etiology detection rate on the specimens sampling by CEUS-guided biopsy. The etiology detection rate was associated with histopathological caseous necrosis. Current examinations on specimens by CEUS-guided core biopsy can achieve a high diagnostic efficacy for TBLN. Pathological differentiation of CEUS-guided biopsy tissue, then followed by Xpert, may be the best pattern for the diagnosis of TBLN in high TB burden areas.

Association between Fine-needle Aspiration Cytological Features and CD4 Level in Human Immunodeficiency Virus-Associated Tuberculous Lymphadenitis Patients Admitted to Haji Adam Malik Hospital in 2017.

BACKGROUND:World Health Organization stated that one-third of the world’s population has tuberculosis with one infected person in every second. In 2015 there were 330,910 tuberculosis cases in Indonesia. This number increased compared to 2014, which amounted to 324,539 cases. HIV-positive patients with extrapulmonary tuberculosis accounted for 50% of TB cases, of which 35% were lymphadenitis. Lymph node fine-needle aspiration (FNA) is considered effective in determining the early diagnosis of lymphadenopathy.AIM:This study aims to evaluate the association between cytological features and CD4 level in HIV-associated tuberculous lymphadenitis patients in Haji Adam Malik Hospital in 2017.METHODS:This is an analytical study with a cross-sectional approach involving 42 samples. Cytological features were obtained by slide reviewed and CD4 level were obtained from the medical record.RESULTS:Analysis of the association of cytological features with CD4 level association revealed p-value of 0.353.CONCLUSION:This indicates that there is no significant association between FNA cytological features and CD4 level in HIV-associated tuberculous lymphadenitis patients.

Diagnostic accuracy of Xpert MTB/RIF assay and non-molecular methods for the diagnosis of tuberculosis lymphadenitis

BackgroundTuberculous lymphadenitis (TBLN) diagnosis remains a challenge in resource limited countries like Ethiopia. Most diagnostic centers in Ethiopia use smear microscopy, but it has low sensitivity in detecting tubercle bacilli in fine needle aspiration (FNA) specimens. FNA cytology (FNAC) is another widely applicable diagnostic option but it has low specificity for diagnosing TBLN. In 2014, WHO recommended Xpert MTB/RIF assay to be used in detecting TB from FNA specimen by considering the diagnostic limitations of microscopy and cytology. In Ethiopia, there is limited data on Xpert MTB/RIF performance in detecting TBLN from FNA. Therefore, this study aimed to evaluate the diagnostic performance of Xpert MTB/RIF assay and non-molecular methods (cytology, microscopy and culture) for the diagnosis of TBLN.MethodsA cross-sectional study was conducted on 152 presumptive TBLN patients at St. Paul’s Hospital Millennium Medical College (SPHMMC) from December 2015 to May 2016 in Addis Ababa, Ethiopia. FNA specimens were collected from each patient. Individual patient specimens were examined by microscopy (acid fast and auramine O staining), cytology, Xpert MTB/RIF and culture. Each specimen was directly inoculated and its sediment following decontamination procedure onto two duplicate Löwenstein-Jensen (LJ) media. Composite culture (specimen positive by direct or concentrated or both culturing methods) and composite method (positive by either one of the non-molecular methods) were taken as reference methods. The data was captured and analyzed using software packages SPSS version 20 (SPSS Inc, Chicago, Illinois, USA). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.ResultA total of 152 presumptive TBLN patients were enrolled in this study. Of these, 105(69%), 68(44.7%), 64(42%), 48(32%) and 33(22%) were positive for M. tuberculosis using composite method (positive by either one of the non-molecular method), composite culture, direct, and concentrated culture, respectively. TB positivity rate was 67.8%, 49.3%, 24.3%, and 14.5% using cytology, Xpert MTB/RIF, Auramine O (FM) microscopy, and Ziehl Nelson (ZN) microscopy, respectively. Using composite culture as reference, the sensitivity and specificity of Xpert MTB/RIF was 78% (95% CI: 73.7% to 82.3%) and 74% (95%CI: 69.4% to 78.6%), respectively. However, the sensitivity of Xpert MTB/RF improved from 78% to 92% using composite method as a reference. The high positivity rate observed in purulent (70%) followed by caseous (66.7%) type of aspirates by Xpert MTB/RIF.ConclusionXpert MTB/RIF assay has both considerable sensitivity and specificity; it may be employed for better diagnosis, management and treatment of presumptive TBLN patients.

Clinical Characteristics and Treatment Outcomes of Definitive Versus Standard Anti-Tuberculosis Therapy in Patients with Tuberculous Lymphadenitis.

Although it is necessary to culture Mycobacterium tuberculosis from tuberculous lymphadenitis (TBL) patients for definitive therapy, based on the drug-sensitivity test (DST), substantial cases remain culture-negative. Limited data are available regarding the treatment outcomes after standard anti-tuberculosis therapy in culture-negative TBL. The aim of this study was to compare the recurrence rates between definitive anti-tuberculosis therapy, based on DST and standard anti-tuberculosis therapy in culture-negative TBL. A multicenter retrospective cohort study was performed from 2011 to 2015 in South Korea. The study population was divided into two groups according to treatment type. A total of 234 patients with TBL were analyzed, who were treated with definitive (84 patients) and standard anti-tuberculosis (150 patients) therapy, respectively. During a 28.0 (24.0–43.0) month follow-up period, nine cases (3.8%) had recurrence of TB after treatment completion. The recurrence rate was not significantly different between the two groups (2/84, 2.4% in definitive anti-tuberculosis therapy group versus 7/150, 4.7% in standard anti-tuberculosis therapy group, p = 0.526). The recurrence in all nine cases was diagnosed as clinical recurrence rather than microbiological recurrence. Therefore, culture-negative TBL can be treated with standard anti-TB medication, although DST is not available but clinically stable after initiation of treatment.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Diagnosis of Tuberculous Lymphadenitis

Background: Tuberculosis is still a global health problem. Most common presentation of extrapulmonary tuberculosis is tuberculous lymphadenitis. In our setting, keeping huge burden of tuberculosis in mind, clinicians have to depend on pathological diagnosis of enlarged lymph nodes, i.e., cytomorphology with acid-fast staining in diagnosing these cases so that diagnosis and management of such cases can be initiated quickly. Fine needle aspiration cytology (FNAC) of lymph nodes has been a simple, rapid and cost-effective procedure for diagnosis of various causes of lymphadenopathies.&#x0D; Objective: To determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of tuberculous lymphadenitis patients in Bangladesh.&#x0D; Materials and Methods: This cross-sectional study was done on 317 subjects in Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with icddr,b. After clinical examination, fine needle aspiration (FNA) was done. The FNA materials were processed for Papanicoulaou staining (PAP stain), Ziehl-Neelsen staining and culture for the diagnosis of tuberculosis. Sensitivity, specificity, positive and negative predictive values of FNAC were determined where culture was taken as the gold standard.&#x0D; Results: Initially 351 clinically suspected tuberculous lymphadenitis patients were enrolled, but 34 cases were excluded due to diagnosis of malignancy. Among them 123 were male and 194 were female. Mean age was 27.91±13.16 years. Among the subjects 95.9% presented with cervical lymphadenopathy, others presented with lymphadenopathy of axillary or other groups of lymph nodes. The results of cytomorphological diagnosis of TB were in 58.36% cases, and culture was positive in 23.3% cases. Sensitivity, specificity, positive predictive value and negative predictive value of cytomorphological diagnosis were 79.7%, 48.1%, 31.9% and 88.6% respectively.&#x0D; Conclusions: FNAC is an effective diagnostic method for tuberculous lymphadenitis. It can diagnose granulomatous inflammation as well as reactive and other disease conditions including malignancies, thereby providing more information about the patient’s disease status.&#x0D; J Enam Med Col 2019; 9(1): 30-33

Diagnostic Utility of Interferon-Gamma Release Assay in Tuberculous Lymphadenitis

Objective The aim of this study was to evaluate the diagnostic performance of T-SPOT.TB for tuberculous lymphadenitis. Methods Suspected tuberculous lymphadenitis patients between September 2010 and September 2018 who had both peripheral blood T-SPOT.TB test and lymph node biopsy were retrospectively enrolled in this study. The cutoff value of T-SPOT.TB test for peripheral blood was set as 24 spot forming cell (SFC)/106 periphreral blood monocyte cell (PBMC) according to the instruction of testing kits. The gold standard for diagnosis of TBL was the combination of microbiology results, histopathology results and patient's response to anti-TB treatment. Diagnostic efficacy of T-SPOT.TB was evaluated, including sensitivity, specificity, accuracy, predictive values, and likelihood ratio. Results Among 91 patients who met the inclusion criteria, we excluded 8 cases with incomplete clinical information and 6 cases who lost to follow-up. According to the gold standard, there were 37 cases of true TBL (9 confirmed TBL and 28 probable TBL), 30 cases of non-TBL, and 10 cases of clinically indeterminate diagnosis who were excluded from the final analyses. The T-SPOT.TB tests yielded 43 cases of positive response and 24 cases of negative response. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of peripheral blood T-SPOT.TB for diagnosing TBL were 89.2%, 66.7%, 79.1%, 76.7%, 83.3%, 2.68 and 0.16, respectively. The number of SFCs of T-SPOT.TB in TBL patients [432(134-1264)/106 PBMCs] was higher than that in non-TBL patients [0 (0–30)/106 PBMCs] with a significant difference (Z=-5.306, P Conclusion T-SPOT.TB is a rapid and simple diagnostic test for TBL with a high sensitivity and negative predictive value.