Tuberculous Lymphadenopathy Research Articles

Sensitivity of acid-fast bacilli smear, erythrocyte sedimentation rate, and Mantoux test in diagnosing tuberculous cervical lymphadenopathy

Sensitivity of acid-fast bacilli smear, erythrocyte sedimentation rate, and Mantoux test in diagnosing tuberculous cervical lymphadenopathy

Value of apparent diffusion coefficient for differentiating peripancreatic tuberculous lymphadenopathy from metastatic lymphadenopathy.

To evaluate effectiveness of the apparent diffusion coefficient (ADC) values of the peripancreatic lymphadenopathy to differentiate tuberculous lymphadenopathy from metastatic lymphadenopathy. Twenty-nine patients with 65 peripancreatic necrotic tuberculous lymphadenopathy and 31 patients with 47 peripancreatic necrotic metastatic lymphadenopathy from pancreatic ductal adenocarcinoma, who underwent magnetic resonance imaging (MRI), were included in this study. MRI features in the T1-weighted image (WI), T2WI, and diffusion-weighted image were analyzed. The ADC values of necrotic and non-necrotic portions of the lymphnodes were measured and compared using t test. Receiver operating characteristic analysis was performed to obtain the optimal ADC threshold value and diagnostic accuracy for differentiating tuberculous lymphadenopathy from metastatic lymphadenopathy. On T2WI, the signal intensity of necrotic portions was variable in tuberculous lymphadenopathy, but was mostly high in metastatic lymphadenopathy. The mean ADCs of necrotic portions of tuberculous lymphadenopathy were significantly lower than those of metastatic lymphadenopathy ([0.919 ± 0.272] × 10-3 mm2/s vs. [1.553 ± 0.406] × 10-3mm2/s, p < 0.001). Receiver operating characteristic analysis for differentiating tuberculous from metastatic lymphadenopathy demonstrated an area under the curve for the ADC values of necrotic portions of 0.929 (95% CI, 0.865-0.969) with an ADC threshold of 1.022. The sensitivity and specificity for the differentiation of tuberculous from metastatic lymphadenopathy were 80.0% and 97.8%, respectively. The ADC values of necrotic portions of peripancreatic lymphadenopathy may be useful for differentiating tuberculous from metastatic lymphadenopathy.

Evaluation of Tubercular Cervical Lymphadenopathy: Diagnostic and Therapeutic Utility

Introduction: Lymphadenitis is the most common extrapulmonary manifestation of tuberculosis. It remains both diagnostic and therapeutic challenge as not only mimics other diseases but also inconsistent physical and laboratory findings. Diagnosis is difficult often requiring biopsy.&#x0D; Aim: Aim of the study was to evaluate the role of surgical dissection of tuberculous cervicle lymphadenopathy for diagnosis as well as therapeutic purpose.&#x0D; Methods: This observational study was conducted during the time period of 01 july 2015 to 30 june 2017 in ENT &amp; Pulmonology department, combined military hospital Dhaka on 100 patients who have undergone surgical neck dissection.&#x0D; Result: In our study total 100 patients were biopsied. Among them 56 patient was diagnosed as tubercular lymphadenitis after lymphnode excision biopsy. Among them 47 tubercular lymphadenitis patient responded to ATT (CAT-1), only 2 patient developed cold abscess which required further surgery. Six patient showed relapse during follow-up and 9 patient did not respond to CAT-1 treatment (treatment failure). Surgical intervention along with CAT-2 treatment showed cure in all of them. 2nd surgical interventions were done in total 17 patients, 2 TB abscess during ATT (CAT-1 HRZE), 9 treatment failure patients and 6 relapse patients along with ATT (CAT-2 SHRZE) and all these patients had no relapse or treatment failure during further follow up.&#x0D; Bangladesh J Otorhinolaryngol; October 2017; 23(2): 127-132

Coexistence of metaplastic carcinoma of the breast with tuberculous axillary lymphadenopathy: A rare occurrence

Metaplastic breast carcinoma (MBC) is a rare malignant neoplasm of the breast which is highly aggressive and is known for its early recurrence and poor prognosis. Concurrent detection of a MBC and tuberculosis of the axillary lymph node is a rarity. To the best of our knowledge, there is no such case report in the literature. A 35-year-old premenopausal woman was diagnosed as a case of left carcinoma breast with a left axillary lymph node. Core-needle biopsy of the breast was suggestive of squamous cell carcinoma. The patient underwent modified radical mastectomy with a latissimus dorsi myocutaneous flap. The postoperative biopsy of the breast and axilla revealed MBC and tuberculous lymphadenitis of the axillary lymph node. The patient received antitubercular therapy and radiotherapy, followed by chemotherapy and had no recurrence on follow-up. This case report emphasizes that metaplastic carcinoma breast can coexist with tuberculous axillary lymphadenopathy.

'Beehive-like'appearance in thoracic tuberculous lymphadenopathy.

Sir, A 12-year-old girl presented with intermittent fever of moderate grade, since 15 days with normal examination findings. Mantoux test was positive. Radiograph of chest showed hilar lymphadenopathy (Figure 1: Panel a: Red arrow). Computerised tomography of the thorax and abdomen with oral and intravenous contrast showed enlarged lymph node mass in the mediastinum with hypointense spaces giving 'beehive like appearance' likely due to necrosis/caseation at the centre of lymph nodes. Lymph node groups involved included superior mediastinal (Figure 1: Red arrows in panels b and e) and inferior mediastinal (yellow arrow in panel c and d) but sparing groups on the left of the aorta. Lung fields were clear. No lymph node masses were present in the abdomen. Blood tests revealed lymphocytosis and elevated erythrocyte sedimentation rate (100 mm/h). She was treated with standard antituberculous therapy [isoniazid 300 mg once a day [OD], rifampicin 450 mg OD, ethambutol 800 mg OD and pyrazinamide 1 g OD] and on follow-up after 1 month was responding to treatment with absence of fever and good appetite. Tuberculous lymphadenopathy has been reported in several publications.[12] However, the 'beehive appearance' in this case is striking in appearance and is important to be recognized for distinguishing from other causes of mediastinal masses in children such as lymphoma, germ cell tumour and neuroblastoma.[3] It is especially important when there is no primary lung focus visible on the chest X-ray as in our case. And it is an important non-invasive sign for tuberculous lymphadenopathy for early and proper management.Figure 1: (a) X-ray chest: widened mediastinum due to enlarged lymph node mass. (b-d) Computerised tomography scan chest coronal view, e (axial view): beehive sign in tuberculosis-enlarged lymph node mass with cavities of various sizes surrounding tracheobronchial treeTeaching point: This is a useful sign to distinguish tuberculous adenopathy from other mediastinal masses. This will help minimise the need for invasive tests such as fine-needle aspiration cytology studies or biopsy to detect tuberculosis. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

A case of isolated axillary tuberculous lymphadenitis

Tuberculosis (TB) is one of the communicable diseases with high morbidity to the patient. TB is divided into pulmonary and extrapulmonary TB. In extrapulmonary TB, isolated axillary TB is rare and sometimes creates diagnostic difficulty, particularly in female patients. The axillary lymph nodes are affected in around 3% of tuberculous lymphadenitis. Our case presented with isolated axillary tuberculous lymphadenitis which is rare without evidence of TB elsewhere in the body. It is more common in females compared to males, and it commonly involves the left side. Most of the cases do not show systemic manifestations. Chest X-ray and ultrasound are useful primary investigations for the diagnosis. Histopathological examination of the lymph node is the confirmatory test for axillary tuberculous adenitis. Hence, tuberculous lymphadenopathy should be considered one of the differential diagnoses in a female patient with isolated axillary lymphadenopathy even without clinical manifestations of TB.

ENT manifestations of tuberculosis: an important aspect of ENT practice.

Tuberculosis involving organs other than the lungs is termed as 'extra pulmonary tuberculosis'. Tuberculosis (TB) remains a worldwide public health problem despite the fact that the causative organism was discovered more than 100 years ago. The present study was conducted to assess different manifestations of tuberculosis affecting the ear, nose and throat (ENT) in patients attending the outpatient department in a total of 520 cases of tuberculosis. One hundred and eight cases were of extra pulmonary tuberculosis. Sixty nine cases had the manifestations of TB in the ENT region. These included patients with tuberculous cervical lymphadenopathy (91.35), laryngeal TB (4.3%), tuberculous otitis media (1.4%), nasal TB (1.4%) and oral tuberculosis (1.4%). Extra pulmonary tuberculosis constitutes about 15-20% of all tuberculosis cases as per WHO survey and it is 20.6% in the present study.

150 Abdominal Tuberculosis in the 21st Century in Peru: A Description of 22 Cases

INTRODUCTION: The diagnosis of abdominal tuberculosis (AT) remains complicated, although it's a common pathology in developing countries. A high degree of clinical suspicion is always needed in order to ensure its rapid detection. We aimed to describe and analyze the epidemiological, clinical and radiological features of patients diagnosed with abdominal tuberculosis: tuberculous lymphadenopathy, gastrointestinal, visceral and peritoneal tuberculosis (TB). METHODS: A prospective study was conducted between 2015 and 2016 and patients diagnosed with AT based on clinical, endoscopic and histopathologic features were collected. The clinical, epidemiological and radiological features were described by frequencies and percentages and then analyzed in Stata 12 to evaluate the associations between them. RESULTS: A total of 22 patients were included: 17 males (77%) with a mean age of 38.6 years. Twelve patients (55%) had only one type of AT and 10 patients (45%) had more than one. The most common diagnosis was gastrointestinal TB (14 cases, 64%), followed by peritoneal TB (10 cases, 45%), tuberculous lymphadenopathy (8 cases, 36%) and visceral TB (2 cases, 9%). The former showed 6 presentations: ileocecal (8 cases, 57%), colorectal (7 cases, 50%), duodenal (3 cases, 21%), gastric (2 cases, 14%), esophageal (1 case, 7%) and jejunal (1 case, 7%). The most important antecedents were HIV infection (11 cases, 52%), TB contact (9 cases, 43%) and pulmonary TB and alcoholism (7 cases, 33% each one). The most common symptoms were abdominal pain and weight loss (19 cases, 90% each one), anorexia (17 cases, 81%), fever (15 cases, 71%), nocturnal sweating (13 cases, 62%), chronic diarrhea (12 cases, 57%), cough (11 cases, 52%) and abdominal distension (11 cases, 52%). The physical findings were ascites (8 cases, 38%) and hepatosplenomegaly (5 cases, 24%), and the principal complication was lower gastrointestinal bleeding (5 cases, 24%). Radiological findings consistent with pulmonary tuberculosis were also common (13 cases, 62%). Only abdominal distention and ascites showed statistical association with peritoneal tuberculosis (Fisher's exact = 0.0001 and 0.008 respectively). CONCLUSION: Abdominal pain, B symptoms and chronic diarrhea are the most important manifestations of AT. Hence attention must be paid in patients with this symptoms, especially if they are immunocompromised. In these subjects abdominal distension and ascites seem to suggest the diagnosis of peritoneal TB.

3208 Small Bowel Obstruction Due to Tuberculous Lymphadenopathy

INTRODUCTION: Mycobacterium tuberculosis is estimated to infect 1.7 billion people worldwide. When untreated, disseminated tuberculosis can occur through hematogenous seeding from primary infection or reactivation of latent disease. Abdominal tuberculosis can be seen in 5% cases of tuberculosis worldwide, with complications such as bowel obstruction resulting from localized infection or tuberculous lymphadenopathy. We present a patient with a history of latent tuberculosis who presented with bowel obstruction secondary to calcified mesenteric lymphadenopathy. CASE DESCRIPTION/METHODS: An 82-year old woman was initially seen in Pulmonology clinic regarding latent tuberculosis. Testing was notable for a positive interferon gamma release assay and a chest CT showed calcified lymphadenopathy in the neck and chest. She was started on isoniazid but was unable to tolerate the medication due to dizziness, headaches, and gastrointestinal upset. Over the next year, she developed intermittent abdominal discomfort and was eventually hospitalized for severe abdominal pain, nausea and vomiting. Physical examination revealed stable vital signs and a mildly distended abdomen. Laboratories were notable for a sodium of 129 mmol/L and hemoglobin 11.3 g/dL. An abdominal CT revealed a dilated stomach and duodenum with a transition point in the distal duodenum. There were multiple new calcified mesenteric and retroperitoneal lymph nodes compressing the distal duodenum, causing partial small bowel obstruction (Figure A). Subsequent esophagogastroduodenoscopy demonstrated white plaques in the distal esophagus, consistent with candida esophagitis (Figure B). The stomach and duodenal mucosa appeared endoscopically normal, with exception of narrowing at the second portion of the duodenum. This was suggestive of extrinsic compression and correlated with the area seen on the CT scan (Figure C). Duodenal biopsies were unremarkable. Her presentation was attributed to progressive calcific tuberculous lymphadenopathy and she improved with conservative management. Due to her other comorbidities and intolerance of prior therapy, anti-tubercular treatment was not pursued. DISCUSSION: Bowel obstruction is a common complication of abdominal tuberculous. Calcified tuberculous lymphadenopathy should be considered in the differential as a cause for bowel obstruction in patients with a history of untreated latent tuberculosis. Most cases clinically improve with medical therapy; however, in some cases, surgical management is needed.

PULMONARY TB PRESENTING AS HOARSENESS: A CASE REPORT

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Pulmonary tuberculosis is prevalent in the Philippines with incidence of 554/100,000 people, they usually present as chronic cough, hemoptysis, night sweats, afternoon fever and weight loss, but a patient presenting as hoarseness of voice is rare and the tendency would be a delay in its diagnosis and management CASE PRESENTATION: A 41 year old male, who came in due to hoarseness of voice associated with occasional cough, no fever, no weight loss, chest x-ray showing homogenous haziness at the right lung apex, chest ct scan showed enlarged lymph nodes at the aorto-pulmonary window, a tuberculin skin test was done and was positive hence patient was started on anti tuberculosis treatment, after 3 months of treatment patient noted only partial relief of hoarseness of voice. Repeat chest ct scan showed interval decrease in the size of non enhancing mass lesion with coarse calcifications at the aortopulmonary window due to conglomeration of enlarged lymph nodes, minimal fibrosis in the right apex and lingula. Bronchoscopy revealed paralysis of left vocal cords with no mass or any other lesions. DISCUSSION: Aorto-pulmonary window is a small space between the aortic arch and the pulmonary artery. A variety of structures traverse this window including left recurrent laryngeal nerve. Enlargement of lymph nodes secondary from our patients’ tuberculosis infection which may compress the recurrent laryngeal nerve causing vocal cord paralysis, resulting to hoarseness. CONCLUSIONS: In the investigation of the causes of recurrent laryngeal nerve paralysis, pulmonary tuberculosis must be a consideration especially in a patient presenting with hoarseness. Thus, clinicians must always consider the possibility of impingement or compression of the recurrent laryngeal nerve from tuberculous lymphadenopathy. Reference #1: Dikici O, Muluk NB. Left vocal cord paralysis due to lymphadenopathy of mediastinal tuberculosis. ENT updates. 2013 Aug 1;3(2):98 Reference #2: Meral M., Akgun M, Kaynar H, Mirici A, Gorguner M, Saglam L, Erdogan F. Mediastinal Lymphadenopathy due to mycobacterial infection. Japnese journal of infectious disease 2004 Jun 1;57(3):124-6 DISCLOSURES: No relevant relationships by May Joy Canillas, source=Web Response No relevant relationships by Gladys Judynil Daba, source=Web Response

Therapeutic Effect of Oral Administration and External Therapy of Traditional Chinese Medicine on Cervical Tuberculous

Objective: To analyze the clinical effect and value of oral administration and external therapy of traditional Chinese medicine for treatment of cervical tuberculous lymphadenopathy. Methods: A total of 56 patients with cervical tuberculous lymphadenopathy admitted to our hospital from January 1 to January 2018 were recruited. By using double-blind method, the patients were divided into control group (n=28) and experimental group (n=28). Control group comprised of patients with conventional anti-tuberculosis treatment, while the experimental group comprised of patients treated with oral administration and external therapy of traditional Chinese medicine. Total effective rate, incidence of complication and level of T lymphocyte subsets were compared between the two groups of cervical tuberculous lymphadenopathy patients. Results: Post-treatment data of total effective rate, complication rate, CD3+, CD4+, CD8+, CD4+/CD8+ of the experimental group were compared with the control group. P&lt;0.05; statistical analysis showed statistical significance. Post-treatment data of CD3+, CD4+, CD8+, CD4+/CD8+ of both control and experimental groups were compared with pre-treatment data. P&lt;0.05; statistical analysis showed statistical significance. Conclusion: Oral administration and external therapy of traditional Chinese medicine possesses significant effect in treatment of cervical tuberculous lymphadenopathy.

A prospective study on clinicopathological study of cervical lymphadenopathy

Cervical lymphadenopathy is a common clinical presentation in various departments of clinical practice. This study was done to know the correlation between clinical presentation of FNAC and histopathology of cervical lymphadenopathy, to emphasize the role of fine needle aspiration cytology (FNAC) in etiologic workup in cervical lymphadenopathy. 50 patients with cervical lymphadenopathy were assessed clinically, by laboratory and by FNAC study over a period of two years. In the present study, results revealed that tuberculous lymphadenopathy is the commonest cause of cervical lymphadenopathy with 68% followed by chronic non-specific lymphadenopathy with 32. Of the 35 patients whose fine needle aspiration cytology (FNAC) showed granulomatous changes, 50 had subsequent surgery and histological confirmation of the cytological appearance. 34 had TBLN (Tuberculous Lymphadenopathy), thus the specificity of FNAC was 94 per cent in diagnosing tuberculosis related granulomatous lymphadenopathy. One false positive FNAC was reported histologically to be non specificity. Present study had cervical lymph node swelling. Other common presenting symptoms were loss of weight and loss of appetite (20%), fever (30%), axillary and inguinal swellings (4%), cold abscesses (8%), pain (6%), sore throat, cough, discharging sinus, old sinus scars, caries tooth (2%). there was only unilateral involvement of node in 72% of cases right side was affected in 32% and left side was affected in 40% of cases bilateral involvement was seen in 14% of the cases. The lymph nodes were associated with other groups of lymph nodes in 10% of cases. In our study the sensitivity and specificity of FNAC of tuberculous cervical lymphadenopathy is 77 and 94 respectively. The results concluded that tuberculosis is the most common cause of cervical lymphadenopathy in the Indian population followed by reactive lymphadenitis and metastatic deposits. Reactive lymphadenitis is the commonest cause of cervical lymph node enlargement in different age group, infective in 11-40 yrs. age group including tuberculous and suppurative lymphadenitis, neoplastic lesions in more than 40 age group including metastatic disease and nonhodgkins lymphomas. FNAC is an important diagnostic modality for the etiologic workup in significant cervical lymphadenopathy and is almost as sensitive and specific as excision lymph node biopsy when an adequate aspirate is examined by expert eyes.

Tuberculous lymphadenitis with anthracosis: an unusual cause of unilateral vocal cord paralysis

Background: Tuberculous lymphadenopathy is an extremely common condition in developing countries; however, vocal cord paralysis secondary to compression by enlarged tuberculous lymph node is an extremely rare presentation.&#x0D; Case Presentation: In this paper, we present the case of a 72-year-old male patient who came to us with concerns of hoarseness of voice for the last eight months with fever and chills. He had been treated previously at ear, nose and throat (ENT) clinics and on evaluation, we discovered he had left vocal cord paralysis. Imaging showed multiple enlarged mediastinal and right hilar lymph nodes.&#x0D; Management &amp; Results: Mediastinoscopy with biopsy was done and after histopathologic confirmation of tuberculosis, the patient was prescribed antituberculous treatment.&#x0D; Conclusion: Antituberculous treatment in such patients shows signs of clinical and radiologic improvement.

Comparison of the Microwave-Heated Ziehl-Neelsen Stain and Conventional Ziehl-Neelsen Method in the Detection of Acid-Fast Bacilli in Lymph Node Biopsies.

BACKGROUND:Tuberculosis is a chronic inflammatory disease with lymphadenopathy being the most common extra-pulmonary manifestation. The conventional Ziehl–Neelsen method plays an essential role in the diagnosis of tuberculosis; however, it has a low sensitivity in detecting acid-fast bacilli.AIM:The present study emphasises the role of the microwave-heated method (modified Ziehl–Neelsen) over conventional Ziehl-Neelsen stain and to set at the best condition for irradiation.MATERIAL AND METHODS:The study included 90 patients with clinically suspected tuberculous lymphadenopathy who were referred to the Department of Pathology at Omdurman Military Hospital, Sudan. Demographic data such as age, sex, and site of swelling were documented for each patient. Specimens were stained with conventional Ziehl-Neelsen, fluoresce and the modified methods.RESULTS:Patient’s age ranged from 20 to 70 year. Of the total 90 cases with clinically suspected tuberculous lymphadenopathy, 18 cases were positive for AFB in conventional Ziehl-Neelsen method giving a sensitivity of 13.3%, while in microwave-heated method 82 cases of TB were detected positive for AFB yielded sensitivity and specificity of 97.6% and 85.7%, respectively, and positive and negative predictive values of 98.8% and 75.0% respectively compared to fluorescence methods.CONCLUSION:In the present study, the microwave-heated Ziehl-Neelsen method, was found to have sensitivity and specificity of 97.6% and 85.7%, respectively which matches the fluorescence technique. It has specificity in detecting lymph node tuberculosis that makes it superior over all other modified methods. However, the availability and cost-effectiveness might limit the use of fluorescence in routine practice. Furthermore, the study set the best staining temperature is provided at power 1 level (60 w) for 1.5 minutes.

Role of fine needle aspiration cytology as a diagnostic tool in lymphadenopathy with utility of CBNAAT in tuberculous lymphadenopathy

Introduction: Lymphadenopathy is a common, nonspecific clinical sign. Fine Needle Aspiration Cytology (FNAC) is the first line of investigation in the evaluation of lymphadenopathy. FNAC material can be used for cytological evaluation and other ancillary tests in Tuberculous Lymphadenopathy. Aims and Objectives To evaluate the role of FNAC as a diagnostic tool in lymphadenopathy. To assess the role of Cartridge based nucleic acid amplification test (CBNAAT) in suspected cases of tuberculous lymphadenopathy. Materials and methods: The study conducted at department of Pathology in MVJMC &RH, Hoskote, Bangalore from January 2017 to June 2018 A total of 104 cases of lymphadenopathy were subjected to FNAC. In each case at least 3 smears for H & E, Giemsa stain and Special stain like AFB done for tuberculous lymphadenopathy. FNAC material sent for CBNAAT in suspected cases of Tuberculosis . Results: The age ranged from 1-90years, Male:Female of ratio1.26 :1. Most common site was cervical and cytological pattern was granulomatous -41(39.4%) followed by reactive -38(36.5%).Majority of them presented with solitary node (77%) and followed by bilateral/multiple (23%). One case of reactive (11%), two cases of suppurative (50%) and ten cases of granulomatous (37%) were found to be positive for Tuberculosis by CBNAAT. Conclusion: FNAC is simple, cost effective diagnostic tool with high degree of accuracy.FNAC coupled with AFB staining is the first line of investigation for Tuberculous lymphadenopathy. According to New Revised National TB Control Programme (RNTCP) guidelines CBNAAT sputum is a must for paediatric cases. The present study highlights the utility of CBNAAT from FNAC material as one of the rapid and adjuvant diagnostic tool in tuberculous lymphadenopathy. Keywords: FNAC, Tuberculous lymphadenopathy, CBNAAT.

Biopsy of sonologically detected peripheral lymph nodes: diagnostic value in HIV positive patients

Background: One of the most common manifestations in human immunodeficiency virus (HIV) is generalized lymphadenopathy. Biopsy of these nodes can help in diagnosing associated conditions. Biopsy of clinically non-palpable lymph nodes can help physician to obtain an early diagnosis of associated diseases in people living with HIV (PLHIV). Present research was undertaken to study diagnostic yield of sonologically detected peripheral lymph node biopsy in symptomatic PLHIV.Methods: One hundred ten PLHIV above age of 18 years referred to surgery department for excision biopsy of sonologically detected peripheral lymph nodes were included. Specimen was sent in normal saline to laboratory for testing and part of the specimen was fixed in formalin for further evaluation. Gram stain, Zeil Nelson stain, histopathological examination and genotype MTBDR plus test were conducted. Comparison of quantitative variables and qualitative variables was done by using Kruskal wallis test and Chi-square test / Fisher’s exact test respectively.Results: Most common diagnosis obtained was tuberculous lymphadenopathy followed by reactive hyperplasia. Significantly higher percentage of patients having weight loss was diagnosed with tuberculous lymphadenopathy. Percentage of tuberculous lymphadenopathy patients was higher in patients who were not on anti-retroviral therapy (ART) as compared to those who were on ART. Median duration of HIV in tuberculosis lymphadenopathy patients was less as compared to patients with malignancy. Sensitivity, and specificity was 91.7%, and 61.5% respectively for diagnostic yield of USG in non-palpable lymph nodes.Conclusions: USG is a sensitive tool for early detection of clinically non-palpable pathological lymph nodes in symptomatic PLHIV.

A clinical study of tuberculous cervical lymphadenopathy: surgeon’s perspectives

Background: Cervical lymphadenopathy is common in this country. There are many causes of cervical lymphadenopathy like, malignancies, infections, autoimmune disorders, iatrogenic, and other miscellaneous conditions. There are more chances of wrong clinical diagnosis in case of lymphadenopathy than any other diseases. The present study was planned with the objective to study the clinical presentation of tuberculous cervical lymphadenopathy.Methods: A prospective, cross-sectional study was undertaken with inclusion of all cases of cervical lymphadenopathy attending the department of general surgery. The patients with cervical lymphadenopathy irrespective of age, sex, caste, religion, socio-economic status, duration and severity of illness were included in this study. The patients with primary malignancy, patients with clinical features of suspected malignancy like obvious growth or ulcer in head and neck region and pregnant women were excluded from the study.Results: Total 130 patients presented with cervical lymphadenopathy during the study duration. Infective etiology was the commonest (55, 42.31%) cause for the cervical lymphadenopathy followed by TB (50, 38.46%). The commonest age group affected by tuberculous cervical lymphadenopathy (TCL) was 20-35 years. The females (29, 58.00%) were more affected with TCL as compared to males (21, 42.00%). A majority of the patients (45, 90.00%) had unilateral TCL. Commonly involved lymph node group was level V (26, 52.00%). Other than excision biopsy (12 patients), no other type of surgery was needed in patients.Conclusions: Though, anti-tuberculous chemotherapy is the mainstay of treatment for TCL, surgical treatment is more useful in selected cases. In this regard, early diagnosis and treatment are critical in lowering the overall prevalence. Therefore, it is important that surgeons are aware of tuberculosis in the head and neck region.

Simultaneous amplification and testing method for Mycobacterium tuberculosis rRNA to differentiate sputum-negative tuberculosis from sarcoidosis.

We use the simultaneous application and testing method to detect Mycobacterium tuberculosis rRNA (SAT-TB) with the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy specimens to differentiate sputum-negative tuberculosis from sarcoidosis. In the first part, we validated the SAT-TB on the bronchial or EBUS-TBNA biopsy specimens from sputum smear-positive pulmonary tuberculosis. In the second part, all EBUS-TBNA specimens for sputum smear-negative intrathoracic tuberculous lymphadenopathies or sarcoidosis were tested with the SAT-TB, acid-fast bacilli smear, and culture. In the 16 sputum-positive tuberculosis cases, 5 showed negative SAT (2 nontuberculous mycobacteria and 3 had anti-tuberculosis therapies previously); the remaining 11 were positive. Of the 41 sputum-negative tuberculosis cases in the second part, five other diseases were negative. In the remaining 36 cases, 27 sarcoidosis cases were negative; 7 in 9 with sputum-negative tuberculosis were positive (77.78%). In these 36 patients, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the SAT method were 77.78, 100, 100, 93.10, and 94.44%, respectively. The SAT distinguished sputum-negative tuberculosis from sarcoidosis significantly ( P < 0.0001) and identified cases with active M. tuberculosis as accurately as the conventional methods (κ = 0.912, P < 0.0001). We conclude that the SAT-TB may be an effective method for using biopsy specimens to differentiate sputum-negative tuberculosis from sarcoidosis.

Aspiration cytology study of lymphadenopathy: Is EPTB a common pathology? A three-year retrospective study in Melmaruvathur teaching hospital

Background: Lymphadenopathy is a common clinical presentation among all age group and the aetiology may varies from inflammatory condition to malignancy. In India, tuberculous lymphadenopathy is quiet common. Objective: This study was aimed to assess the common pathology in lymphadenopathy by fine needle aspiration cytology study and to observe the spectrum of cytomorphological features in granulomatous lymphadenitis to enhance the aetiological awareness and diagnostic accuracy. Materials and methods: This retrospective study was conducted in Melmauvathur teaching hospital for a period of three years between 2016-2018.Patients subjected to Fine needle aspiration cytology study for lymphadenopathy were included in this study irrespective of age and sex. All demographic, clinical and cytological findings were collected from laboratory documents and statistically analysed. Results: A total of 167 cases were studied, of which 100 Cases were female and 67 were male 81 cases were children below 14 years and 86 were adults. 161 nodes were cervical nodes and 91% of node showed inflammatory pathology. Granulomatous adenitis was the common pathology observed in 107 cases (64%) which was statistically significant (P= < 0.00001) followed by nonspecific adenitis in 45 cases (27%). The common age group affected with granulomatous adenitis were adult between 15-30 years (n=37; 34.5%) followed by children between 5-10 years (n=24; 22.4%) with females predominance (65. 4%). Among the cytomorphological features, late granulomatous changes with caseation were seen predominantly in adults and early granulomatous changes were seen commonly in children and the specific morphology of granuloma with neutrophilic infiltration was predominantly seen in female (82.4%). Conclusion: Granulomatous inflammation was the common pathology affecting cervical nodes predominantly. Among age, increased prevalence occurs in adults between 15-30 years followed by children between 5-10 years with female preponderance.

Cytomorphological Spectrums in Tuberculous Lymphadenitis: Understanding the Stages of Disease

Introduction: Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis and one of the main causes of lymphadenopathy. Fine Needle Aspiration Cytology (FNAC) has played a substantial role in diagnosis of tuberculous lymphadenopathy and it has become a first-line diagnostic technique. The aim of this study was to describe and understand the spectrum of cytomorphological changes seen in tuberculous lymphadenitis corresponding to stages of disease and to associate the cytomorphological changes with Acid Fast Bacilli (AFB) positivity.&#x0D; Methods: This is a retrospective cytomorphological study of cytologically diagnosed tuberculous lymphadenitis. The recorded details of clinical presentation and site of the lymph nodes were noted. The slides were stained with Papanicolaou, Giemsa and AFB.&#x0D; Result: There were a total of 203 cases with age ranging from 3- 75 years. Four cytomorphological patterns observed were Necrotising Granulomatous Lymphadenitis (NGL; 45.32%), Granulomatous Lymphadenitis (GL, 18.22%), Necrotising Suppurative Lymphadenitis (NSL; 21.18%) and Necrotising Lymphadenitis (NL; 15.27%). Necrotising patterns were observed in immunocompromised individuals like HIV infected patients, in patients with previous history of tuberculosis and in patients with chronic renal disease. Strong AFB positivity was observed in necrotising patterns. Lymph nodes of head and neck region were the most common site of involvement with cervical being the commonest.&#x0D; Conclusion: Necrotizing patterns are observed in the later stages of disease or in the immunocompromised patients. Strong positivity for AFB is observed in the smears with necrotizing patterns and less in the granulomatous pattern.