Combination method for the diagnosis of Tuberculous lymphadenitis in high burden settings

Abstract

Background India reports the highest number of extrapulmonary tuberculosis (EPTB) cases globally, most of which are lymph node TB (LNTB). In high tuberculosis (TB) burden countries rapid diagnosis is very important. Fine needle aspirate cytology (FNAC) diagnosis can be made with features of caseous necrosis with/without epithelioid granulomas. However, bacteriological confirmation is essential. This study was performed to evaluate the performance of the diagnostic tests available namely FNAC, GeneXpert (GX) and Ziehl Neelsen stain (ZN) stain at resource restricted settings, for LNTB. Methods FNAC samples from affected lymph nodes were collected from 100 consenting patients with clinically suspected LNTB. FNA material was analyzed by cytomorphology, ZN and GX. If no Mycobacterium tuberculosis (MTB) was detected, repeat aspirate was cultured on Lowenstein Jensen medium. Descriptive statistical analysis was performed. Results Out of 100 cases, 73% showed cytological features consistent with TB. The most common cytomorphological pattern was epithelioid cell granulomas with caseous necrosis (59%). Caseous necrosis only pattern was seen in 14%. MTB was detected in 34% by ZN and 60% by GX. Overall, the combination of FNAC, ZN, GX detected 85% of LNTB. Conclusions A combination of FNAC, ZN and GX is a practical tool that can improve and quicken the diagnosis of LNTB in resource restricted high-burden settings.

Comparative serum lipid and immunohematological values among adult pulmonary tuberculosis and tuberculosis lymphadenitis cases and their association with sputum bacilli load and time to culture positivity in Northwestern Ethiopia

“…Studies showed that the Mtb bacilli load was very low in FNA samples [ 56 , 57 ] including the present study. Hence, FNA samples were excluded and bacilli load was enumerated only for PTB samples.…”

HBHA-IGRA and cytotoxic mediators release assays for the diagnosis of cervical tuberculous lymphadenitis

“…CTL is a health threat in Tunisia, and despite advances in molecular diagnostic tools, especially for patients without a history of TB, the diagnosis of CTL remains challenging ( 7 ). In the differential diagnosis of CTL, other granulomatous lymphadenitis, such as those caused by other bacterial diseases such as sarcoidosis, toxoplasmosis, tularemia, fungal disease, cat-scratch disease, and neoplasms, must be taken into consideration ( 8 ).…”

“…Therefore, imaging and evaluation of clinical symptoms are insufficient to conclusively diagnose CTL. Furthermore, the paucibacillary nature of CTL results in low sensitivity of bacteriological diagnostic tests ( 6 , 7 ). As a result, invasive sampling, such as fine needle aspiration and biopsies, is often required for a decisive diagnosis ( 8 ).…”

Primary Bilateral Tuberculous Otitis Media After Kidney Transplantation: A Case Report

“… 15 This is in contrast to a report on TB lymph node pathology in 100 immunocompetent patients, where 73% of cases showed caseous necrosis; as a result, the proportion for non-caseous necrosis is thought to be much higher in TOM. 16 However, many cases of TOM have also reported caseous changes in pathology. Furthermore, there is no evidence that non-caseous necrosis is more common in TB infections that occur in confined spaces such as the paranasal sinuses or nasal cavities.…”