Epidemiology and Diagnosis of Tuberculous Lymphadenitis in a Tuberculosis Low-Burden Country

Abstract

The aim of this article is to describe epidemiological and clinical data of patients with tuberculous lymphadenitis (TL) and evaluate the yield of the diagnostic techniques employed.Retrospective observational study was performed at the Vall d’Hebron University Hospital, Barcelona, Spain. All adult patients with confirmed TL (microbiologically) or probable TL (suspected by clinical presentation, cyto/histopathological features, and clinical improvement after specific treatment) diagnosed from January 2001 to December 2013 were included.One hundred twenty-two patients were included: 78 (63.9%) patients with confirmed diagnosis and 44 (36.1%) patients with probable TL. Seventy (57.4%) patients were nonnative residents. From 83 fine-needle aspiration (FNA) specimens, 54.8% (40/73) showed granulomatous inflammation, 62.5% (40/64) had positive mycobacterial culture, and 73.3% (11/15) tested positive with Xpert MTB/RIF (Cepheid, Sunnyvale, CA). From 62 biopsy samples, 96.8% (60/62) showed granulomatous inflammation, 64.6% (31/48) had positive mycobacterial culture, and 46.1% (6/13) tested positive with Xpert MTB/RIF.TL has increasingly been diagnosed in our setting, mostly because of cases diagnosed in nonnative residents. FNA is an easy and safe technique for the diagnosis of suspected TL, and the yield regarding mycobacterial culture seems to be similar to the obtained with biopsy. The Xpert MTB/RIF test from FNA specimens may increase the accuracy of the TL diagnosis and provides quicker results.

The diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in mediastinal tuberculous lymphadenitis

“…In published data, AFB detection ranged from 0.8% to 48.5%, while culture positivity ranged from 20% to 62% (10)(11)(12)(13)(14)(15)(16)(17). When these results are compared with fineneedle aspiration results for peripheral lymph nodes and EUS studies for mediastinal lymph nodes, sensitivities and specificities are similar (2,(18)(19)(20)(21). As a result, conventional microbiological methods have low diagnostic sensitivity for the diagnosis of MTLA, mostly due to a low burden of bacilli and insufficient sample amount (22).…”

“…The most commonly affected lymph nodes (LNs) are the cervical, followed by mediastinal, supraclavicular, and inguinal LNs (2). In the International Standards for Tuberculosis Care it is recommended that microbiological confirmation must be made, and diagnostic materials should be obtained for microbiological and histopathological evaluation for diagnosis of EPT (3).…”

Delays in the Diagnosis and Treatment of Tuberculous Lymphadenitis in Low-Incidence Countries: A Systematic Review

“…In 8 studies, there was information on HIV infection of which 1 study solely included HIV patients [25]. Three studies reported other comorbidities than HIV [20, 26, 29]. …”

“…Five articles had data on patient delay [20, 22-25], three on health care delay [19, 26, 27], and three on total delay [21, 28, 29]. …”

“…The case definition of TBLA was inconsistent in the different studies with specimens examined with microscopy, culture, polymerase chain reaction, and pathology, and/or cases based on clinical assessment. Most samples were collected using fine-needle aspiration (FNA) and/or excisional biopsy [19, 20, 23-29]. A single article had no information on the type of biopsy [21], while another study used bronchoalveolar lavage fluid, lumbar puncture, paracentesis of ascites fluid, and surgically obtained abdominal biopsies [22].…”