Tuberculous lymphadenitis in South India—A histopathological and bacteriological study

Krishnaswami, H; Koshi, G; Kulkarni, Ketan; Job, C. K.

doi:10.1016/0041-3879(72)90019-0

Cited by 32 publications

(12 citation statements)

References 15 publications

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“…[1][2][3] In developing countries where the incidence of TB is high, tuberculous lymphadenitis is one of the most frequent causes of lymphadenopathy (30-52%). 4 In contrast, in developing countries, TB was implicated in as few as 1.6% of patients with lymphadenopathy in one series.…”

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confidence: 99%

Comparison of in house polymerase chain reaction with conventional techniques for the detection ofMycobacterium tuberculosisDNA in granulomatous lymphadenopathy

Singh

Muralidhar²,

Kumar³

et al. 2000

J Clin Pathol

153

131

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Aims-To evaluate the usefulness of the devR based polymerase chain reaction (PCR) in the detection of Mycobacterium tuberculosis in lymph node aspirates and tissues of lymphadenitis and to compare PCR with conventional diagnostic techniques. Subjects and methods-Coded specimens of fine needle aspirates and biopsies from 22 patients with tuberculous lymphadenitis, 14 patients with non-tubercular lymphadenitis, and nine patients with granulomatous lymphadenitis were processed and subjected to analysis by PCR, smear microscopy, M tuberculosis culture, histology, and cytology. Results-Tuberculous lymphadenitis was correctly diagnosed by PCR in 18 patients, by culture in five patients, by histology in 13 patients, and by cytology in seven patients. PCR gave two false positive results in 14 patients with non-tubercular lymphadenitis. The sensitivity of the conventional techniques was significantly higher with biopsies (17 of 22 specimens; 77%) than with fine needle aspirates (nine of 22 specimens; 41%). However, the sensitivity of PCR was not significantly higher with biopsies (68%) in comparison with fine needle aspirates (55%). The sensitivity of either biopsy PCR or fine needle aspirate PCR was not significantly diVerent from that of either histology combined with culture or cytology combined with culture. The overall combined specificity of PCR was 86%. Mycobacterium tuberculosis DNA was detected in six of nine patients with granulomatous lymphadenitis. Conclusion-PCR is the most sensitive single technique available to date for the demonstration of M tuberculosis in specimens derived from patients with a clinical suspicion of tuberculous lymphadenitis. The value of PCR lies in its use as an adjunct test in the diagnosis of tuberculous lymphadenitis, particularly in those patients where conventional methods fail. Because fine needle aspiration is not an invasive procedure, it is the procedure of choice, and PCR should be performed initially on these samples. Excisional biopsy histology and PCR should be recommended only for patients in whom fine needle aspirate PCR is negative or when there is discrepancy with the clinical impression. (J Clin Pathol 2000;53:355-361)

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Comparison of in house polymerase chain reaction with conventional techniques for the detection ofMycobacterium tuberculosisDNA in granulomatous lymphadenopathy

Singh

Muralidhar²,

Kumar³

et al. 2000

J Clin Pathol

153

131

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“…In developing countries with a high incidence of tuberculosis, tuberculous lymphadenitis (TBLN) is one of the most frequent causes of lymphadenopathy (12) and it is the most common form of extrapulmonary tuberculosis (16). TBLN also occurs with increased frequency in human immunodeficiency virus type 1 (HIV-1)-infected individuals (9,27).…”

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Identification of the Causative Organism of Tuberculous Lymphadenitis in Ethiopia by PCR

et al. 2002

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Tuberculous lymphadenitis (TBLN) is a common form of extrapulmonary tuberculosis with multiple differential diagnoses. Demonstration of the etiologic agent by smear microscopy or culture of fine needle aspirate (FNA) specimens is often unsuccessful. FNA specimens from 40 patients presenting at a rural health center in South Ethiopia and diagnosed as positive for TBLN on the basis of clinical and cytological criteria were analyzed for mycobacterial DNA by PCR. Thirty (75%) had cervical lymphadenitis and 11 (27.5%) were seropositive for human immunodeficiency virus (HIV). Three primer sets were initially used to identify the causative agent at the genus (antigen 85 complex), complex (IS6110 insertion sequence), and species (pncA gene and allelic variation) levels. Among the forty TBLN cases, 35 (87.5%) were positive by PCR at the genus and complex levels. Based on PCR for detection of allelic variation at position 169, 24 (68.6%) of the 35 were positive for Mycobacterium tuberculosis and 6 (17.1%) were positive for M. bovis. These six were positive in additional PCR assays using the JB21-JB22 primer set, which is highly specific for M. bovis. In developing countries with a high incidence of tuberculosis, tuberculous lymphadenitis (TBLN) is one of the most frequent causes of lymphadenopathy (12) and it is the most common form of extrapulmonary tuberculosis (16). TBLN also occurs with increased frequency in human immunodeficiency virus type 1 (HIV-1)-infected individuals (9, 27). Within the Mycobacterium tuberculosis complex, M. tuberculosis and M. bovis are the most common causative agents of TBLN. Which control measures and treatment are to be instituted depends on the most common causative agent in the area. Therefore, species identification is of paramount importance.Over the past decades, fine needle aspirate (FNA) cytology, an alternative procedure less invasive than excision biopsy, has assumed an important role in the diagnosis of peripheral lymphadenopathy. The cytological criteria for diagnosis of TBLN have been clearly defined (13,19). However, the amount of material obtained in FNA is usually so small that it is often inadequate for performance of acid-fast smear and culture examinations with reasonable sensitivity.Introduction of the PCR provided new possibilities for identification of mycobacteria in various types of clinical samples (3, 5); based on the amplification of common sequences, the identification time for detection of mycobacteria in clinical specimens was reduced (4, 8). The M. tuberculosis complex, consisting of M. tuberculosis, M. bovis, M. africanum, and M. microti, has been identified with a number of different targets, including the IS6110 insertion element sequence, using PCR methods (2, 6).In the present study, PCR was applied for assays of FNAs to identify the causative agent in TBLN in Ethiopia at the genus, complex, and species levels. MATERIALS AND METHODS Patients.The study was initiated after approval by the institutional and national ethical committees. FNAs which were collect...

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“…(9,10,22,23,26,29,30). The most common form of extrapulmonary tuberculosis is tuberculous lymphadenopathy (2,17,20), and its diagnosis remains a challenge since granulomatous lymphadenopathy has an extensive differential diagnosis. Several conditions, including sarcoidosis, fungal infections, and other inflammatory conditions, can present the same cytology and/or histopathology as tuberculous lymphadenopathy.…”

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Diagnosis of Extrapulmonary Tuberculosis by Smear, Culture, and PCR Using Universal Sample Processing Technology

2005

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Definitive and rapid diagnosis of extrapulmonary tuberculosis is challenging since conventional techniques have limitations. We have developed a universal sample processing (USP) technology for detecting mycobacteria in clinical specimens. In this study, this technology was evaluated blindly on 99 extrapulmonary specimens collected from 87 patients. USP-processed specimens were submitted to smear microscopy for detection of acid-fast bacilli (AFB), culture, and two PCR tests targeting devR (Rv3133c) and IS6110 gene sequences. On the basis of clinical characteristics, histology and cytology, conventional microbiology results, and response to antitubercular therapy, 68 patients were diagnosed with tuberculosis. Although USP smear and culture were significantly superior to conventional microbiology, which was not optimized (P < 0.0001), these approaches fell short of PCR tests (P < 0.0001). The low yields by smear and culture are attributed to the paucibacillary load in the specimens. The highest sensitivity in PCR was achieved when devR and IS6110 test results were combined; the sensitivity and specificity values were 83 and 93.8%, 87.5 and 100%, and 66.7 and 75%, respectively, in pleural fluid, needle-biopsied pleural tissue, and lymph node specimens. In conclusion, the application of USP technology, together with clinicopathological characteristics, promises to improve the accuracy and confidence of extrapulmonary tuberculosis diagnosis.Significant mortality and morbidity is caused by tuberculosis in developing countries, including India (31). Tuberculous pleural effusion is the most common exudative pleural effusion prevalent in India in contrast to the west, where malignant effusions are more frequent (27). However, the disease most often remains undiagnosed and, even worse, untreated. The chief difficulty with extrapulmonary specimens is that they yield very few bacilli and consequently are associated with low sensitivity of acid-fast bacillus (AFB) smear and culture. Acid-fast staining was positive in fewer than 10% of patients in most reports, whereas pleural fluid cultures for M. tuberculosis were positive in up to 12 to 70% of cases and pleural biopsies revealed granulomas in 50 to 97% of patients with tuberculous pleural effusion (1). The role of PCR in the diagnosis of tubercular pleural effusion has been evaluated extensively as an alternative diagnostic tool and has yielded variable results, with sensitivities ranging between 42 and 100% and specificities ranging between 85 and 100% using various PCR targets such as IS6110, 65kDa, TRC4, GCRS, etc. (9,10,22,23,26,29,30). The most common form of extrapulmonary tuberculosis is tuberculous lymphadenopathy (2,17,20), and its diagnosis remains a challenge since granulomatous lymphadenopathy has an extensive differential diagnosis. Several conditions, including sarcoidosis, fungal infections, and other inflammatory conditions, can present the same cytology and/or histopathology as tuberculous lymphadenopathy. A diagnosis of tuberculosis is then confirmed by ...

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Tuberculous lymphadenitis in South India—A histopathological and bacteriological study

Cited by 32 publications

References 15 publications

Comparison of in house polymerase chain reaction with conventional techniques for the detection ofMycobacterium tuberculosisDNA in granulomatous lymphadenopathy

Comparison of in house polymerase chain reaction with conventional techniques for the detection ofMycobacterium tuberculosisDNA in granulomatous lymphadenopathy

Identification of the Causative Organism of Tuberculous Lymphadenitis in Ethiopia by PCR

Diagnosis of Extrapulmonary Tuberculosis by Smear, Culture, and PCR Using Universal Sample Processing Technology

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