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Jha H, Baveja CP, Kamal V, Agarwal PN, Saxena S, Dhakad MS, Sharma D. Comparative Diagnostic of Cervical Tuberculous Lymphadenitis: PCR is a Fast, Efficient, and Improved Diagnostic Approach. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:3312250. [PMID: 37346247 PMCID: PMC10281827 DOI: 10.1155/2023/3312250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023]
Abstract
Methods The study included 100 clinically suspected cases of TBLN. Fine needle aspirate (FNA) samples were processed for cytology staining and cultured on LJ & BACTEC 12B media. The biochemical tests were performed to identify the isolates at the species level. Additionally, for PCR, DNA was extracted and used for the diagnosis and identification of mycobacterial species. Results Patients ranged from 2 to 45 years with a mean age of 24.96 ± 9.10 years. Out of 100 patients, 73% had clinical symptoms of weight loss, followed by fever (72%), anorexia (66%), and night sweats (58%). 24% of patients were found to be smear-positive after Ziehl-Neelsen (ZN) staining and statistically highly significant with PCR. On LJ medium 34% and on BACTEC radiometric 45% of samples were smearing positive. Overall, 48% of cases were PCR-positive for TBLN. When compared with culture, the sensitivity and specificity of PCR were 93.75% and 100%, respectively, which are higher than cytology. The true positive predictive value (PPV) and negative predictive value (NPV) were 83.3% and 61.5%, respectively. Conclusion This study suggests that PCR is a rapid, sensitive, and specific tool for correct diagnosis of TBLN cases as compared to staining and culture which lead to the early and proper management of mycobacterial diseases.
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Affiliation(s)
- Himanshu Jha
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India
- Lab Strengthening & Diagnostics, Jhpiego, India
| | | | - Vinay Kamal
- Department of Pathology, Maulana Azad Medical College, New Delhi 110002, India
| | | | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India
| | - Megh Singh Dhakad
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India
| | - Divakar Sharma
- Department of Microbiology, Lady Hardinge Medical College, New Delhi 110001, India
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Tahtabasi M, Sahiner F. Tuberculous and non-tuberculous cervical lymphadenopathy incidence and distribution in Somalia from 2016 to 2020: A review of 241 cases. World J Otorhinolaryngol Head Neck Surg 2022; 8:361-369. [PMID: 36474662 PMCID: PMC9714051 DOI: 10.1016/j.wjorl.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/10/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To determine the incidence of tuberculous lymphadenitis (TBL) and other pathologies in cervical lymphadenopathies in Somalia and accompanying radiological findings. Methods In this hospital-based retrospective study, the demographic characteristics, pathology results and radiological findings of 263 patients who underwent ultrasound (US)-guided cervical lymph node biopsy between January 2016 and February 2020 were analyzed. Results Of 241 patients 118 men and 123 women (mean age 27.9 ± 18.1 years) included in the study, 46.1% (n = 111) were diagnosed as necrotizing granulomatous lymphadenitis (caseified, consistent with TBL) and 21.6% (n = 12, atypical lymphoid cells and n = 40, metastases) as malignancy. The most common type of metastasis was squamous cell cancer (n = 31), and the primary source of most of them was esophageal cancer (16/31, 51.6%). The age of patients with TBL was significantly lower than that of non-TBL (21.9 ± 14.6 vs. 41.9 ± 24.6, P = 0.003) and the incidence of TBL in pediatric patients was statistically higher (58.0% vs. 21.5%, P = 0.019). The rate of patients with TBL being localized at level 4 and level 5 was significantly more than non-TBL patients (18.0% vs. 10.0% and 23.4% vs. 10.8%, respectively, P = 0.01). Half of patients with TBL who have chest radiography had pathological findings; consolidation and bronchopneumonia were present in 52.6% of them. There were 2 patients with paravertebral abscess and one patient with gastrointestinal tuberculosis. Conclusion In Somalia, in the presence of cervical lymphadenopathy, after diagnosis by using US-guided biopsy; primarily considering of TBL and malignancy, thoracic involvement should be investigated, and esophageal carcinoma must be excluded in terms of metastatic lymph node.
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Affiliation(s)
- Mehmet Tahtabasi
- Department of RadiologyUniversity of Health Sciences‐Somalia Turkey Recep Tayyip Erdogan Education and Research HospitalMogadishuSomalia
| | - Fatih Sahiner
- Department of Medical MicrobiologyUniversity of Health Sciences‐Somalia Turkey Recep Tayyip Erdogan Education and Research HospitalMogadishuSomalia
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Mulugeta F, Tiruneh M, Abebe B, Yitayew G, Ayehubizu Z, Getahun M, Gelaw A. Evaluation of modified bleach technique for the detection of acid fast bacilli in lymph node aspirate at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. J Clin Tuberc Other Mycobact Dis 2022; 28:100328. [PMID: 35990771 PMCID: PMC9386082 DOI: 10.1016/j.jctube.2022.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Tuberculous Lymphadenitis (TBLN) is the commonest form of extrapulmonary tuberculosis. Definitive diagnosis of TBLN is difficult due to the low efficacy of the routine diagnostic techniques as compared to culture. Objective To determine whether prior bleach concentration can improve the detection of acid-fast bacilli when compared with conventional Ziehl-Neelsen (ZN) staining by using culture as the gold standard. Methods Cross-sectional study was conducted from March 01, 2015 to May 30, 2015. The study subjects were clinically suspected TBLN patients. Fine needle aspiration (FNA) was performed. Two different smears were prepared directly from the first needle pass for cytology and ZN staining. The remaining aspirate was used for the modified bleach concentration. The second needle pass aspirate was transferred into a sterile container containing sterile normal saline. The sediment was inoculated on the Lowenstein Jensen (LJ) medium. Measurement parameters for reliability and validity were used to analyze the results. Result A total of 93 participants were included in the study. Fifty-six out of the 93 (60.2 %) cases were positive for mycobacterium tuberculosis complex on LJ culture. The detection rates of direct ZN staining and modified bleach method were 20.4 % and 44.1 %, respectively. 73.1 % of the cases showed cytomorphological features consistent with TBLN by cytologic examination. The sensitivities of direct ZN staining and modified bleach method and cytomorphology were 32.0 %, 67.8 %, and 92.8 %, respectively. Conclusion Implementation of bleach concentration increases the detection rate of AFB over the direct ZN method. The bleach method can also be easily performed and provide a safe working environment by reducing infections.
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Affiliation(s)
- Firehiwot Mulugeta
- University of Gondar, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, Department of Medical Microbiology, Ethiopia
| | - Moges Tiruneh
- University of Gondar, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, Department of Medical Microbiology, Ethiopia
| | - Bewketu Abebe
- University of Gondar, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, Department of Pathology University, Ethiopia
| | | | - Zimam Ayehubizu
- Bahir Dar University, College of Health Science, Department of Medical Laboratory Sciences, Ethiopia
| | - Muluwork Getahun
- Ethiopian Public Health Institute, Tuberculosis Laboratory, Addis Ababa, Ethiopia
| | - Aschalew Gelaw
- University of Gondar, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, Department of Medical Microbiology, Ethiopia
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Wang Y, Chen M, Ni C, Tong J, Chen P, Zhang Y, Yang G. Case Report: Primary Mediastinal Large B-Cell Lymphoma Invasion of Extranodal Thyroid Tissue Mimicking Tuberculosis and Confounded by Similar Ultrasonic Appearance. Front Oncol 2022; 12:879295. [PMID: 35664739 PMCID: PMC9159155 DOI: 10.3389/fonc.2022.879295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Primary mediastinal large B-cell lymphoma (PMBCL) is a rare type of diffuse large B-cell lymphoma, which has significant features that overlap with those of Hodgkin’s lymphoma. Ultrasound is a commonly used modality to characterize superficial lymph no5des, and ultrasonic findings are often used to distinguish lymphoma from lymph node tuberculosis in daily clinical practice. Although a common malignancy, lymphoma rarely involves extranodal tissues. Case Presentation Here we report the case of a 42-year-old Chinese male patient with PMBCL who was misdiagnosed with tuberculosis because of extranodal invasion. He visited our hospital for a neck mass that he had been noting for 1 week. Ultrasound revealed multiple enlarged lymph nodes on both sides of the neck. The lesions appeared to involve the surrounding soft tissue and thyroid gland, resembling a tuberculous sinus tract formation. Cervical spine computed tomography showed no obvious abnormalities in the cervical cone or bone damage. Contrast-enhanced ultrasound indicated that one of the enlarged lymph nodes in the right neck was rich in blood supply and exhibited centripetal enhancement, with uniform high enhancement at the peak. The patient underwent two ultrasound-guided punctures; the first puncture was performed for an enlarged lymph node in the right neck at Hangzhou Red Cross Hospital. Hodgkin’s lymphoma was suspected based on pathological and immunohistochemical findings, whereas a rare type of diffuse large B-cell lymphoma was suspected at Zhejiang Cancer Hospital. Conclusions Lymphoma is often misdiagnosed, causing delayed treatment initiation and affecting patient outcomes as the disease progresses. The present case demonstrates that the ultrasonic appearance of lymphoma may sometimes be confused with that of tuberculosis. Although ultrasound-guided needle biopsy has a high diagnostic accuracy, it may also cause diagnostic deviation because of insufficient sampling volume. Moreover, owing to the enlargement of multiple lymph nodes due to lymphoma or lymph node tuberculosis, puncturing different lymph nodes may provide different results.
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Affiliation(s)
- Ying Wang
- Department of Ultrasonography, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Menghan Chen
- Department of Ultrasonography, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Chen Ni
- Department of Ultrasonography, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiahui Tong
- Department of Ultrasonography, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Peijun Chen
- Department of Ultrasonography, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ying Zhang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine. Chinese and Western Hospital of Zhejiang Province (Hangzhou Red Cross Hospital), Hangzhou, China
| | - Gaoyi Yang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine. Chinese and Western Hospital of Zhejiang Province (Hangzhou Red Cross Hospital), Hangzhou, China
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Shen Y, Fang L, Ye B, Xu X, Yu G, Zhou L. The Role of Core Needle Biopsy Pathology Combined with Molecular Tests in the Diagnosis of Lymph Node Tuberculosis. Infect Drug Resist 2022; 15:335-345. [PMID: 35140479 PMCID: PMC8818765 DOI: 10.2147/idr.s350570] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/14/2022] [Indexed: 12/28/2022] Open
Abstract
Background Early lymph node tuberculosis (LNTB) diagnosis is still difficult. The majority of LN specimens require the undertaking of invasive and unpleasant procedures. Purpose To evaluate the diagnostic efficacy of pathology when combined with molecular tests for the diagnosis of LNTB in core needle biopsy (CNB) specimens and to compare that diagnostic efficacy with that deriving from tissue specimens’ examination alone. Methods We retrospectively analyzed the medical records of LNTB patients who met the inclusion criteria. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of pathology, molecular tests, and parallel test (positive result for either of these two assays) were calculated to evaluate their diagnostic efficacy compared with a composite reference standard. Results A total of 289 patients were included in the study. The overall sensitivity, specificity, PPV, NPV, and AUC of pathology, molecular tests, and parallel test were 94.5%, 97.2%, 99.6%, 71.4%, 0.96; 73.1%, 100.0%, 100.0%, 34.6%, 0.87; and 98.4%, 97.2%, 99.6%, 89.7%, 0.98, respectively. For CNB specimens, these values for pathology, molecular tests, and parallel test were 93.3%, 96.2%, 99.4%, 69.4%, 0.95; 76.4%, 100.0%, 100.0%, 40.0%, 0.88; and 99.4%, 96.2%, 99.4%,96.2%,0.98, while those same values for the tissue were 96.6%, 100.0%, 100.0%, 76.9%, 0.98; 67.1%, 100.0%, 100.0%, 25.6%, 0.84; and 96.6%, 100.0%, 100.0%, 76.9%,0.98, respectively. Conclusion The validity of pathology and molecular testing when using CNB specimens was similar to that of tissue specimens for relevant assessment approaches. For the LNTB diagnosis, CNB specimens were preferred for the simultaneous undertaking of pathological examination and molecular testing.
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Affiliation(s)
- Yanqin Shen
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Likui Fang
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Bo Ye
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Xudong Xu
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Guocan Yu
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, People’s Republic of China
- Correspondence: Guocan Yu; Lihong Zhou, Email ;
| | - Lihong Zhou
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, People’s Republic of China
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Extrapulmonary Tuberculosis—An Update on the Diagnosis, Treatment and Drug Resistance. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1020015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pathogenic Mycobacterium tuberculosis complex organisms (MTBC) primarily cause pulmonary tuberculosis (PTB); however, MTBC are also capable of causing disease in extrapulmonary (EP) organs, which pose a significant threat to human health worldwide. Extrapulmonary tuberculosis (EPTB) accounts for about 20–30% of all active TB cases and affects mainly children and adults with compromised immune systems. EPTB can occur through hematogenous, lymphatic, or localized bacillary dissemination from a primary source, such as PTB, and affects the brain, eye, mouth, tongue, lymph nodes of neck, spine, bones, muscles, skin, pleura, pericardium, gastrointestinal, peritoneum, and the genitourinary system as primary and/or disseminated disease. EPTB diagnosis involves clinical, radiological, microbiological, histopathological, biochemical/immunological, and molecular methods. However, only culture and molecular techniques are considered confirmatory to differentiate MTBC from any non-tuberculous mycobacteria (NTM) species. While EPTB due to MTBC responds to first-line anti-TB drugs (ATD), drug susceptibility profiling is an essential criterion for addressing drug-resistant EPTB cases (DR-EPTB). Besides antibiotics, adjuvant therapy with corticosteroids has also been used to treat specific EPTB cases. Occasionally, surgical intervention is recommended, mainly when organ damage is debilitating to the patient. Recent epidemiological studies show a striking increase in DR-EPTB cases ranging from 10–15% across various reports. As a neglected disease, significant developments in rapid and accurate diagnosis and better therapeutic interventions are urgently needed to control the emerging EPTB situation globally. In this review, we discuss the recent advances in the clinical diagnosis, treatment, and drug resistance of EPTB.
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