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Kaur J, Jain A, Rai AK. Clinicopathological Profile in Patients with Tubercular Cervical Lymphadenitis and Its Treatment Outcome. Indian J Otolaryngol Head Neck Surg 2024; 76:4080-4085. [PMID: 39376317 PMCID: PMC11455750 DOI: 10.1007/s12070-024-04786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/31/2024] [Indexed: 10/09/2024] Open
Abstract
Tuberculosis is a common occurrence in developing countries. Drug resistance, co-morbidities, and limited availability of new rapid tests such as the GeneXpert/MTB Rif assay make diagnosis and treatment of extrapulmonary tuberculosis burdensome. A cross-sectional study was carried out at Employees' State Insurance Corporation Medical College and Hospital, Faridabad, Haryana of patients treated for tubercular cervical lymphadenopathy from December 2021 to March 2023 in the department of ENT. This study included 58 patients. The clinicopathological profile of patients and the outcome of treatment with antitubercular therapy were noted. The majority of patients had level V (39.6%) involvement. Incidental diagnosis of diabetes mellitus was seen in 2 cases (3.4%). Fever was the commonest constitutional symptom observed in 27.5% of cases. FNAC was suggestive of tubercular abscess in 48.2% and the GeneXpert MTB/RIF assay detected Mycobacterial tuberculosis in all the cases with rifampicin resistance in only one case. 56 cases (96.5%) had complete resolution after completion of antitubercular therapy including patients with rifampicin resistance and patients with diabetes mellitus. In the remaining two cases, treatment was prolonged for a few months before the resolution of the disease was observed. Timely diagnosis, patient compliance to antitubercular therapy, and adequate management of comorbidities lead to successful treatment outcomes in tubercular cervical lymphadenitis. Delayed response to treatment in a few cases needs further research into factors like immune status, nutrition, living conditions, and quality of drugs available to the public.
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Affiliation(s)
- Jasleen Kaur
- Department of ENT, Employees’ State Insurance Corporation Medical College and Hospital, Faridabad, Haryana India
| | - Avani Jain
- VMMC and Safdarjung Hospital, New Delhi, India
| | - Anil Kumar Rai
- Department of ENT, Employees’ State Insurance Corporation Medical College and Hospital, Faridabad, Haryana India
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Machona MS, Muloiwa R, Porter M, Peter J, Lehloenya RJ. Advanced human immunodeficiency virus (HIV) does not affect ability to utilize lymphadenopathy in assessment of drug reaction with eosinophilia and systemic symptoms syndrome in HIV and tuberculosis: Prospective comparative study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100276. [PMID: 38946893 PMCID: PMC11214507 DOI: 10.1016/j.jacig.2024.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 07/02/2024]
Abstract
Background RegiSCAR validation criteria for drug reaction with eosinophilia and systemic symptoms (DRESS) includes lymphadenopathy, a frequent feature of both tuberculosis (TB) and human immunodeficiency virus (HIV). TB is the most common HIV-associated coinfection. Advanced HIV is associated with lymph node (LN) fibrosis. It is not clear if this negatively affects case validation in HIV-associated DRESS. To answer this question, we designed a prospective descriptive study to assess lymphadenopathy in various combinations of comorbid HIV, TB, and DRESS. Objectives We sought to describe the prevalence of DRESS-associated lymphadenopathy and characterize LN quality, size, and distribution in a high HIV-TB burden setting over time. Methods We prospectively and systematically examined LN in 25 consecutive acute DRESS cases hospitalized at a South African tertiary-care center and 10 hospitalized non-DRESS HIV-TB coinfected controls. Results Fourteen (56%) of 25 patients were HIV infected, with a median (interquartile range) CD4 count of 254 (66-478) cells/mm³, and 7 of 14 were coinfected with TB. Using RegiSCAR criteria, 12 (46%) of 25 were definite DRESS cases, 8 (31%) of 25 probable, and 5 (23%) of 25 possible. Possible cases were excluded in the analysis. Fifteen (75%) of 20 subjects had LN in ≥2 anatomic sites, including all 7 patients with HIV-TB coinfection. In contrast, 1 (20%) of 5 hospitalized non-DRESS HIV-TB coinfected controls had LN. Cervical LN, in 15 (88%) of 17, was most common, followed by axillary (76%) and inguinal (59%). Cervical LN ranged between 1 and 2 cm in size. Among the 8 (32%) of 25 subjects with follow-up data, LN had regressed in all within 6 weeks of stopping the offending drug and initiating TB treatment. There was no correlation with CD4 cell count and LN. Conclusion Lymphadenopathy is a common feature of acute DRESS, even among HIV-TB-coinfected patients with advanced immunosuppression.
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Affiliation(s)
- Musonda Sharon Machona
- Department of Medicine, Division of Dermatology, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Rudzani Muloiwa
- Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Mireille Porter
- Department of Medicine, Division of Allergy and Clinical Immunology, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
- Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa
| | - Jonny Peter
- Department of Medicine, Division of Allergy and Clinical Immunology, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
- Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa
| | - Rannakoe J. Lehloenya
- Department of Medicine, Division of Dermatology, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
- Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa
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Aldrees AM, Alnajeim MH, Alomran AA, Alshehri AA. The Role of Therapeutic Drug Monitoring in Slow Response Extra-Pulmonary Tuberculosis Treatment: A Case Report. Cureus 2023; 15:e51301. [PMID: 38161565 PMCID: PMC10756859 DOI: 10.7759/cureus.51301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/03/2024] Open
Abstract
Tuberculosis is caused by an infectious bacterium and it has significant morbidity and mortality rates globally. It mostly affects the lungs, but it can also spread to other parts of the body, like the lymph nodes (tuberculous lymphadenitis). The most common way to treat it is with the RIPE regimen, which includes rifampin, isoniazid, pyrazinamide, and ethambutol. The drugs can be slowly or rapidly metabolized, resulting in either increased toxicity or subtherapeutic drug levels. In this paper, we discuss the case of a slow responder who was treated with increased rifampin and isoniazid doses and improved clinically and biochemically. It's the first case of a slow responder diagnosed with tuberculous lymphadenitis reported in the Gulf region.
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Affiliation(s)
- Abdulwahab M Aldrees
- Internal Medicine/Infectious Diseases, King Khalid University Hospital, Riyadh, SAU
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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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Prabhu SR, Steward N E, Steward SE. A retrospective analysis of 1019 cases of tuberculous cervical lymphadenitis in a rural setup in 20 years. Indian J Tuberc 2023; 70:162-167. [PMID: 37100572 DOI: 10.1016/j.ijtb.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/05/2022] [Accepted: 03/26/2022] [Indexed: 04/28/2023]
Abstract
BACKGROUND This article is to review cervical lymphadenitis due to tuberculosis (TB), their presentation, their aetiology, the methods used to diagnose them, the treatment modalities offered and the response to treatment. METHODS 1019 patients were diagnosed and treated for TB of the lymph nodes of the neck from 1st November 2001 to 31st August 2020 at a tertiary ENT hospital, Nadiad, Gujarat, India. Study consisted about 61% males and 39% females with the mean age being 37.3 years. RESULT Commonest factor or habit among those diagnosed for tuberculous cervical lymphadenitis was consumption of unpasteurized milk. HIV and diabetes were the most common co-morbid conditions found with this disease. Swelling in the neck was most common clinical feature followed by loss of weight, formation of abscess, fever and fistula. Rifampicin resistance was found in 1.5% of patients among those tested for the same. CONCLUSION The most commonly affected site for extra pulmonary TB is posterior triangle of neck than the anterior triangle. Patients with HIV and diabetes are at higher risk for the same. Testing for drug susceptibility has to be done due to increased resistant of drugs for extra pulmonary TB. GeneXpert and histopathological examination are important for its confirmation.
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Affiliation(s)
- Supreet R Prabhu
- Dr. N. D. Desai Medical College & Hospital, Nadiad, Gujarat, India.
| | - Enosh Steward N
- Kumar's Dental, Maxillofacial & Facial Aesthetic Clinique, Vadodara, Gujarat, India
| | - Sharon Enosh Steward
- Kumar's Dental, Maxillofacial & Facial Aesthetic Clinique, Vadodara, Gujarat, India
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Maghous A, Marnouch EA, Hommadi M, Benlemlih M, Zaghba N, Nadif A, Bazine A, Lalya I, Andaloussi Saghir K, Elmarjany M, Hadadi K, Sifat H. Co-existent Disseminated Lymph Node Tuberculosis with Invasive Cervical Adenocarcinoma: A Problem Solving. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00677-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nanomaterial-Based Drug Delivery System Targeting Lymph Nodes. Pharmaceutics 2022; 14:pharmaceutics14071372. [PMID: 35890268 PMCID: PMC9325242 DOI: 10.3390/pharmaceutics14071372] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/28/2022] [Accepted: 06/22/2022] [Indexed: 02/06/2023] Open
Abstract
The lymphatic system plays an indispensable role in humoral balance, lipid metabolism, and immune regulation. The lymph nodes (LNs) are known as the primary sites of tumor metastasis and the metastatic LNs largely affected the prognosis of the patiens. A well-designed lymphatic-targeted system favors disease treatment as well as vaccination efficacy. In recent years, development of nanotechnologies and emerging biomaterials have gained increasing attention in developing lymph-node-targeted drug-delivery systems. By mimicking the endogenous macromolecules or lipid conjugates, lymph-node-targeted nanocarries hold potential for disease diagnosis and tumor therapy. This review gives an introduction to the physiological functions of LNs and the roles of LNs in diseases, followed by a review of typical lymph-node-targeted nanomaterial-based drug-delivery systems (e.g., liposomes, micelles, inorganic nanomaterials, hydrogel, and nanocapsules). Future perspectives and conclusions concerned with lymph-node-targeted drug-delivery systems are also provided.
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Islam Sheikh N, Babar M, Zahoor A, Idrees Z, Naseem S, Fatima S. The Pattern of Superficial Lymphadenopathy on Fine Needle Aspiration Cytology in Clinical Practice in Islamabad. Cureus 2021; 13:e17075. [PMID: 34522552 PMCID: PMC8429801 DOI: 10.7759/cureus.17075] [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] [Accepted: 08/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background: In adults, lymph nodes are not normally palpable. A number of patients with asymptomatic lymphadenopathy never visit physicians for the condition, and thus, this important sign is often missed by the medical practitioner if it is not the presenting complaint. The incidence of lymphadenopathy is suggested to be increasing. While lymphadenopathy is benign and self-limiting in most patients, the underlying disease may range from treatable infectious etiology to malignant neoplasms. In most cases clinical examination and history guide towards the cause of lymphadenopathy. In recent years, fine needle aspiration cytology (FNAC) has become an easy clinical tool (with or without the assistance of CT, MRI, and ultrasound) for the diagnosis of the underlying cause of lymphadenopathy. Aims and objectives: To find out the cytomorphological pattern in superficial lymphadenopathy with the help of FNAC. Materials and methods: This descriptive cross-sectional study was conducted at HBS General Hospital, Islamabad from January 2017 to June 2019. Patients presenting with superficial lymphadenopathy were included in the study. FNAC was performed by the pathologist, histopathological reports were examined and analyzed using Statistical Package for the Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY). Results: Six hundred and thirty-two patients underwent FNAC. Tuberculous lymphadenitis was the most common diagnosis (56.1%) followed by reactive hyperplasia (28.29%). The sample showed metastatic malignancy 3.36% and lymphoma 2.05%. Cervical lymphadenopathy was the most common site for TB (49.36%). Metastatic cancer observed in cervical lymph nodes was 3.16% and lymphoma was 1.74%. Conclusion: FNAC is recognized as a simple and safe diagnostic technique that can diagnose cases of superficial and deep lymphadenopathy easily. The most common cause of superficial lymphadenopathy in our study was tuberculosis with cervical lymph nodes.
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Affiliation(s)
| | - Mehreen Babar
- Ear, Nose, and Throat, Hazrat Bari Imam Sarkar (HBS) Medical College, Islamabad, PAK
| | - Ambreen Zahoor
- Medicine, Hazrat Bari Imam Sarkar (HBS) Medical College, Islamabad, PAK
| | - Zaidan Idrees
- Psychiatry, Hazrat Bari Imam Sarkar (HBS) Medical College, Islamabad, PAK
| | - Sajid Naseem
- Medicine, Hazrat Bari Imam Sarkar (HBS) Medical College, Islamabad, PAK
| | - Saba Fatima
- Medical Affairs and Clinical Research, Hilton Pharma Pvt. Ltd., Karachi, PAK
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Affiliation(s)
- Chong Karleen
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, WP Kuala Lumpur, Malaysia
| | - Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, W P Kuala Lumpur, Malaysia
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Zenebe Y, Adem Y, Tulu B, Mekonnen D, Derbie A, Mekonnen Z, Biadglegne F. Tuberculosis Lymphadenitis and Human Immunodeficiency Virus Co-infections among Lymphadenitis Patients in Northwest Ethiopia. Ethiop J Health Sci 2021; 31:653-662. [PMID: 34483623 PMCID: PMC8365488 DOI: 10.4314/ejhs.v31i3.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tuberculosis and human immunodeficiency virus (HIV) are among the major health problems in Ethiopia. This study assessed the proportion of tuberculosis lymphadenitis (TBLN), HIV infection and their co-infection among TBLN presumptive individuals at the selected hospitals in Northwest Ethiopia. METHODS Institution based cross sectional study was carried out. Data on demographic and clinical variables were collected with standardized questionnaire. Microbiological culture was done on specimen obtained by fine needle aspirates. The HIV status was determined by rapid anti-HIV antibody test. Data was entered and scrutinized using SPSS version 20 statistical packages. A stepwise logistic regression model was used. The result was considered as statistically significant at P<0. 05. RESULTS A total of 381 lymphadenitis patients were included in the study. The overall prevalence of TBLN and HIV were at 250(65.6%) and 9(2.4%), respectively and their co-infection was at 6(2.4%). Based on the cytological examination, 301(79.0%) of them were diagnosed as TBLN. The age group, (P=0.01) and residency, (P=0.01) were found significantly associated with TBLN. Similarly, unsafe sex was also statistically significant for HIV infection (P=0.007). CONCLUSION Tuberculosis lymphadenitis is the leading cause of TB and lymphadenitis in the region. However, TBLN-HIV coinfection was promisingly low. High rate of discrepancy was noticed between cytological and culture results. Hence, the TBLN diagnostic criteria shall pursue revision.
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Affiliation(s)
- Yohannes Zenebe
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yesuf Adem
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Begna Tulu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Mekonnen
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
| | - Awoke Derbie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
| | - Zewdie Mekonnen
- Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
- Biochemistry Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fantahun Biadglegne
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Leipzig university, Institute of Clinical Immunology, Germany
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Khurana AK, Gupta V, Joshi D, Goyal A, Khurana U, Pakhare A. Determinants of lymph node resolution in patients of tubercular lymphadenitis treated with anti tuberculous chemotherapy: A hospital based longitudinal study. Indian J Tuberc 2020; 68:215-220. [PMID: 33845955 DOI: 10.1016/j.ijtb.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/21/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The variable course of illness in patients of Tubercular lymphadenitis remains a therapeutic challenge to treating physicians in a significant proportion of patients. This study was aimed to explore the possible determinants which could predict the outcome of this subgroup of patients. METHODOLOGY This was a prospective cohort study where 94 patients of TB lymphadenitis were enrolled who could be followed up till the end of treatment. They were evaluated in the beginning and monitored till the end of treatment keeping into account the clinical behaviour of lymph nodes during the course of Anti tubercular chemotherapy. RESULTS Out of 94 patients, 60 had their lymph nodes resolved at the end of prescribed treatment duration wheras 34 were classified as partial responders. Another 26 amongst them had their nodes resolved by an extension of continuation phase by 3-6 months. Presence of bilateral and multiple lymph nodes, necrosis on Fine needle aspiration at initial diagnosis and occurrence of Paradoxical upgrading reaction were associated with the partial resolution of lymph nodes at the end of stipulated ATT duration. CONCLUSION Treatment duration should be individualized by the treating physicians. Certain parameters mentioned above can be taken as warning signals of patients ending up as partial responders and hence the need of a prolonged extension phase.
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Affiliation(s)
| | - Vikas Gupta
- Otorhinolaryngology & Head and Neck Surgery, AIIMS Bhopal, India
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Rai DK, Kumar R, Ahmad S. Clinical characteristics and treatment outcome in Tubercular lymphadenitis patients- A prospective observational study. Indian J Tuberc 2020; 67:528-533. [PMID: 33077055 DOI: 10.1016/j.ijtb.2020.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis. This study was primarily designed to assess clinical characteristics of Peripheral tubercular lymphadenitis and incidence of Paradoxical reaction. MATERIALS & METHODS It is a prospective observational study for 130 peripheral Lymph node tuberculosis patients diagnosed and treated between 1st Jan 2018 to 31st Dec 2019. All statistical analyses were performed using statistical software SPSS version 20 (SPSS Inc, Chicago, USA). A P value of <0.05 is considered significant. RESULTS Out of 130 study patients, 54 were male, and 76 were female, with a sex ratio of 1:1.4. The mean age of the patients was 28.01 years (±12.41). Almost one-fourth of study patients (25.38%) had symptoms for more than one years before the diagnosis of tubercular lymphadenitis. Of the 130 patients, 62 (47.69%) were classified as having confirmed TB based on AFB positivity in FNAC sample. More than half of study patients (55.38%) received homoeopathic treatment before initiation of anti-tubercular treatment. The most common Lymph node involved was cervical (66.15%). Forty-six (35.38%) patients developed Paradoxical reaction, and most of this occurred in the first two months of the initiation of Anti-tubercular treatment. Fifty-eight patients (44.61%) had a residual Lymph node of size more than one centimetre after six months of treatment. Only 9 patients out of 54 patients had significant reduction in the size of the lymph node with 9 months of treatment. CONCLUSION Significant number of patients had residual lymph node at the end of 6 months of treatment, but extending the treatment to 9 months was not beneficial. More than half of patients had history of homoeopathic treatment that could lead to delayed presentation. The paradoxical reaction is very common but most of it subsided spontaneously.
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Affiliation(s)
| | - Rahul Kumar
- Department of Pulmonary Medicine, AIIMS Patna, 801505, India
| | - S Ahmad
- Department of CFM, AIIMS Patna, 801505, India
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Affiliation(s)
- Isabel Ramírez
- Internal Medicine, Infectious Diseases, Hospital Pablo Tobón Uribe, Medellín, Colombia.,Universidad de Antioquia, Medellín, Colombia
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Kesari SP, Basnett B, Chettri A. Spectrum of Tuberculous Infection in Patients Suffering from HIV/AIDS and Its Correlation with CD-4 Counts: A Retrospective Study from Sikkim. Indian J Otolaryngol Head Neck Surg 2019; 71:167-171. [PMID: 31275824 DOI: 10.1007/s12070-016-1001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022] Open
Abstract
To determine the spectrum of Tuberculous Infection in Patients suffering from HIV/AIDS and its correlation with CD-4 cell counts. A retrospective analysis of data of all the patient suffering from HIV/AIDS who are registered in the Sikkim State AIDS control society register during the past 7 years to look for tuberculosis as a opportunistic infection and its correlation with CD4 cell counts. Out of 268 patient registered, 51 were suffering with tuberculosis as co-infection, Amongst which cervical tuberculosis was common. There was significantly relation with CD4 cells count. Tuberculosis is one of the commonest opportunistic infection and chances of developing tuberculosis increases with decrease CD4 cell count.
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Affiliation(s)
- Santosh Prasad Kesari
- 1Department of ENT, Central Referral Hospital, Sikkim Manipal University, Sikkim Manipal Institute of Medical Sciences, 5th Mile Tadong, Gangtok, Sikkim 737102 India
| | - Bina Basnett
- 2Department of Physiology, Sikkim Manipal University, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim India
| | - Ajay Chettri
- 3Department of Orthopaedics, Sikkim Manipal University, SMIMS, Gangtok, Sikkim India
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Jasim HA, Abdullah AA, Abdulmageed MU. Tuberculous lymphadenitis in Baghdad city: A review of 188 cases. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hwang E, Szabo J, Federman A, Margolies LR. Reactivation tuberculosis presenting with unilateral axillary lymphadenopathy. Radiol Case Rep 2018; 13:1188-1191. [PMID: 30233757 PMCID: PMC6141701 DOI: 10.1016/j.radcr.2018.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/08/2018] [Indexed: 11/25/2022] Open
Abstract
Unilateral axillary lymphadenopathy has various benign and malignant etiologies. Although benign causes are more common, it is important to exclude malignant causes, including metastasis from primary breast carcinoma. Benign etiologies include reactive adenopathy, granulomatous disease, and collagen vascular disease. We present a case of unilateral right axillary lymphadenopathy in a patient with rheumatoid arthritis. The pathologic diagnosis of granulomatous lymphadenitis and interval discovery of patient's history of latent tuberculosis led to a second biopsy for special mycobacterial staining and cultures with a final diagnosis of reactivation tuberculosis. The extrapulmonary manifestation of reactivation tuberculosis with tuberculous lymphadenitis is uncommon and particularly rare in the axillary lymph nodes.
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Zellweger JP, Sousa P, Heyckendorf J. Clinical diagnosis of tuberculosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10021017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tagne Nouemssi AB. Disseminated tuberculous lymphadenitis presenting as cervical mass in patient with HIV infection, worsening after antiretroviral initiation: diagnosis and treatment challenges. BMJ Case Rep 2018; 2018:bcr-2017-221775. [PMID: 29545423 DOI: 10.1136/bcr-2017-221775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Tuberculosis (TB) continues to represent an important public health challenge in the world and the USA, especially given its association with HIV infection and population migration. Cervical tuberculous lymphadenitis represents the most common extrapulmonary presentation of TB in the USA. Considerations for other causes of neck mass often contribute to delay in diagnosis. In this report, we describe the case of a 41-year-old man who presented with painful swelling of the neck and was diagnosed with tuberculous lymphadenitis, complicated by HIV therapy-associated immune reconstitution syndrome. Prior to this diagnosis, he presented with a chronic intermittent cough, repeatedly treated as bronchitis. Furthermore, TB is a recognised occupational risk for primary care physician, as they are often the first contact for patients. With the Patient Protection and Affordable Care Act in the USA, the risk is likely to increase with the influx of newly insured often poor,and/or immigrants.
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Affiliation(s)
- Alain Bruno Tagne Nouemssi
- Family Medicine Residency Department, NYMC at Saint Joseph Medical Center, Yonkers, NY, United States of America
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Collu C, Fois A, Crivelli P, Tidore G, Fozza C, Sotgiu G, Pirina P. A case-report of a pulmonary tuberculosis with lymphadenopathy mimicking a lymphoma. Int J Infect Dis 2018; 70:38-41. [PMID: 29477363 DOI: 10.1016/j.ijid.2018.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 12/18/2022] Open
Abstract
Clinical and radiological manifestations of tuberculosis (TB) are heterogeneous, and differential diagnosis can include both benign and malignant diseases (e.g., sarcoidosis, metastatic diseases, and lymphoma). Diagnostic dilemmas can delay appropriate therapy, favoring Mycobacterium tuberculosis transmission. We report on a case of TB in an immunocompetent, Somalian 22-year-old boy admitted in the respiratory unit of an Italian university hospital. His symptoms and clinical signs were thoracic pain, weight loss, latero-cervical, mediastinal, and abdominal lymphadenopathy. Smear microscopy and PCR were negative for Mycobacterium tuberculosis. The unclear histological pattern, the unusual clinical presentation, the CT scan signs, the BAL lymphocytes suggested the suspicion a lymphoma. Culture conversion proved Mycobacterium tuberculosis infection. This case report highlights the risk of misdiagnosis in patients with generalized lympho-adenopathy and pulmonary infiltrates, particularly in Africans young patients.
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Affiliation(s)
- Claudia Collu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Alessandro Fois
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Paola Crivelli
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Gianni Tidore
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Claudio Fozza
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
| | - Pietro Pirina
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
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Abstract
Tuberculous lymphadenitis is the most common extrapulmonary manifestation of disseminated tuberculosis (TB). It is considered to be the local manifestation of the systemic disease that has disseminated to local lymph nodes, but a high index of suspicion is needed for the diagnosis, because there are several infectious and noninfectious diseases that can mimic the same clinical picture. In recent years, different diagnostic methods have been introduced, including fine-needle aspiration cytology, which has emerged as a simple outpatient diagnostic procedure that replaced the complete excisional node biopsy, and a number of molecular methods which have greatly improved diagnostic accuracy. This chapter covers the most actual knowledge in terms of epidemiology, clinical manifestations, pathogenesis, and treatment and emphasizes current trends in diagnosis of tuberculous lymphadenitis. TB parotid gland involvement is extremely rare, even in countries in which TB is endemic. Because of the clinical similarity, parotid malignancy and other forms of parotid inflammatory disease always take priority over the rarely encountered TB parotitis when it comes to differential diagnosis. As a result, clinicians often fail to make a timely diagnosis of TB parotitis when facing a patient with a slowly growing parotid lump. This chapter highlights the most important features of this uncommon disease.
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Ding RL, Cao HY, Hu Y, Shang CL, Xie F, Zhang ZH, Wen QL. Lymph node tuberculosis mimicking malignancy on 18F-FDG PET/CT in two patients: A case report. Exp Ther Med 2017; 13:3369-3373. [PMID: 28587415 PMCID: PMC5450601 DOI: 10.3892/etm.2017.4421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 12/23/2016] [Indexed: 01/06/2023] Open
Abstract
18F-fluorodeoxyglucose positron emission/computed tomography (18F-FDG PET/CT) imaging, an established procedure for evaluation of malignancy, reports an increased 18F-FDG uptake in acute or chronic inflammatory condition. Lymph node tuberculosis (LNTB) is the most common form of extrapulmonary tuberculosis. However, the absence of clinical symptoms and bacteriological basis makes it difficult to diagnose. In the current case report, two patients with LNTB mimicking malignant lymphoma are presented by 18F-FDG PET/CT. The objective of the present report is to emphasize that LNTB should be considered as a noteworthy differential diagnosis in patients with enlarged lymph nodes, particularly in tuberculosis-endemic countries, and that lymph node biopsy serves a vital role in diagnosing LNTB.
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Affiliation(s)
- Rui-Lin Ding
- Department of Oncology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
| | - Hong-Ying Cao
- Department of Emergency, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
| | - Yue Hu
- Department of Oncology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
| | - Chang-Ling Shang
- Department of Oncology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
| | - Fang Xie
- Department of Oncology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
| | - Zhen-Hua Zhang
- Department of Oncology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
| | - Qing-Lian Wen
- Department of Oncology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P.R. China
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Zider A, Kamangar N. An 80-Year-Old Woman With Progressive Shortness of Breath and a Mediastinal Mass. Chest 2017; 150:e19-22. [PMID: 27396796 DOI: 10.1016/j.chest.2016.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/24/2015] [Accepted: 01/18/2016] [Indexed: 01/28/2023] Open
Abstract
An 80-year-old woman from Iran presented to our institution for evaluation of insidious onset of dyspnea and progressive hypoxemia. She had a history of hypertension, COPD attributed to secondhand smoke, and an unprovoked pulmonary embolus that was treated with lifelong anticoagulation. In addition, she had a history of latent TB status posttreatment with isoniazid 10 years prior. One year ago, home oxygen therapy was started at 4 L/min via nasal cannula, and because of her decline, her son had brought her to the United States 3 months earlier for medical help. After a contrast-enhanced thoracic CT scan followed by a nondiagnostic thoracentesis, another hospital informed her that she likely had inoperable lung cancer. She presented to our institution for a second opinion.
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Affiliation(s)
- Alexander Zider
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Sylmar, CA
| | - Nader Kamangar
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Sylmar, CA; UCLA-Olive View Medical Center, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Sylmar, CA.
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Bacha S, Khemiri M, Racil H, Hantous S, Chaouch N, Cheikhrouhou S, Chabbou A, Megdiche ML. [Paradoxical reaction following antituberculosis therapy in immunocompetent patient]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:367-372. [PMID: 27776947 DOI: 10.1016/j.pneumo.2016.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 08/27/2016] [Accepted: 09/17/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The features of paradoxical reactions (PR) that occurred in non-HIV infected patients are rare and not well known. CASE REPORT The authors reported the case of a 21years old, non-immunocompromised, and HIV negative patient treated for disseminated tuberculosis. PR occurred after 8months after initiation of antituberculous treatment. PR presented as left cervical lymphadenopathy, pulmonary, pleural, costal and spinal location of the tuberculosis. The antituberculous drugs were prolonged. Patient's clinical symptoms improved initially. However, left inguinal lymphadenopathy appeared after 20months of antituberculous therapy. Inguinal lymph node biopsy revealed tuberculous lymphadenitis. The patient has a good compliance to the treatment. The patient was continued on same antituberculous treatment for a total of 28months. The cervical and inguinal lymphadenopathy disappeared and CT scan showed regression of thoracic, abdominal, costal and spinal lesions. CONCLUSION PR during antituberculous treatment must be considered after exclusion of other causes. No consensus on the therapeutic management of this entity has been developed to date.
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Affiliation(s)
- S Bacha
- Service de pneumologie, hôpital Abderrahmane Mami, pavillon 2 Ariana, Tunisie.
| | - M Khemiri
- Service de pneumologie, hôpital Abderrahmane Mami, pavillon 2 Ariana, Tunisie
| | - H Racil
- Service de pneumologie, hôpital Abderrahmane Mami, pavillon 2 Ariana, Tunisie
| | - S Hantous
- Service de radiologie, hôpital Abderrahmane Mami, Ariana, Tunisie
| | - N Chaouch
- Service de pneumologie, hôpital Abderrahmane Mami, pavillon 2 Ariana, Tunisie
| | - S Cheikhrouhou
- Service de pneumologie, hôpital Abderrahmane Mami, pavillon 2 Ariana, Tunisie
| | - A Chabbou
- Service de pneumologie, hôpital Abderrahmane Mami, pavillon 2 Ariana, Tunisie
| | - M L Megdiche
- Service de pneumologie, hôpital Abderrahmane Mami, pavillon 2 Ariana, Tunisie
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Minakawa S, Kaneko T, Hagiwara C, Takahata T, Sawamura D. A diagnostically challenging case of tuberculous lymphadenitis. DERMATOL SIN 2016. [DOI: 10.1016/j.dsi.2016.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Diagnostic challenges in cervical tuberculous lymphadenitis: A review. North Clin Istanb 2016; 3:150-155. [PMID: 28058405 PMCID: PMC5206468 DOI: 10.14744/nci.2016.20982] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/23/2016] [Indexed: 11/20/2022] Open
Abstract
Tuberculosis is a very serious disease and incidence is once again on the rise. Lymph node tuberculosis is one of the most common extrapulmonary manifestations of tuberculosis. In differential diagnosis of chronic, painless cervical lymphadenopathy, cervical tuberculous lymphadenitis should be kept in mind. A high index of suspicion is needed for diagnosis of tuberculous lymphadenitis, which is known to mimic a number of pathological conditions. This article reviews epidemiology, clinical manifestations, and diagnostic techniques for cervical tuberculous lymphadenitis.
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Sancak R, Celiksoy MH. An unusual cause of an anterior mediastinal mass in a 52-day-old infant with mediastinal tuberculosis. World J Pediatr 2016; 12:372-373. [PMID: 27351574 DOI: 10.1007/s12519-016-0031-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/23/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Recep Sancak
- Department of Pediatric Allergy and Immunology, Ondokuz Mayıs University, Kurupelit, Samsun, Turkey
| | - Mehmet Halil Celiksoy
- Department of Pediatric Allergy and Immunology, Ondokuz Mayıs University, Kurupelit, Samsun, Turkey.
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Soft-tissue calcification on a panoramic radiograph. J Am Dent Assoc 2016; 147:362-5. [DOI: 10.1016/j.adaj.2015.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/25/2015] [Accepted: 09/20/2015] [Indexed: 11/23/2022]
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Meghji S, Giddings CEB. What is the optimal diagnostic pathway in tuberculous lymphadenitis in the face of increasing resistance: Cytology or histology? Am J Otolaryngol 2015; 36:781-5. [PMID: 26545471 DOI: 10.1016/j.amjoto.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/30/2015] [Accepted: 08/04/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The London Borough of Newham has the highest rates of tuberculosis (TB) within Europe (116 per 100,000). There is a lack of guidance in lymph node (LN) TB on how to best obtain a positive culture, which is the gold standard in the face of increasing mycobacterial resistance. METHODS An individual cohort study was carried out via a prospective local TB database capturing 90 cases of cervical LN TB over 34 months. We compared the diagnostic efficacy of fine needle aspiration (FNA) and excision biopsy of LN. RESULTS FNA cytology revealed granulomata in 49%, acid-fast bacilli (AFB) in 8.6% and a positive culture in 40%. LN excision showed granulomata in 97.6%, AFB in 17.1% and a positive culture in 70.1%. There was an 18% resistance to first-line antimicrobials. CONCLUSIONS We describe our experience and suggest an algorithm for the culture of TB organisms to avoid a lengthy diagnostic process.
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Khandkar C, Harrington Z, Jelfs PJ, Sintchenko V, Dobler CC. Epidemiology of Peripheral Lymph Node Tuberculosis and Genotyping of M. tuberculosis Strains: A Case-Control Study. PLoS One 2015; 10:e0132400. [PMID: 26177546 PMCID: PMC4503442 DOI: 10.1371/journal.pone.0132400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/13/2015] [Indexed: 11/19/2022] Open
Abstract
Background This study examined potential risk factors of lymph node tuberculosis (LNTB), including phylogenetic lineages of Mycobacterium tuberculosis (MTB), in comparison to pulmonary tuberculosis (PTB) in a setting with an ethnically diverse population. Methods We conducted a case-control study at a major tuberculosis clinic in Sydney, Australia, which included all patients with peripheral LNTB seen at the clinic between 2000 and 2012. Controls were randomly selected patients with PTB seen at the same clinic during the study period. Epidemiological data were extracted from the hospital electronic database and medical records. Associations between LNTB and age, sex, ethnicity, comorbidities and phylogenetic lineages of MTB in comparison to PTB were examined using logistic regression in univariate and multivariate analyses. Results There were 212 cases with LNTB and 424 randomly selected controls with PTB. Among patients with LNTB, 74% were female and the mean age (standard deviation, SD) was 42 (16) years. Among patients with PTB, 43% were female and the mean age was 44 (22) years. Females, 45 to 64-year-olds and Southern Asians had an increased risk for LNTB (OR 3.13, 95% CI 2.10-4.67; OR 2.50, 95% CI 1.29-4.84; OR 3.95, 95% CI 1.54-10.12 respectively). Patients with diabetes were at a higher risk of PTB (OR 0.40, 95% CI 0.19 – 0.83 for LNTB). A subset analysis showed that patients infected with the East African Indian strain of MTB were more likely to develop LNTB (OR 10.07, 95% CI 2.37-42.77). Conclusions An increased risk for LNTB (but still lower rates than for PTB) was found among females, people aged 45 to 64 years and people born in Southern Asia. An increased risk for PTB was found among patients with diabetes. The East African Indian strain of MTB was significantly associated with a higher likelihood of LNTB compared to other MTB strains.
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Affiliation(s)
- Chinmay Khandkar
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
| | - Zinta Harrington
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter J. Jelfs
- NSW Mycobacterium Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Vitali Sintchenko
- NSW Mycobacterium Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, New South Wales, Australia
| | - Claudia C. Dobler
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Smaoui S, Mezghanni MA, Hammami B, Zalila N, Marouane C, Kammoun S, Ghorbel A, Ben Jemaa M, Messadi-Akrout F. Tuberculosis lymphadenitis in a southeastern region in Tunisia: Epidemiology, clinical features, diagnosis and treatment. Int J Mycobacteriol 2015; 4:196-201. [PMID: 27649866 DOI: 10.1016/j.ijmyco.2015.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/26/2015] [Accepted: 04/27/2015] [Indexed: 11/26/2022] Open
Abstract
AIM To evaluate patients' profiles, demographics, clinical and therapeutic approaches and strategies in patients with tuberculous lymphadenitis (TBG). PATIENTS AND METHODS A retrospective study of all TBG-confirmed cases admitted in a tuberculosis-specific health care facility between 1 January 2009 and 16 June 2013. RESULTS A total of 181 clinical files were examined. Mean age was 32years old; the female/male ratio was 1.78 to 1. Raw milk consumption was noted in 1/3 of patients. Most cases involved the head and neck region (83.4%), nodes involvement, including axillary (12 cases), and mediastinal (9 cases). Clinical symptoms were present in only 55.2%. Tuberculin skin test (TST) was conducted with 82.6% positive responses. Diagnostics confirmation was done with anatomical pathology in most of the patients; only 56 of them had any microbiology analysis done. Demonstration of acid-fast bacilli in microscopy from either fine-needle aspirates or biopsies was done in 17.5% of cases, and cultures yielded positive results in 27%. Treatment duration was varied. Paradoxical reactions were noted in 12% and persistent lymphadenopathy after treatment completion was noted in 10% of cases. CONCLUSIONS TBG remains a disease of interest. Today, its diagnosis and management is still a problem despite its increasing worldwide incidence, and especially in this study area. Disease control should be strengthened in this country.
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Affiliation(s)
- Salma Smaoui
- Regional Laboratory of Hygiene, Tunisia; Faculty of Pharmacy, Monastir, Tunisia
| | | | - Bousaima Hammami
- Department of Infectious Diseases, CHU Hedi Chaker, Sfax, Tunisia
| | - Neila Zalila
- Department of Care and Basic Health, Sfax, Tunisia
| | - Chema Marouane
- Regional Laboratory of Hygiene, Tunisia; Faculty of Pharmacy, Monastir, Tunisia
| | - Sana Kammoun
- Regional Laboratory of Hygiene, Tunisia; Faculty of Pharmacy, Monastir, Tunisia
| | | | - Mounir Ben Jemaa
- Department of Infectious Diseases, CHU Hedi Chaker, Sfax, Tunisia
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Karunanithi S, Kumar G, Sharma P, Bal C, Kumar R. Potential role of (18)F-2-fluoro-2-deoxy-glucose positron emission tomography/computed tomography imaging in patients presenting with generalized lymphadenopathy. Indian J Nucl Med 2015; 30:31-8. [PMID: 25589803 PMCID: PMC4290063 DOI: 10.4103/0972-3919.147532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Generalized lymphadenopathy is a common and often vexing clinical problem caused by various inflammatory, infective and malignant diseases. We aimed to review briefly and highlight the potential role of 18F-2-fluoro-2-deoxy-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in such patients. 18F-FDG PET/CT can play an important role in the management of generalized lymphadenopathy. It can help in making an etiological diagnosis; can detect extranodal sites of involvement and employed for monitoring response to therapy.
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Affiliation(s)
- Sellam Karunanithi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ganesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Punit Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Ben Brahim H, Kooli I, Aouam A, Toumi A, Loussaief C, Koubaa J, Chakroun M. [Diagnostic and therapeutic management of lymph node tuberculosis in Tunisia]. Pan Afr Med J 2014; 19:211. [PMID: 25829976 PMCID: PMC4372307 DOI: 10.11604/pamj.2014.19.211.5213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 09/27/2014] [Indexed: 11/29/2022] Open
Abstract
La tuberculose ganglionnaire est la localisation extra-pulmonaire la plus fréquente de la tuberculose. Nous nous proposons dans ce travail d’étudier les modalités diagnostiques, thérapeutiques et évolutives de cette localisation. Il s'agit d'une étude rétrospective portant sur 100 cas de tuberculose ganglionnaire. L’âge moyen était de 35 ± 15 ans (15-85 ans). Aucun malade n’était VIH positif. L'aire cervicale était la plus touchée (93 cas). L'intradermo-réaction à la tuberculine était positive dans 76/91 cas (83,5%). L'examen bactériologique des prélèvements au niveau des ganglions atteints avait mis en évidence des bacilles acido-alcoolo-résistants à l'examen direct dans 2/31 cas (6,4%) et la culture avait isolé Mycobacteruim tuberculosis dans 1/31 cas (3,2%). La cytoponction ganglionnaire (FNAC) était évocatrice de tuberculose dans 35/42 cas (83,3%). La biopsie ganglionnaire était réalisée dans 69 cas et avait permis de retenir le diagnostic de tuberculose dans tous les cas. La FNAC, comparativement à la biopsie, avait permis de raccourcir significativement le délai de la prise en charge (15,1 vs 22,8 jours; p=0,001) et la durée d'hospitalisation (17,3 vs 24,6; p=0,004). La durée moyenne du traitement antituberculeux était de 9,8 ± 4,6 mois (7 à 44 mois). Le traitement chirurgical initial avait raccourci significativement la durée du traitement médical. Il n'avait pas d'impact sur le taux de guérison. Nous avons noté 10 cas de réponse paradoxale aux antituberculeux, quatre cas de résistance clinique et une rechute dans deux cas. La tuberculose ganglionnaire pose un problème diagnostique et thérapeutique. La microbiologie est d'un faible apport. La FNAC est un moyen diagnostique très utiles dans les pays endémiques et à faibles ressources. Un traitement médical seul permet d’éviter les inconvénients de la chirurgie.
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Affiliation(s)
- Hajer Ben Brahim
- Service de Maladies Infectieuses, CHU Fattouma Bourguiba, 5000 Monastir, Tunisie
| | - Ikbel Kooli
- Service de Maladies Infectieuses, CHU Fattouma Bourguiba, 5000 Monastir, Tunisie
| | - Abir Aouam
- Service de Maladies Infectieuses, CHU Fattouma Bourguiba, 5000 Monastir, Tunisie
| | - Adnene Toumi
- Service de Maladies Infectieuses, CHU Fattouma Bourguiba, 5000 Monastir, Tunisie
| | - Chawki Loussaief
- Service de Maladies Infectieuses, CHU Fattouma Bourguiba, 5000 Monastir, Tunisie
| | - Jamel Koubaa
- Service d'Oto-Rhino-Laryngologie, CHU Fattouma Bourguiba, 5000 Monastir, Tunisie
| | - Mohamed Chakroun
- Service de Maladies Infectieuses, CHU Fattouma Bourguiba, 5000 Monastir, Tunisie
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Kawano S, Maeda T, Watanabe J, Fujikura Y, Mikita K, Hara Y, Kanoh S, Kimura F, Miyahira Y, Kawana A. Successful diagnosis of tuberculous lymphadenitis by loop-mediated isothermal amplification of cutaneous samples from an ulcerated surface lesion: a case report. J Med Case Rep 2014; 8:254. [PMID: 25030753 PMCID: PMC4108240 DOI: 10.1186/1752-1947-8-254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 06/11/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Tuberculous lymphadenitis is the most frequent form of extrapulmonary tuberculous. Although nucleic acid amplification assays such as polymerase chain reaction have recently become mainstream techniques for diagnosing tuberculous lymphadenitis, they are still not routinely performed in developing countries because of their high costs and complicated procedures. CASE PRESENTATION We describe a case of tuberculous lymphadenitis in a 79-year-old Japanese man who had been on continuous hemodialysis for end-stage renal disease. We employed loop-mediated isothermal amplification and the procedure for ultrarapid extraction to develop a fast and easy-to-perform procedure for diagnosing tuberculous lymphadenitis. CONCLUSIONS The commercially available loop-mediated isothermal amplification assay kit and a rapid purification procedure enabled us to identify and amplify a Mycobacterium tuberculosis-specific gene within just 1.5 hours.
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Affiliation(s)
| | - Takuya Maeda
- Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama 359-8513, Japan.
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Diffuse lymphadenopathy as the presenting manifestation of systemic lupus erythematosus. J Clin Rheumatol 2014; 19:397-9. [PMID: 24048114 DOI: 10.1097/rhu.0b013e3182a6a924] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the case of a 27-year-old African American man who presented with 6 months of generalized lymphadenopathy and nothing in his history or examination to suggest systemic lupus erythematosus (SLE). He was thought to have lymphoma, syphilis, or tuberculosis, and an extensive workup was done. Laboratory investigation finally revealed leukopenia (4.0), proteinuria (1.87 g), antinuclear antibodies (640 speckled), anti-double-stranded DNA (640), anticardiolipin immunoglobulins G and M, anti-Smith, Coombs, anti-Ro, anti-La, CK (531 U/L), aldolase (8.5 U/L), high erythrocyte sedimentation rate (130 mm/h), and low complement (C3 15 mg/dL and C4 3 mg/dL). A kidney biopsy showed diffuse proliferative glomerulonephritis, International Society of Nephrology class IV. Generalized lymphadenopathy as the first and only manifestation for 6 months made the diagnosis of SLE challenging. Generalized diffuse lymphadenopathy has been associated with SLE but is much less frequent now than in the past. The differential diagnosis of lymphadenopathy relevant to rheumatologists includes Kikuchi histiocytic necrotizing lymphadenitis, Castleman disease, syphilis, tuberculosis, sarcoidosis, and lymphoma.
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Zhao N, Yang JJ, Zhang GS. Differential diagnosis between AML infiltration, lymphoma and tuberculosis in a patient presenting with fever and mediastinal lymphadenopathy: A case report. Oncol Lett 2014; 7:705-708. [PMID: 24527075 PMCID: PMC3919864 DOI: 10.3892/ol.2014.1785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 12/12/2013] [Indexed: 11/21/2022] Open
Abstract
The diagnosis of tuberculosis in immunocompromised hosts is often difficult as the hosts have atypical tuberculosis symptoms. The current study presents a case of scrofula and pulmonary tuberculosis with acute myelocytic leukemia (AML). As the disease became aggravated, the patient presented with fever, hemophagocytosis in the bone marrow, lymphadenopathy of the supraclavicular fossa, and mediastinal and nodular shadow in the chest by computed tomography. The symptoms presented successively or were coexistent, which made differentiation between tuberculosis, lymphoma, AML infiltration or other infections challenging. The diagnosis of tuberculosis was based on clinical and radiographic observations, morphological observation of the biopsies and the positive effect of antituberculosis drugs, while Ziehl-Neelsen stainings for acid fast bacilli were negative. The patient was treated with antituberculosis drugs, while receiving chemotherapy for AML. It is important to distinguish tuberculosis in adults with AML from other causes of fever, mediastinal masses in radiographic observations and hemophagocytosis in the bone marrow.
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Affiliation(s)
- Na Zhao
- Division of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China ; Division of Hematology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Jun-Jie Yang
- Division of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Guang-Sen Zhang
- Division of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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Head and neck tuberculosis in KwaZulu-Natal, South Africa. The Journal of Laryngology & Otology 2014; 128:86-90. [PMID: 24423085 DOI: 10.1017/s0022215113003435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe the clinical features of head and neck tuberculosis in KwaZulu-Natal, South Africa. STUDY DESIGN Retrospective, observational study. METHOD The study included 358 patients who received a histopathologically and/or microbiologically confirmed diagnosis of tuberculosis in the head and neck region between 1 January 2007 and 31 December 2011. RESULTS A total of 358 new cases of head and neck tuberculosis were identified during the study period, involving 196 males (54.7 per cent) and 162 females (45.3 per cent). These patients had a median age of 31 years (range, 3 months to 83 years). Testing for human immunodeficiency virus was positive in 233 (65.1 per cent) and negative in 125 (34.9 per cent). Right-sided cervical lymphadenitis was the commonest form of presentation of head and neck tuberculosis. CONCLUSION In this study, right-sided cervical lymphadenopathy was the commonest presentation of head and neck tuberculosis in both human immunodeficiency virus infected and non-infected individuals. Head and neck tuberculosis should not be excluded solely based on a normal chest X-ray, nor on the absence of constitutional symptoms.
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A case of peripancreatic tuberculous lymphadenitis diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Clin J Gastroenterol 2014; 7:68-73. [PMID: 26183512 DOI: 10.1007/s12328-013-0451-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 12/15/2013] [Indexed: 12/27/2022]
Abstract
Tuberculous lymphadenitis is a rare cause of obstructive jaundice. Here, we report the case of a 33-year-old male with obstructive jaundice caused by tuberculous lymphadenitis around the pancreatic head. The patient was born in China and had immigrated to Japan at 12 years of age. He presented with acute abdominal pain and jaundice. Findings from ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography were suggestive of a stenosis of the distal common bile duct caused by multiple low-density masses around the pancreatic head with a contrast-enhanced solid rim. We successfully diagnosed the mass as tuberculous lymphadenitis using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The patient was treated with anti-tuberculous combination chemotherapy for 6 months, and subsequently exhibited clinical improvement. Thus, we found that EUS-FNA was a valuable minimally invasive method for diagnosing masses that cause icterus.
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Loya A, Nadeem M, Yusuf MA. Use of ancillary techniques in improving the yield of samples obtained at endoscopic ultrasound-guided fine needle aspiration of thoracic and abdominal lymph nodes. Acta Cytol 2014; 58:192-7. [PMID: 24503737 DOI: 10.1159/000357768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/05/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Thoracic and abdominal lymph nodes may be enlarged in a variety of disorders. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a well-established technique for sampling such nodes, but samples obtained are small, which may make definitive diagnosis difficult. We conducted a retrospective review to determine the contribution of ancillary techniques, such as special histochemistry (SHC), immunohistochemistry (IHC) and flow cytometry, in increasing the diagnostic yield of EUS-FNA carried out at our institution. STUDY DESIGN Between November 2005 and December 2012, 278 patients underwent EUS-FNA of enlarged thoracic and abdominal nodes at our institution. All specimens obtained were subjected to rapid on-site evaluation. Data were reviewed in all patients requiring ancillary techniques for definitive diagnosis. RESULTS Ancillary techniques were performed in 111 of 278 cases. IHC was performed in 24, flow cytometry in 3 and SHC staining in 84. IHC and SHC aided in reaching a definitive diagnosis in 19 of 24 and 3 cases, respectively. Flow cytometry led to a definitive diagnosis in 3 cases. A total of 80 cases were also submitted to culture for tuberculosis with 6 positive for Mycobacterium tuberculosis. CONCLUSIONS Ancillary studies in EUS-FNA of thoracic and abdominal lymph nodes can significantly improve the yield of EUS-FNA.
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Affiliation(s)
- Asif Loya
- Department of Pathology and Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
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Isolated Tuberculous Lymphadenitis With Tracheal Involvement in an Elderly Patient. J Bronchology Interv Pulmonol 2013; 20:175-8. [DOI: 10.1097/lbr.0b013e31828f4a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Agaimy A, Brueckl V, Schmidt D, Krieg S, Ullrich E, Meidenbauer N. Tuberculous and non-tuberculous granulomatous lymphadenitis in patients receiving imatinib mesylate (glivec) for metastatic gastrointestinal stromal tumor. Case Rep Oncol 2013; 6:134-42. [PMID: 23569448 PMCID: PMC3618090 DOI: 10.1159/000348712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Imatinib mesylate (IM) is the standard treatment for BCR-ABL-positive chronic myelogenous leukemia (CML) and is the first-line adjuvant and palliative treatment for metastatic and inoperable gastrointestinal stromal tumor (GIST). IM is not known to be associated with an increased risk for development of granulomatous diseases. Methods We describe our experience with 2 patients (42 and 62 years of age) who developed granulomatous disease during IM treatment for metastatic GIST. Results Mean duration of IM treatment was 12 (range 8–16) months. Enlarged lymph nodes with increased metabolism on FDG-PET-CT examination were detected and resected. Affected sites were supraclavicular (1) and subcarinal/mediastinal (1) lymph nodes. Histological examination revealed caseating and non-caseating granulomas suggestive of tuberculosis and sarcoidosis, respectively. Mycobacterium tuberculosis was detected by PCR in lymph nodes of 1 patient who was then successfully treated by anti-tuberculous agents. The other patient had negative sputum test for acid-fast bacilli and PCR-DNA-analysis was negative for M. tuberculosis and other mycobacteria. He received no anti-tuberculous therapy and had no evidence of progressive lymphadenopathy or new lung lesions during follow-up. Conclusion Our observations underline the necessity to obtain biopsy material from enlarged or metabolically active lymph nodes developing during IM treatment for timely diagnosis and appropriate treatment of these rare complications. Follow-up without treatment is safe for patients without detectable microorganisms by sputum examination and PCR.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, University Hospital, Erlangen, Germany
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Karabay O, Kilic S, Gurcan S, Pelitli T, Karadenizli A, Bozkurt H, Bostanci S. Cervical lymphadenitis: tuberculosis or tularaemia? Clin Microbiol Infect 2012; 19:E113-7. [PMID: 23211027 DOI: 10.1111/1469-0691.12097] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 09/26/2012] [Accepted: 10/31/2012] [Indexed: 11/28/2022]
Abstract
Both tuberculosis cervical lymphadenitis (TCL) and oropharyngeal tularaemia (OT) have similar signs, symptoms and pathological findings. We aimed to investigate the frequency of tularaemia antibodies in patients diagnosed with TCL. Using data from the Tuberculosis Control Dispensaries between the years of 2008 and 2011 in Turkey, all patients diagnosed with TCL were informed about and included in the study. Control group subjects were selected from healthy blood donors who lived in the same region. After informed consent was obtained, the sera obtained from volunteer TCL patients and the control group were tested with a microagglutination technique for Francisella tularensis. Antibodies to Brucella were also investigated with a tube agglutination test for cross-reactivity in sera that were seropositive for tularaemia. Sera were obtained from a total of 1170 individuals in the TCL group and 596 in the control group from 67 of 81 provinces in Turkey. Francisella tularensis-positive antibodies were found in 79 (6.75%) cases in the TCL group and two (0.33%) cases in the control group with a titre of ≥1:80 (p < 0.01). When the presence of antibody of any titre was considered, the ratio became 8.2% (96/1170) in the TCL group and 0.67% (4/596) in the control group (p < 0.001). For the first time, with this study, tularaemia serology was found to be positive in a significant portion (6.75%) of diagnosed cases of TCL. In tularaemia endemic regions, it was concluded that tularaemia serology should be investigated in patients suspected of having TCL.
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Affiliation(s)
- O Karabay
- Department of Infectious Diseases, Sakarya University Medical Faculty, Sakarya, Turkey.
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Ścieszka J, Urbańska-Krawiec D, Kajor M, Stefański L. Isolated axillary lymph node tuberculosis in ultrasonography. A case report. J Ultrason 2012; 12:354-7. [PMID: 26674808 PMCID: PMC4582526 DOI: 10.15557/jou.2012.0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 03/10/2012] [Accepted: 03/23/2012] [Indexed: 11/22/2022] Open
Abstract
We present a rare case of isolated axillary lymph node tuberculosis. A 66-year-old patient was admitted in order to perform the diagnostics of a painless tumor of the left armpit. Blood biochemistry tests and chest X-ray did not show any abnormalities. In the ultrasound examination a solid structure of the dimensions of 1.8×1 cm of irregular outline with adjacent hypoechogenic lymph nodes was visualized. The diagnosis of tuberculosis was based on histopathologic examination of the excised tumor. In the latter years an increase in extrapulmonary type of tuberculosis has been observed. Extrapulmonary tuberculosis may appear in practically each organ, nevertheless it affects pleura most often. Lymph node tuberculosis is the second, when it comes to the prevalence rate, type of extrapulmonary tuberculosis. In the majority of cases of lymph node tuberculosis it affects superficial lymph nodes. In the ultrasound examination a packet of pathological, enlarged and hypoechogenic lymph nodes is stated. In 1/3 of cases the central part of the nodes is hyperechogenic which indicates its caseation necrosis. Lymph nodes have a tendency to be matted and they have blurred outline. We observed this type of lymph node image in the presented patient. This image may be a diagnostic hint. Nevertheless, in the differentiation diagnostics one should take many other disease entities into consideration, inter alia: sarcoidosis, lymphomas, fungal infections, neoplastic metastases; the latter ones have an image most similar to tuberculosis lymph nodes. Tuberculosis ought to be considered in differential diagnosis of atypical masses.
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Affiliation(s)
- Joanna Ścieszka
- Katedra i Klinika Chorób Wewnętrznych, Autoimmunologicznych i Metabolicznych, Śląski Uniwersytet Medyczny, Katowice, Polska
| | - Dagmara Urbańska-Krawiec
- Katedra i Klinika Chorób Wewnętrznych, Autoimmunologicznych i Metabolicznych, Śląski Uniwersytet Medyczny, Katowice, Polska
| | - Maciej Kajor
- Katedra i Zakład Patomorfologii, Śląski Uniwersytet Medyczny, Katowice, Polska
| | - Leszek Stefański
- Katedra i Klinika Chirurgii Przewodu Pokarmowego, Śląski Uniwersytet Medyczny, Katowice, Polska
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Abebe G, Deribew A, Apers L, Abdissa A, Deribie F, Woldemichael K, Shiffa J, Tesfaye M, Jira C, Bezabih M, Aseffa A, Bekele A, Colebunders R. Tuberculosis lymphadenitis in Southwest Ethiopia: a community based cross-sectional study. BMC Public Health 2012; 12:504. [PMID: 22770435 PMCID: PMC3418151 DOI: 10.1186/1471-2458-12-504] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 07/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Ethiopia where there is no strong surveillance system and diagnostic facilities are limited, the real burden of tuberculosis (TB) lymphadenitis is not well known. Therefore, we conducted a study to estimate the prevalence of TB lymphadenitis in Southwest Ethiopia. METHODS A community based cross-sectional study was conducted from February to March 2009 in the Gilgel Gibe field research area. A total of 30,040 individuals 15 years or older in 10,882 households were screened for TB lymphadenitis. Any individual 15 years or older with lumps in the neck, armpits or groin up on interview were considered TB lymphadenitis suspect. The diagnosis of TB lymphadenitis was established when acid fast bacilli (AFB) smear microscopy of fine needle aspiration (FNA) sample, culture or cytology suggested TB. HIV counseling and testing was offered to all TB lymphadenitis suspects. Descriptive and bivariate analysis was done using SPSS version 15. RESULTS Complete data were available for 27,597 individuals. A total of 87 TB lymphadenitis suspects were identified. Most of the TB lymphadenitis suspects were females (72.4%). Sixteen cases of TB lymphadenitis were confirmed. The prevalence of TB lymphadenitis was thus 58.0 per 100,000 people (16/27,597) (95% CI 35.7-94.2). Individuals who had a contact history with chronic coughers (OR 5.58, 95% CI 1.23-25.43) were more likely to have TB lymphadenitis. Lymph nodes with caseous FNA were more likely to be positive for TB lymphadenitis (OR 5.46, 95% CI 1.69-17.61). CONCLUSION The prevalence of TB lymphadenitis in Gilgel Gibe is similar with the WHO estimates for Ethiopia. Screening of TB lymphadenitis particularly for family members who have contact with chronic coughers is recommended. Health extension workers could be trained to screen and refer TB lymphadenitis suspects using simple methods.
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Affiliation(s)
- Gemeda Abebe
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.
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Kandala V, Kalagani Y, Kondapalli NR, Kandala M. Directly observed treatment short course in immunocompetent patients of tuberculous cervical lymphadenopathy treated in revised national tuberculosis control programme. Lung India 2012; 29:109-13. [PMID: 22628922 PMCID: PMC3354481 DOI: 10.4103/0970-2113.95300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Prospective observation analysis to evaluate the cure in tuberculous cervical lymphadenopathy with directly observed treatment short course category III (DOTS CAT III) treatment as per revised national tuberculosis control program (RNTCP) at a tertiary care hospital in AP, India, from October 2007 to September 2009. These cases were followed up for period of 22 months. MATERIALS AND METHODS Total 1521 tuberculous cases were screened in KIMS both pulmonary and extra pulmonary cases out of which 146 cases were tuberculous lymphadenitis. Fifty cases of tuberculous cervical lymphadenopathy were included after diagnostic and treatment algorithm and fine needle biopsy or excision biopsy. Patients below 5 yrs, immunocompromised, having diabetes mellitus, pulmonary tuberculosis and with other co-morbid conditions were excluded from the study. All patients were put on DOTS CAT III as per RNTCP guidelines. Follow-up was done every 2 months till 6 months for 1) Constitution symptoms 2) Weight gain or loss 3) Appetite gain or loss 4) Regression of lymph nodes or increase 5) Compliance 6) Side effects 7) Failures by demonstration of organism by direct smear, culture or histopathological examination. RESULTS In this study, lymph node regression was found in 78% at the end of 2 months, 94% at the end of 4 months and 96% at the end of 6 months, 9 patients had regression in size though the nodes were palpable, 2 had no regression but fresh lymph nodes appeared on the same side and sinus discharge was present, culture was negative in these cases. Two cases had immune reconstitution syndrome, constitutional symptoms disappeared and showed clinical improvement. Four cases were subjected for surgical intervention. CONCLUSION DOTS CAT III is effective in the treatment of tuberculous cervical lymphadenopathy. Compliance was good with minimal, minor side effects, only two had immune reconstitution syndrome and two had sinus formation; they were referred for surgical intervention, and follow-up of 22 months did not show any relapses.
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Affiliation(s)
- Venu Kandala
- Department of Pulmonary Medicine, KIMS Medical College, Narketpally, Nalgonda, Andhra Pradesh, India
| | - Yugveer Kalagani
- Department of Pulmonary Medicine, KIMS Medical College, Narketpally, Nalgonda, Andhra Pradesh, India
| | - Nageswara Rao Kondapalli
- Department of Pulmonary Medicine, KIMS Medical College, Narketpally, Nalgonda, Andhra Pradesh, India
| | - Monisha Kandala
- Department of Microbiology, KIMS Medical College, Narketpally, Nalgonda, Andhra Pradesh, India
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Fontanilla JM, Barnes A, von Reyn CF. Current diagnosis and management of peripheral tuberculous lymphadenitis. Clin Infect Dis 2012; 53:555-62. [PMID: 21865192 DOI: 10.1093/cid/cir454] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Peripheral tuberculous lymphadenitis accounts for ~10% of tuberculosis cases in the United States. Epidemiologic characteristics include a 1.4:1 female-to-male ratio, a peak age range of 30-40 years, and dominant foreign birth, especially East Asian. Patients present with a 1-2 month history of painless swelling of a single group of cervical lymph nodes. Definitive diagnosis is by culture or nucleic amplification of Mycobacterium tuberculosis; demonstration of acid fast bacilli and granulomatous inflammation may be helpful. Excisional biopsy has the highest sensitivity at 80%, but fine-needle aspiration is less invasive and may be useful, especially in immunocompromised hosts and in resource-limited settings. Antimycobacterial therapy remains the cornerstone of treatment, but response is slower than with pulmonary tuberculosis; persistent pain and swelling are common, and paradoxical upgrading reactions may occur in 20% of patients. The role of steroids is controversial. Initial excisional biopsy deserves consideration for both optimal diagnosis and management of the otherwise slow response to therapy.
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Affiliation(s)
- Jose-Mario Fontanilla
- Joan C Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
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Tschopp R, Bobosha K, Aseffa A, Schelling E, Habtamu M, Iwnetu R, Hailu E, Firdessa R, Hussein J, Young D, Zinsstag J. Bovine tuberculosis at a cattle-small ruminant-human interface in Meskan, Gurage region, Central Ethiopia. BMC Infect Dis 2011; 11:318. [PMID: 22085784 PMCID: PMC3235076 DOI: 10.1186/1471-2334-11-318] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 11/15/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bovine tuberculosis (BTB) is endemic in Ethiopian cattle. The aim of this study was to assess BTB prevalence at an intensive contact interface in Meskan Woreda (district) in cattle, small ruminants and suspected TB-lymphadenitis (TBLN) human patients. METHODS The comparative intradermal test (CIDT) was carried out for all animals involved in the cross-sectional study and results interpreted using a > 4 mm and a > 2 mm cut-off. One PPD positive goat was slaughtered and lymph nodes subjected to culture and molecular typing. In the same villages, people with lymphadenitis were subjected to clinical examination. Fine needle aspirates (FNA) were taken from suspected TBLN and analyzed by smear microscopy and molecular typing. RESULTS A total of 1214 cattle and 406 small ruminants were tested for BTB. In cattle, overall individual prevalence (> 2 mm cut-off) was 6.8% (CI: 5.4-8.5%) with 100% herd prevalence. Only three small ruminants (2 sheep and 1 goat) were reactors. The overall individual prevalence in small ruminants (> 2 mm cut-off) was 0.4% (CI: 0.03-5.1%) with 25% herd prevalence. Cattle from owners with PPD positive small ruminants were all PPD negative. 83% of the owners kept their sheep and goats inside their house at night and 5% drank regularly goat milk.FNAs were taken from 33 TBLN suspected cases out of a total of 127 screened individuals with lymph node swellings. Based on cytology results, 12 were confirmed TBLN cases. Nine out of 33 cultures were AFB positive. Culture positive samples were subjected to molecular typing and they all yielded M. tuberculosis. M. tuberculosis was also isolated from the goat that was slaughtered. CONCLUSIONS This study highlighted a low BTB prevalence in sheep and goats despite intensive contact with cattle reactors. TBLN in humans was caused entirely by M. tuberculosis, the human pathogen. M. tuberculosis seems to circulate also in livestock but their role at the interface is unknown.
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Affiliation(s)
- Rea Tschopp
- Swiss Tropical and Public Health Institute, PO Box, CH-4002, Basel, Switzerland.
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Abstract
Tuberculosis (TB) poses a serious threat to public health throughout the world but disproportionately afflicts low-income nations. Persons in close contact with a patient with active pulmonary TB and those from endemic regions of the world are at highest risk of primary infection, whereas patients with compromised immune systems are at highest risk of reactivation of latent TB infection (LTBI). Tuberculosis can affect any organ system. Clinical manifestations vary accordingly but often include fever, night sweats, and weight loss. Positive results on either a tuberculin skin test or an interferon-γ release assay in the absence of active TB establish a diagnosis of LTBI. A combination of epidemiological, clinical, radiographic, microbiological, and histopathologic features is used to establish the diagnosis of active TB. Patients with suspected active pulmonary TB should submit 3 sputum specimens for acid-fast bacilli smears and culture, with nucleic acid amplification testing performed on at least 1 specimen. For patients with LTBI, treatment with isoniazid for 9 months is preferred. Patients with active TB should be treated with multiple agents to achieve bacterial clearance, to reduce the risk of transmission, and to prevent the emergence of drug resistance. Directly observed therapy is recommended for the treatment of active TB. Health care professionals should collaborate, when possible, with local and state public health departments to care for patients with TB. Patients with drug-resistant TB or coinfection with human immunodeficiency virus should be treated in collaboration with TB specialists. Public health measures to prevent the spread of TB include appropriate respiratory isolation of patients with active pulmonary TB, contact investigation, and reduction of the LTBI burden.
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MESH Headings
- Antitubercular Agents
- Comorbidity
- Drug Resistance, Multiple, Bacterial
- HIV Infections/epidemiology
- Humans
- Interferon-gamma/metabolism
- Nucleic Acid Amplification Techniques
- Pericarditis/microbiology
- Public Health
- Tuberculin Test
- Tuberculosis/diagnosis
- Tuberculosis/drug therapy
- Tuberculosis/epidemiology
- Tuberculosis, Lymph Node/diagnosis
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/prevention & control
- Tuberculosis, Pulmonary/therapy
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Affiliation(s)
- Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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Legesse M, Ameni G, Mamo G, Medhin G, Bjune G, Abebe F. Knowledge of cervical tuberculosis lymphadenitis and its treatment in pastoral communities of the Afar region, Ethiopia. BMC Public Health 2011; 11:157. [PMID: 21385472 PMCID: PMC3062609 DOI: 10.1186/1471-2458-11-157] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 03/09/2011] [Indexed: 11/19/2022] Open
Abstract
Background Infection with Mycobacterium bovis (Mb) predominantly causes cervical TB lymphadenitis (TBL). Raw milk is considered the main source of Mb infection and raw milk is a major food source for Afar pastoralists. The aim of this study was to assess Afar pastoralists' knowledge concerning cervical TBL and its treatment. Methods A community-based cross-sectional survey involving 818 interviewees was conducted in two districts of the Afar Region, Ethiopia. In addition, two focus group discussions (FGDs) were conducted in each of the study areas, one with men and the other with women. Results Of the 818 interviewees [357 (43.6%) females and 461 (56.4%) males], 742 (90.7%) reported that they had knowledge of cervical TBL, mentioning that swelling(s) on the neck resulting in a lesion and scar are common symptoms. However, only 11 (1.5%) individuals mentioned that bacteria or germs are the causative agents of TBL. Three interviewees and a male discussant mentioned drinking raw milk as the cause of TBL. A considerable proportion (34.2%) of the interviewees and almost all the discussants suggested herbal medicine as an effective treatment. Male study participants were 1.82 times more likely to have overall knowledge of TBL than female study participants (adjusted OR, 1.82; 95% CI, 1.32 to 2.51, p < 0.001). Conclusion The pastoral community members in the study areas had little biomedical knowledge of the cause, the source of infection and the transmission route of cervical TBL. Furthermore, most community members believed that herbal medicines are the most effective treatment for TBL. Therefore, TB control programs in the Afar Region require the incorporation of public health education introducing current biomedical knowledge of the disease. In addition, further studies are important to elucidate which medicinal plants are used by Afar pastoralists to treat TBL.
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Affiliation(s)
- Mengistu Legesse
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
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49
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M. tuberculosis in Lymph Node Biopsy Paraffin-Embedded Sections. Tuberc Res Treat 2011; 2011:127817. [PMID: 22567262 PMCID: PMC3335535 DOI: 10.1155/2011/127817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/01/2011] [Accepted: 10/17/2011] [Indexed: 11/17/2022] Open
Abstract
Background. Tuberculosis lymphadenitis is one of the most common forms of all extrapulmonary tuberculosis. Objective. To evaluate the magnitude of M. tuberculosis from lymph node biopsy paraffin-embedded sections among suspected patients visiting the Jimma University Specialized Hospital. Method. A cross-sectional study design of histological examination among lymph node biopsy paraffin-embedded sections by Ziehl-Neelsen and hematoxylin/eosin staining technique was conducted from December, 2009, to October, 2010, at the Department of Medical Laboratory Science and Pathology. Result. Histopathological examination of the specimens by hematoxylin and eosin staining technique revealed the presence of granulomas. But for the caseation and necrosis they were present in 85% cases of nodal tissue biopsies. From those, 56.7% were from females. The presence of acid-fast bacilli was microscopically confirmed by ZN staining in 37 (61.7%) of the nodal tissue biopsies. Conclusion and Recommendation. Tuberculosis lymphadenitis is significantly more common in females. Hence, attention should be given for control and prevention of extrapulmonary tuberculosis.
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50
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Hong JY, Jung JY, Kang YA, Park BH, Jung WJ, Lee SH, Kim SY, Lee SK, Chung KS, Park SC, Kim EY, Lim JE, Kim SK, Chang J, Kim YS. Utility of Routine Culture for Tuberculosis from Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in a Tuberculosis Endemic Country. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.71.6.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ji Young Hong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Ye Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ae Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Hoon Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jai Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Su Hwan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Song Yee Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kook Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Soo Chung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Seon Cheol Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Eun Lim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Se Kyu Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Chang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
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