Tuberculosis (TB) remains one of the major public health problems with a considerable number of new cases. Tuberculous lymphadenitis is one of the most common forms of extra-pulmonary TB whose diagnosis still faces many challenges. The case to report is a 17-year old female patient with a painful swelling in her right infra-retro-auricular area and the auramine stain was negative for acid-fast bacilli (AFB). GeneXpert was done, which confirmed the right infra-retro-auricular tuberculous lymphadenitis. The patient responded well to anti-TB treatment. Key words: Lymphadenitis; Mycobacterium tuberculosis; Auramine; GeneXpert
Purpose To explore challenges associated with the timely diagnosis, therapy, and prognosis of acute leukemia in Rwanda. Methods This is a qualitative study using a phenomenological approach that involved patients, patients’ guardians, and healthcare professionals such as physicians from district hospitals and specialists from referral hospitals, as well as healthcare administrators. The primary data were collected from district and referral hospitals and central healthcare administration in Rwanda. The data were collected between July and October 2019. In-depth interviews were conducted, and thematic analysis was employed to interpret the results. Results We identified barriers to seeking healthcare such as (i) insufficient knowledge within the population may lead patients and their guardians to consult traditional healers before seeking qualified medical care, and (ii) financial constraints that preclude payment of healthcare fees or other out-of-pocket cost related to diagnosis and treatment. We also observed that the referral system is tedious and primary healthcare facilities lack the competence and resources for the necessary diagnostic practices. Both may further delay diagnosis and therapy. Accordingly, healthcare professionals at the referral hospitals stated that most patients were seen at an advanced stage of the disease. For the treatment of acute lymphoblastic leukemia (ALL), only chemotherapy is utilized in Rwanda, while bone marrow (BM) transplantation is not available. Palliation is the only available treatment for the vast majority of Rwandan acute myeloid leukemia (AML) patients. Conclusion ALL and AML are likely under-reported in Rwanda and diagnosis may be delayed, which may be explained by patient-related factors (lack of knowledge, financial constraints), a tedious referral system, and suboptimal diagnostic resources.
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