Bacterial Lymphadenitis at a Major Referral Hospital in France from 2008 to 2012

Abstract

Lymph node enlargement is a common medical problem, and in a large number of patients, the causes of lymphadenopathy remain undiagnosed. We report a thorough microbiological analysis of 1,688 lymph node biopsy specimens collected in our bartonellosis reference center. We studied lymph node biopsy samples from patients with suspected regional infectious lymph node enlargement from January 2008 to December 2012. To evaluate a useful strategy for the diagnosis of infectious lymphadenitis, specimens were cultured and subjected to molecular assays. Histologic analysis was done when possible. A total of 642 (38%) biopsy specimens were infected with a bacterial agent, and quantitative PCR (qPCR) was significantly better than 16S rRNA gene PCR (rrs) for the detection of Bartonella henselae (P ‫؍‬ 0.05), Mycobacterium tuberculosis (P ‫؍‬ 0.05), and Mycobacterium avium (P ‫؍‬ 0.007). Molecular assays were significantly better than bacterial cultures for the diagnosis of Francisella tularensis (P ‫؍‬ 0.017) but were less effective for detecting M. tuberculosis (P ‫؍‬ 0.004) and M. avium (P ‫؍‬ 0.001). Histologic analysis was done for 412 lymph nodes, and 20% of these were compatible with an infectious lymphadenitis, whereas a neoplasm was found in 29% of these lymph nodes. M. tuberculosis was detected significantly more in female than in male patients (P ‫؍‬ 0.01), and patients with cat scratch disease (CSD) were younger than patients with M. tuberculosis, Tropheryma whipplei, and F. tularensis. Negative rrs PCR does not exclude the diagnosis of infectious lymphadenitis. Histologic analysis of lymph node biopsy specimens is critical, as a diagnosis of infectious lymphadenitis does not preclude other concurrent diseases.

Coxiella burnetii-positive PCR in febrile patients in rural and urban Africa

“…DNA extracts were also tested by RT-PCR for the presence of Tropheryma whipplei, Bartonella spp, Rickettsia spp, Francisella tularensis, Staphylococcus aureus, Escherichia coli, and Plasmodium falciparum. 13 Samples were also tested by 16S rRNA and 18S rRNA gene amplification and sequencing. 13,14 We determined the multi-spacer sequence typing (MST) genotypes of C. burnetii in the positive C. burnetii samples from Senegal and Oran, as described previously.…”

“…13 Samples were also tested by 16S rRNA and 18S rRNA gene amplification and sequencing. 13,14 We determined the multi-spacer sequence typing (MST) genotypes of C. burnetii in the positive C. burnetii samples from Senegal and Oran, as described previously. 15 …”

Rickettsia sibirica mongolitimonae infection, Sri Lanka

“…A negative control (sterile water and DNA from a sterile biopsy specimen) and a positive control (DNA from R. montanensis) were included in each test. Finally, the quality of DNA handling and extraction was verified by qPCR for a housekeeping gene encoding beta-actin [13].…”

Carcinoma of Maxillary Gingiva with Non-specific Cervical Lymph Node Swelling

“…However, bilateral swelling of the cervical lymph nodes to 40 mm was observed on postoperative imaging. In terms of differential diagnosis, postoperative swelling of the cervical lymph nodes may represent lymph node metastases from a carcinoma of the maxillary gingiva; subacute regional lymphadenitis (cat-scratch disease) 11) ; subacute necrotizing lymphadenitis 7) ; viral lymphadenitis 12) ; tuberculous lymphadenitis 3) ; malignant lymphoma 10) ; or some other form of cervical lymph node metastasis 1) . Cat-scratch disease is a zoonotic disease …”