Diversities in presentations of extrapulmonary tuberculosis

Neelakantan, Shiba; Nair, Preeti P; Emmanuel, Roby V; Agrawal, Kavita

doi:10.1136/bcr-2013-008597

Cited by 9 publications

(8 citation statements)

References 26 publications

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“…These findings are important in the diagnosis of extra-pulmonary TB specifically in the pediatric age group where up to 60% of patients with extra-pulmonary TB develop cervical lymphadenitis. 13 Furthermore, since the diagnosis of MTB in children is often delayed due to non-specific clinical features and difficult expectoration, the Xpert MTB/RIF assay stands out as a useful method in the diagnosis of pediatric MTB. 14 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of GeneXpert MTB/RIF for detection of Mycobacterium tuberculosis complex and rpo B gene in respiratory and non-respiratory clinical specimens at a tertiary care teaching hospital in Saudi Arabia

Somily

Barry

Habib

et al. 2016

SMJ

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ObjectivesTo assess the performance of Xpert MTB/RIF, an automated molecular test for Mycobacterium tuberculosis (MTB) and resistance to rifampin (RIF), against smear microscopy and culture method for diagnosis of MTB infection.MethodsThis is a retrospective analysis of 103 respiratory and 137 non-respiratory patient specimens suspected of tuberculosis at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia performed between April 2014 and March 2015. Each sample underwent smear microscopy, mycobacterial culture, and GeneXpert MTB/RIF test.ResultsFifteen out of 103 respiratory samples were smear and culture positive, whereas 9 out of 137 non-respiratory samples were smear positive. Out of 9 smear positive specimens, 8 were also culture positive. All 15 culture positive respiratory samples were detected by Xpert MTB/RIF (sensitivity and positive predictive value [PPV]=100%). Similarly, all 8 culture positive non-respiratory specimens were identified by Xpert MTB/RIF (sensitivity 100%; PPV 88.8%). The Xpert MTB/RIF detected only one false positive result in 88 smear negative respiratory specimens (specificity 98.9%; negative predictive value [NPV]= 100%). All 125 smear negative non-respiratory specimens tested negative by culture and Xpert MTB/RIF (sensitivity, specificity, PPV, NPV= 100%).ConclusionThe performance of Xpert MTB/RIF was comparable to the gold standard culture method for identification of MTB in both respiratory and non-respiratory clinical specimens.

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Section: Discussionmentioning

confidence: 99%

Evaluation of GeneXpert MTB/RIF for detection of Mycobacterium tuberculosis complex and rpo B gene in respiratory and non-respiratory clinical specimens at a tertiary care teaching hospital in Saudi Arabia

Somily

Barry

Habib

et al. 2016

SMJ

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“…Commonly involved lymph node regions in both ( 2 , 7 , 16 , 17 , 20 , 21 ): cervical, axillary, and inguinal lymph nodes.…”

Section: Lymphadenopathy: Tb and Fl – Similarities ( 14 mentioning

confidence: 99%

Lymphadenopathy: Differentiation between Tuberculosis and Other Non-Tuberculosis Causes like Follicular Lymphoma

Thakkar

Ghaisas

Singh

2016

Front. Public Health

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“…Many pathogens, particularly viruses but also protozoa and bacteria, have been described to enter through the oral mucosa and to be drained to CLN [ 1 ]. Toxoplasma infection might as well be the reason for cervical lymphadenopathy [ 16 ] as extrapulmonary tuberculosis which mostly affects lymph nodes and of these most frequently the CLN [ 17 , 18 ]. Especially in children, cervical lymphadenitis is a common phenomenon [ 19 ], likely reflecting the constant exposure of these organs to foreign material drained from mucosa tissue of the head in a developmental stage when the immune system is still in development.…”

Section: Discussionmentioning

confidence: 99%

Cervical Lymph Nodes as a Selective Niche for Brucella during Oral Infections

et al. 2015

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Cervical lymph nodes (CLN) are the first lymph nodes encountered by material taking the oral route. To study their role in orally acquired infections, we analyzed 307 patients of up to 14 years treated in the university clinic of Skopje, Macedonia, for brucellosis, a zoonotic bacterial disease frequently acquired by ingestion of contaminated dairy products. From these children, 36% had lymphadenopathy. Among orally infected children, lymphadenopathy with CLN being the only lymph nodes affected was significantly more frequent as compared to those infected by contact with animals (83% vs. 63%), suggesting a possible involvement of CLN during orally acquired human brucellosis. Using a murine model where bacteria are delivered into the oral cavity, we show that Brucella quickly and selectively colonize the CLN where they proliferate and persist over long periods of time for up to 50 days post-infection. A similar efficient though less specific drainage to CLN was found for Brucella, Salmonella typhimurium and fluorescent microspheres delivered by gavage, a pathway likely representing a mixed infection mode of intragastric and oral infection, suggesting a central pathway of drained material. Microspheres as well as bacteria drained to CLN predominately reside in cells expressing CD68 and no or low levels of CD11c. Even though no systemic response could be detected, Brucella induced a locally restricted inflammatory reaction with increased expression levels of interferon γ, interleukin (IL)-6, IL-12, granzyme B and a delayed induction of Nos2. Inflammation led to pronounced lymphadenopathy, infiltration of macrophages/monocytes expressing high levels of major histocompatibility complex II and to formation of epitheloid granulomas. Together, these results highlight the role of CLN in oral infections as both, an initial and efficient trap for bacterial invaders and as possible reservoir for chronic pathogens. They likewise cast a new light on the significance of oral routes for means of vaccination.

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Diversities in presentations of extrapulmonary tuberculosis

Cited by 9 publications

References 26 publications

Evaluation of GeneXpert MTB/RIF for detection of Mycobacterium tuberculosis complex and rpo B gene in respiratory and non-respiratory clinical specimens at a tertiary care teaching hospital in Saudi Arabia

Evaluation of GeneXpert MTB/RIF for detection of Mycobacterium tuberculosis complex and rpo B gene in respiratory and non-respiratory clinical specimens at a tertiary care teaching hospital in Saudi Arabia

Lymphadenopathy: Differentiation between Tuberculosis and Other Non-Tuberculosis Causes like Follicular Lymphoma

Cervical Lymph Nodes as a Selective Niche for Brucella during Oral Infections

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