Magnitude of tuberculosis lymphadenitis, risk factors, and rifampicin resistance at Adama city, Ethiopia: a cross-sectional study

Abstract

Mycobacterium tuberculosis complex has an impact on public health and is responsible for over one million deaths per year. Substantial numbers of people infected with M. tuberculosis can develop tuberculosis lymphadenitis; however, there is a limited study in Adama, Ethiopia. The aim of this study was to determine the magnitude of Tuberculosis lymphadenitis, its predictors, and rifampicin-resistance gene-positive M. tuberculosis. A total of 291 patients with enlarged lymph nodes were recruited from May 2022 to August 30 at Adama Comprehensive Specialized Hospital Medical College (ACSHMC). GeneXpert, Ziehl–Neelsen staining, and cytology were used for the diagnosis of TB lymphadenitis from the Fine Needle Aspirate (FNA) specimen. Rifampicin-resistant gene was detected using GeneXpert. For data entry and analysis, Epi Data version 3.0 and SPSS version 25 were used respectively. A binary logistic regression model was used to identify predictors of TB lymphadenitis. A p < 0.05 with a 95% confidence interval (CI) was taken as a cut point to determine the significant association between dependent and independent variables. The prevalence of TB lymphadenitis using GeneXpert, Ziehl–Neelsen staining, and cytology were 138 (47.4%) (95% CI 41.70–53.10), 100 (34.4%) (95% CI 28.94–39.85), and 123 (42.3%) (95% CI 36.63–47.00) respectively. Nine (3.1%) participants were infected with rifampicin-resistant gene-positive M. tuberculosis. Out of the total M. tuberculosis detected by GeneXpert (n = 138), 9 (6.5%) were positive for rifampicin resistance-gene. Participants with a chronic cough had 2 times odds of developing TB lymphadenitis (AOR: 2.001, 95% CI 1.142–3.508). Close to half of patients with enlarged lymph nodes were positive for M. tuberculosis by the GeneXpert method in the study area. Chronic cough was significantly associated with TB lymphadenitis. Rifampicin-resistant gene-positive M. tuberculosis was relatively prevalent among patients with enlarged lymph node in the study area.

Primary Rifampicin Mono-Resistant Tuberculosis of the Cervical, Mediastinal, and Axillary Lymphadenopathy in an Indian Male: A First-of-Its-Type Case

“…Rifampicin mono-resistance tuberculosis of the lymph nodes is relatively infrequently reported and few studies have reported the prevalence ranging from 2.9-6.5% [ 11 ]. Diagnosis of primary rifampicin mono-resistant tuberculosis is mainly based on fine-needle aspiration cytology and identification of the Mycobacterium tuberculosis with resistance to rifampicin on the cartridge-based nucleic acid amplification test and culture [ 12 ].…”

Performance of fine needle aspiration cytology and Ziehl-Neelsen staining technique in the diagnosis of tuberculosis lymphadenitis

“…AHMC serves as a referral hospital for the people residing in the East Shewa Zone of the Oromia Regional State and adjacent regions. Sociodemographic and clinical data was collected using a structured preprepared format [ 16 ]. For the diagnosis of TBL, the ZN staining technique, FNAC, and GeneXpert were used.…”

“…The air-dried FNA smears were stained with Wright’s stain according to the SOPs [ 16 ] and examined microscopically by experienced pathologists. The FNAC shows up the epithelioid granulomas, and the epithelioid granulomas with multinucleated giant cells, caseous necrosis, degenerating inflammatory cells and liquefied necrotic materials were considered cytologically positive for tuberculosis [ 16 , 17 ].…”

“…ZN staining was performed according to the SOP [ 16 ], and the stained smears were examined by microbiologists at AHMC under the oil-immersion objective (100*) of a light microscope. A minimum of 100 fields were scanned for negative results.…”

“…The GeneXpert MTB/RIF assay (Cepheid, CA, USA) was performed according to microbiology laboratory SOPs [ 16 ]: 2 ml of Gene-Xpert MTB/RIF Specimen Reagent Buffer was added to 1 ml of fine needle aspiration sample using a sterile pipette. The closed sample container was manually vortexed twice for 15 s, allowed to stand at room temperature for 10 min, vortexed after 10 min and allowed to stand for 5 min.…”