Rapid Diagnosis of Pediatric Mycobacterial Lymphadenitis Using Fine Needle Aspiration Biopsy

Coetzee, Liezel; Nicol, Mark P.; Jacobson, Rachael; Schubert, Pawel; Helden, Paul D. van; Warren, Robin M.; Wright, Colleen A.

doi:10.1097/inf.0000000000000312

Cited by 25 publications

(28 citation statements)

References 15 publications

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“…Lymph node aspiration biopsy is safe, feasible and associated with good sensitivity and specificity in adolescents. 30 Microbiologic confirmation of abdominal, renal, genitourinary, meningeal and musculoskeletal tuberculosis generally requires more invasive sampling, and yields from culture and molecular testing are lower than for thoracic disease.…”

Section: Figurementioning

confidence: 99%

Adolescent tuberculosis

Snow

Cruz

Seddon

et al. 2020

The Lancet Child & Adolescent Health

118

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Adolescence is characterised by a dramatic increase in the incidence of tuberculosis, a fact that has been appreciated since the early 20 th century. The majority of the world's adolescents live in low and middle-income countries where tuberculosis remains common, and where they comprise one quarter of the population. Despite this, adolescents have not yet been addressed as a distinct population in tuberculosis policy or within tuberculosis treatment services, and emerging evidence suggests that current models of care do not meet their needs.This article reviews current knowledge about tuberculosis in adolescence with a focus on the management of infection and disease, including HIV co-infection and rifampicin-resistant tuberculosis. Recent progress in vaccine development is outlined and important directions for future research are highlighted. Search strategy and selection criteriaThis was a narrative review of the literature on adolescent tuberculosis, informed by expert opinion and clinical experience. We reviewed the English-and Spanish-language literature for studies on adolescent tuberculosis to identify case series documenting clinical presentation and treatment outcomes. We searched PubMed with the following string on 19August 2019: ('tuberculosis'[Title]) AND ('adolescent'[TIAB]). The search returned 210 results, of which 11 were eligible for inclusion (Table 1), and we identified three additional studies from reference lists, for a total of 14 studies. Studies reporting solely on prevalence or where data from adolescents was aggregated with those of younger children or adults were excluded. Data were extracted regarding major site(s) of disease, percent of adolescents with microbiologic confirmation, adverse drug reactions, and final treatment outcomes.

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Section: Figurementioning

confidence: 99%

Adolescent tuberculosis

Snow

Cruz

Seddon

et al. 2020

The Lancet Child & Adolescent Health

118

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“…A total of 100 of 121 archival FNAB specimens were selected from a previous study in approximately the same ratio of 1:3 culture negative: positive. The age ranged from 2.6 months to 15 years with a mean of 3.6 years (standard deviation 3.5) and an equal gender distribution.…”

Section: Resultsmentioning

confidence: 99%

“…The ZN stain is specific but has low sensitivity . Mycobacterial culture has for long been the reference standard but its main limitation is a slow turnaround time of 2 to 6 weeks . Xpert MTB/RIF (Cepheid, Sunnyvale, California), a real‐time polymerase chain reaction assay, has shown remarkable sensitivity and specificity and was recommended by the World Health Organization (WHO) in 2013 as the first line diagnostic procedure for TB lymphadenopathy (LAD) .…”

Section: Introductionmentioning

confidence: 99%

Papanicolaou induced fluorescence, Ziehl‐Neelsen and Auramine O stains on lymph node fine needle aspiration biopsy specimens from children: A comparative study

Selepe

Wyk

Hoek

et al. 2018

Diagnostic Cytopathology

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“…Table 1 summarizes the characteristics of the included studies. Five studies were conducted in Africa [13][14][15][16][17], 1 study in India [18], and 1 in Italy [19]. One study was a cohort study [19] and the remaining 6 were prospective studies [13][14][15][16][17][18].…”

Section: Studies Identifiedmentioning

confidence: 99%

“…Regarding applicability, one study (Bholla, M., 2016) had low concern because patients were assessed in a local hospital and another study (Held, M., 2016) had high concern because only inpatients were evaluated at a tertiary-care center [13,14]. Other studies reported unclear concern due to lack of enough information regarding the clinical setting [15][16][17][18][19]. Regarding the index test and reference standard, the included studies generally had a low risk of bias and low applicability concerns.…”

Section: Quality Assessmentmentioning

confidence: 99%

Xpert MTB/RIF assay for diagnosis of extrapulmonary tuberculosis in children: A systematic review and meta-analysis

Seo

Kang

Kim

et al. 2019

Preprint

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Background: The Xpert® MTB/RIF assay (Xpert; Cepheid, Sunnyvale, CA, USA) is a cartridge-based nucleic acid amplification assay for rapid tuberculosis diagnosis and assessment of antibiotic sensitivity. Although previous evidence supports the use of Xpert for diagnosing extrapulmonary tuberculosis (EPTB) in adults, information regarding the accuracy of Xpert for EPTB only in children is lacking. This meta-analysis aimed to assess the accuracy of Xpert for detecting EPTB in children. Methods: We searched the MEDLINE, EMBASE, and the Cochrane Infectious Diseases Group Specialized Register from January 1, 2010, to July 16, 2019, for studies on diagnostic performance wherein Xpert was analyzed against cultures or composite reference standards for <18-year-old children with EPTB. Results: Exclusively on the basis of pediatric studies, 7 studies including 560 samples were selected. The pooled sensitivity and specificity of Xpert for all samples were 67% (95% CI 0.51-0.79) and 94% (95% CI 0.87-0.98), respectively. The area under the summary receiver operating characteristic (sROC) curve was 0.89. For lymph node tissues or aspirates, the pooled sensitivity and specificity of Xpert were 75% (95% CI 0.54-0.89) and 90% (95% CI 0.77-0.96), respectively; for cerebrospinal fluid (CSF), they were 40% (95% CI 0.23-0.60) and 96% (95% CI 0.85-0.99), respectively. Conclusion: Overall, Xpert displayed high specificity but modest specificity across various samples in the diagnosis of pediatric EPTB in comparison with the composite reference standard. Xpert sensitivity varied with the sampling site, and was especially lower for CSF samples. Positive Xpert results may be considered to indicate a presumptive case of pediatric EPTB, whereas negative test results indicate that the possibility of pediatric EPTB should not be excluded.

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Rapid Diagnosis of Pediatric Mycobacterial Lymphadenitis Using Fine Needle Aspiration Biopsy

Abstract: FNAB and Xpert MTB/RIF enable a rapid diagnosis in pediatric mycobacterial lymphadenitis, expediting appropriate treatment and potentially preventing morbidity and mortality.

Cited by 25 publications

References 15 publications

Adolescent tuberculosis

Adolescent tuberculosis

Papanicolaou induced fluorescence, Ziehl‐Neelsen and Auramine O stains on lymph node fine needle aspiration biopsy specimens from children: A comparative study

Xpert MTB/RIF assay for diagnosis of extrapulmonary tuberculosis in children: A systematic review and meta-analysis

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