The value of wide-needle aspiration in the diagnosis of tuberculous lymphadenitis in Africa

Bem, Chris; Patil, P. S.; Elliott, Alison M.; Namaambo, K.; Bharucha, H.; Porter, John

doi:10.1097/00002030-199309000-00011

Cited by 44 publications

(21 citation statements)

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“…It has been recommended that all patients with suspected TBLN in Africa undergo fine needle aspiration before surgical biopsy or empirical treatment (1).…”

Section: Discussionmentioning

confidence: 99%

Identification of the Causative Organism of Tuberculous Lymphadenitis in Ethiopia by PCR

et al. 2002

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Tuberculous lymphadenitis (TBLN) is a common form of extrapulmonary tuberculosis with multiple differential diagnoses. Demonstration of the etiologic agent by smear microscopy or culture of fine needle aspirate (FNA) specimens is often unsuccessful. FNA specimens from 40 patients presenting at a rural health center in South Ethiopia and diagnosed as positive for TBLN on the basis of clinical and cytological criteria were analyzed for mycobacterial DNA by PCR. Thirty (75%) had cervical lymphadenitis and 11 (27.5%) were seropositive for human immunodeficiency virus (HIV). Three primer sets were initially used to identify the causative agent at the genus (antigen 85 complex), complex (IS6110 insertion sequence), and species (pncA gene and allelic variation) levels. Among the forty TBLN cases, 35 (87.5%) were positive by PCR at the genus and complex levels. Based on PCR for detection of allelic variation at position 169, 24 (68.6%) of the 35 were positive for Mycobacterium tuberculosis and 6 (17.1%) were positive for M. bovis. These six were positive in additional PCR assays using the JB21-JB22 primer set, which is highly specific for M. bovis. In developing countries with a high incidence of tuberculosis, tuberculous lymphadenitis (TBLN) is one of the most frequent causes of lymphadenopathy (12) and it is the most common form of extrapulmonary tuberculosis (16). TBLN also occurs with increased frequency in human immunodeficiency virus type 1 (HIV-1)-infected individuals (9, 27). Within the Mycobacterium tuberculosis complex, M. tuberculosis and M. bovis are the most common causative agents of TBLN. Which control measures and treatment are to be instituted depends on the most common causative agent in the area. Therefore, species identification is of paramount importance.Over the past decades, fine needle aspirate (FNA) cytology, an alternative procedure less invasive than excision biopsy, has assumed an important role in the diagnosis of peripheral lymphadenopathy. The cytological criteria for diagnosis of TBLN have been clearly defined (13,19). However, the amount of material obtained in FNA is usually so small that it is often inadequate for performance of acid-fast smear and culture examinations with reasonable sensitivity.Introduction of the PCR provided new possibilities for identification of mycobacteria in various types of clinical samples (3, 5); based on the amplification of common sequences, the identification time for detection of mycobacteria in clinical specimens was reduced (4, 8). The M. tuberculosis complex, consisting of M. tuberculosis, M. bovis, M. africanum, and M. microti, has been identified with a number of different targets, including the IS6110 insertion element sequence, using PCR methods (2, 6).In the present study, PCR was applied for assays of FNAs to identify the causative agent in TBLN in Ethiopia at the genus, complex, and species levels. MATERIALS AND METHODS Patients.The study was initiated after approval by the institutional and national ethical committees. FNAs which were collect...

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“…It has been recommended that all patients with suspected TBLN in Africa undergo fine needle aspiration before surgical biopsy or empirical treatment (1).…”

Section: Discussionmentioning

confidence: 99%

Identification of the Causative Organism of Tuberculous Lymphadenitis in Ethiopia by PCR

et al. 2002

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“…Tuberculous lymphadenitis (TBLN) is the most common form of extrapulmonary tuberculosis (1,2) and its recent rise in sub-Saharan countries is probably associated with the alarming increase in the prevalence of human immunodeficiency virus (HIV) infection (3,4).…”

Section: Introductionmentioning

confidence: 99%

“…The sensitivity of conventional methods used in mycobacteriology laboratories, such as acid-fast bacillus (AFB) smear examination and culture, may not exceed 40% (2,3,5,6). Moreover, algorithms particularly requiring excisional biopsy, as suggested by different groups, could be difficult to apply in rural areas with very limited resources (7,8).…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Tuberculous Lymphadenitis in Butajira, Rural Ethiopia

Yassin¹,

Olobo

Kidane

et al. 2003

Scandinavian Journal of Infectious Diseases

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Tuberculous lymphadenitis (TBLN) is a diagnostic challenge in sub-Saharan Africa, where there is a high rate of human immunodeficiency virus (HIV) infection. This study aimed to find ways to improve the diagnosis in Butajira, rural Ethiopia, where TBLN constitutes 40% of the total tuberculosis (TB) diagnosis. Among 147 clinically suspected cases, 107 (72.8%) were confirmed as TBLN by fine-needle aspiration (FNA) cytology and acid-fast bacillus (AFB) smear examination. Of the remaining 40 cases, denoted non-tuberculous lymphadenitis (NTBLN) after this smear examination, 37 (92.5%) showed a cytological pattern with neutrophil aggregates. The clinical manifestations were similar and cervical lymph nodes were the most affected in these 2 groups. 24 of the 107 TBLN cases (22.4%) and 9 (22.5%) of the other cases were seropositive for HIV infection (p > 0.5). FNA cytology combined with AFB smear examination is a good alternative to histology in rural Ethiopia where the expertise in taking biopsies is very limited. Polymerase chain reaction for Mycobacterium tuberculosis complex DNA was positive in 15 of 23 cases tested with NTBLN cytology, showing that an additional independent criterion for the presence of M. tuberculosis is needed for diagnosis in lymphadenitis cases of this kind. These findings could help to strengthen the diagnostic algorithm suggested by the National TB Control Program.

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“…16,17 In our study, epithelioid cell collection (granulomas) was seen in in 98.4% cases while pathognomic caseation was seen in 41.6% similar to that reported in other studies. 18,19 In a study conducted by Samaila MO et al 11 epithelioid cells were seen in all specimens, with caseation seen in 56.3%. AFB positivity was seen in 52% cases in our study.…”

Section: Discussionmentioning

confidence: 85%

Utility of Fine Needle Aspiration Cytology in the Diagnosis of Extrapulmonary Tuberculosis: Study at a Tertiary Care Centre of Kashmir Valley

Yasin¹,

Khan²,

Khan³

2018

IJCMR

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Introduction: Tuberculosis(TB) can involve any organ system of our body. While pulmonary TB is most common presentation, extra pulmonary tuberculosis is also equally important problem. Cervical lymph nodes are the commonest site of involvement.This Extrapulmonary manifestation as peripheral lymphadenopathy or palpable intra-abdominal masses can be diagnosed by fine needle aspiration cytology (FNAC), a technique that is gaining increasing acceptance in the diagnosis of palpable masses and lymphadenopathies. Study objective was to determine the role of fine needle aspiration cytology (FNAC) in the diagnosis of extrapulmonary tuberculosis.

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The value of wide-needle aspiration in the diagnosis of tuberculous lymphadenitis in Africa

Cited by 44 publications

References 0 publications

Identification of the Causative Organism of Tuberculous Lymphadenitis in Ethiopia by PCR

Identification of the Causative Organism of Tuberculous Lymphadenitis in Ethiopia by PCR

Diagnosis of Tuberculous Lymphadenitis in Butajira, Rural Ethiopia

Utility of Fine Needle Aspiration Cytology in the Diagnosis of Extrapulmonary Tuberculosis: Study at a Tertiary Care Centre of Kashmir Valley

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