RESUMEN
INTRODUCTION: In the clinical medicine's immediate assistance unit, care is focused on outpatients with diseases that require early diagnosis, such as tuberculous adenitis (TA). The aim was to describe clinical features, complementary studies and procedures performed in patients with a diagnosis confirmed by bacteriology or pathological anatomy of TA. METHODS: Observational, descriptive, retrospective. PERIOD: 2017-2023. RESULTS: Fourty nine patients were included, with a median age of 31 years, 59% were female, 22% with comorbidities. 40% had localized lymphadenopathy, most of them cervical. HIV serology was positive in 3 cases (6.1%). Samples for bacteriology were submitted in 73%, with isolation of M. tuberculosis in 71%. Nodal fine needle aspiration (FNA) was performed in 79%, and in 48% the cytology results were suggestive of tuberculosis. Nodal biopsy was performed in 77%, with granulomatous adenitis as result in 62%. The term between admission and diagnosis ranged from a median of 40 days. Most treatments were started after the biopsy result, followed by culture, bacilloscopy, FNA, and GeneXpert. One patient died. DISCUSSION: TA predominates in the female sex in the studied group, coinciding with the local experience, the average age of presentation is 30 to 40 years, can affect any lymph node region, although the cervical location predominates, which coincides with the findings of this work. In our series, the diagnostic delay from the first consultation was shorter than reported in the literature.
Introducción: En el consultorio de atención inmediata de clínica se concentra la atención de pacientes ambulatorios con enfermedades que requieren diagnóstico precoz, como la adenitis tuberculosa (AT). El objetivo fue describir las características clínicas, estudios complementarios y procedimientos realizados a pacientes con diagnóstico confirmado por bacteriología o anatomía patológica de AT. Métodos: Estudio observacional, descriptivo, retrospectivo. Período: 2017-2023. Resultados: Se incluyeron 49 pacientes, con una mediana de edad de 31 años; 59% de sexo femenino, 22% con comorbilidades El 40% presentó adenopatías localizadas, la mayoría cervicales. La serología para HIV era positiva en 3 (6.1%). Al 73% se le ingresaron muestras para bacteriología, con aislamiento de M. tuberculosis en 71%. Al 79% se le realizó punción aspiración con aguja fina (PAAF) ganglionar; en el 48% los resultados de la citología fueron sugestivos de tuberculosis (TB). Al 77% se le realizó biopsia ganglionar, resultando en el 62% adenitis granulomatosa. Desde la primera consulta hasta el diagnóstico transcurrieron una mediana de 40 días. La mayoría de los tratamientos se iniciaron luego del resultado de la biopsia, seguido de cultivos, baciloscopia, PAAF y GeneXpert. Un paciente falleció. Discusión: La AT predominó en el sexo femenino en el grupo estudiado, coincidente con la experiencia local, la edad promedio de presentación fue 30 a 40 años. Puede afectar cualquier cadena ganglionar, aunque predomina la localización cervical, que coincide con los hallazgos de este trabajo. En nuestra serie, la demora diagnóstica desde la primera consulta fue menor a la referida en la bibliografía.
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Tuberculosis Ganglionar , Humanos , Femenino , Estudios Retrospectivos , Masculino , Adulto , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/patología , Persona de Mediana Edad , Adulto Joven , Biopsia con Aguja Fina , Mycobacterium tuberculosis/aislamiento & purificación , Adolescente , AncianoRESUMEN
BACKGROUND: Mediastinal tubercular lymphadenitis is form of extrapulmonary tuberculosis [EPTB]. Clinical presentations are non-specific and diagnosis remains great clinical challenge. Microbiological and or histopathological evidences need to be present in order make diagnosis secure before initiation of anti-tubercular therapy (ATT). Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) provides tissue samples and aids management of this difficult to diagnosed entity. Current study describe role of EUS-FNA and Gene Xpert (GXP) in mediastinal tubercular lymphadenitis. METHODS: Retrospective analysis of 72 patients with mediastinal lymphadenopathy who underwent EUS-FNA were carried out. Linear echoendoscope was used for evaluation mediastinum. EUS echo features of LNs were studied. Twenty two-G needle used was for aspiration tissue sample from pathologic lymph nodes (LNs). FNA samples were analysed by cytology, Acid-Fast Bacilli (AFB) staining and GXP study. All procedures were uneventful without any complications. RESULTS: Forty two patients were diagnosed as tuberculosis (TB) following first EUS-FNA setting. Six patients underwent repeat EUS-FNA procedure following which another 3 were diagnosed as TB while remaining 3 started on empirical ATT based on additional supportive evidences. Forty five patients showed granulomatous inflammation on cytological analysis, AFB positivity noted in 16 (33.33%) patients while GXP in 26 (57.78%) patients. Rifampicin resistance detected in 3 ((6.25%) patients. All patients were followed clinico-radiologically for response to treatment. CONCLUSION: Tuberculous lymphadenitis is the most common cause of mediastinal lymphadenopathy in TB endemic countries. EUS-FNA provides microbiological and histopathological/cytological evidences in this difficult to diagnosed EPTB and thereby avoids empirical ATT.
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Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Ganglios Linfáticos , Tuberculosis Ganglionar , Humanos , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Masculino , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/patología , Tuberculosis Ganglionar/tratamiento farmacológico , Femenino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Ganglios Linfáticos/patología , Ganglios Linfáticos/diagnóstico por imagen , Adulto Joven , Mycobacterium tuberculosis/aislamiento & purificación , Adolescente , Enfermedades del Mediastino/patología , Enfermedades del Mediastino/diagnóstico , Anciano , Mediastino/patologíaRESUMEN
INTRODUCTION: In India, EPTB accounts for about 50% of TB cases especially in people living with HIV/AIDS. Microbiological confirmation is present in only about 15% of EPTB cases. Tuberculous Lymphadenitis is the most common form of EPTB in India, accounting for around 35% of EPTB cases. Fine needle aspiration cytology has been found to be highly sensitive and specific in the diagnosis of tuberculous lymphadenitis with 83-94% accuracy. The procedure of AFB detection is exactly the same for the FNAC obtained smears as for the presently examined sputum smears at the DMCs. The aim of the present study was to determine the feasibility and effectiveness of FNAC strategy implemented at DMC level for detection of tuberculous lymphadenitis cases. METHODS: The present study was a randomized cluster trial with one control and one intervention arm. At the intervention units (DMCs) all suspected tuberculous lymphadenitis cases was subjected to FNAC of the suspected superficial lymph nodes by the trained Medical Officers. The control group was free from any such intervention. Effectiveness and feasibility of FNAC strategy in the intervention group was determined by relevant indicators. RESULTS: At the seven intervention DMCs, FNAC was performed on a total number of 1298 suspected cases of Tuberculous Lymphadenitis. Among them 294 cases were selected in the intervention arm and 196 cases in the control arm. Intervals between advice of FNAC and performance of FNAC as well as start of therapy was significantly low in the intervention arm. Complication was insignificant. The concordance between FNAC reports generated at the DMCs and that at Medical College estimated by agreement measurement kappa (0.970) suggested a high level of agreement. CONCLUSION: Implementation of FNAC strategy at the DMC level for detection of tuberculous lymphadenitis cases was found to be feasible as well as effective.
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Tuberculosis Ganglionar , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Biopsia con Aguja Fina/métodos , Estudios de Factibilidad , India , Ganglios Linfáticos/patología , Mycobacterium tuberculosis/aislamiento & purificación , Sensibilidad y Especificidad , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/patologíaRESUMEN
A 78-year-old woman with rheumatoid arthritis, who was started on baricitinib five or six months earlier, was referred to our hospital due to a subcutaneous abscess in her right axilla. Contrast-enhanced chest, abdomen, and pelvis computed tomography showed subcutaneous abscesses in her right axilla and lymphadenopathy with calcification. Cultures from the subcutaneous abscess and skin biopsy specimens were positive for Mycobacterium tuberculosis. These findings led to the diagnosis of scrofuloderma associated with tuberculous lymphadenitis. She was started on an antitubercular regimen of isoniazid, rifampicin, pyrazinamide, and ethambutol as the initial phase treatment (first 2 months), followed by isoniazid and rifampicin for 4 months (total 6 months). After 6 months of antitubercular treatment, the abscesses and lymphadenitis disappeared. Although cases of tuberculosis during JAK inhibitor treatment are rare, they are serious adverse events that require caution.
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Antituberculosos , Artritis Reumatoide , Inhibidores de las Cinasas Janus , Pirazoles , Sulfonamidas , Tuberculosis Ganglionar , Humanos , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/complicaciones , Femenino , Anciano , Inhibidores de las Cinasas Janus/efectos adversos , Antituberculosos/efectos adversos , Antituberculosos/administración & dosificación , Sulfonamidas/efectos adversos , Sulfonamidas/administración & dosificación , Pirazoles/efectos adversos , Tuberculosis Ganglionar/tratamiento farmacológico , Tuberculosis Ganglionar/diagnóstico , Purinas/efectos adversos , Purinas/administración & dosificación , Azetidinas/efectos adversos , Azetidinas/administración & dosificación , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico , Resultado del Tratamiento , Mycobacterium tuberculosis/aislamiento & purificación , Quimioterapia Combinada , Isoniazida/efectos adversos , Isoniazida/administración & dosificaciónRESUMEN
INTRODUCTION: The role of Xpert Ultra in bronchoalveolar lavage (BAL) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples for pulmonary and mediastinal lymph node tuberculosis (TB) remains unclear. METHODS: This was a retrospective observational service evaluation at a tertiary TB centre in a low-incidence setting. The diagnostic indices of Xpert Ultra, smear and culture (with cytology for EBUS-TBNA samples) were compared with culture positivity or a composite reference standard of clinical TB diagnosis. Trace readouts, a new category of results for Xpert Ultra indicating low bacillary load, were analysed in two ways as a true positive or true negative result. 282 BAL and 139 EBUS-TBNA samples were included in the analysis. RESULTS: BAL: sensitivity with 95% CI against culture-confirmed pulmonary TB from BAL samples for Xpert Ultra (trace as positive) was 0.91 (0.82 to 0.98), Xpert Ultra (trace as negative) was 0.76 (0.69 to 0.83), smear was 0.38 (p=0.0009) and culture was 1.00 (0.91 to 1.00). Specificities for all the tests were ≥0.99 (0.98 to 1.00). The addition of smear to Xpert Ultra did not improve the diagnostic accuracy.EBUS-TBNA: sensitivity against culture-confirmed TB from EBUS-TBNA samples for Xpert Ultra (trace as positive) was 0.71 (0.63 to 0.78), Xpert Ultra (trace as negative) was 0.59 (0.54 to 0.63), smear was 0.12 (p=0.002), culture was 1.00 (0.89 to 1.00), cytology was 0.87 (0.76 to 0.98) and rapid on-site evaluation of cytology (ROSE) was 0.92 (0.78 to 1.00). Specificities were 0.99 (0.97 to 1.00), 0.99 (0.97 to 1.00), 1.00 (0.98 to 1.00), 1.00 (0.98 to 1.00), 0.67 (0.67 to 0.68) and 0.42, respectively. CONCLUSION: Xpert Ultra had a significantly higher sensitivity compared with smear in both BAL and EBUS-TBNA samples. Xpert Ultra had a lower sensitivity compared with culture but comparable specificity with results being available within <24 hours. Trace readings in our low-incidence setting were associated with culture positivity in all BAL samples.
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Líquido del Lavado Bronquioalveolar , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Tuberculosis Ganglionar , Tuberculosis Pulmonar , Humanos , Estudios Retrospectivos , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/microbiología , Tuberculosis Ganglionar/patología , Masculino , Femenino , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/microbiología , Persona de Mediana Edad , Líquido del Lavado Bronquioalveolar/microbiología , Líquido del Lavado Bronquioalveolar/citología , Adulto , Mediastino/microbiología , Sensibilidad y Especificidad , Mycobacterium tuberculosis/aislamiento & purificación , Mycobacterium tuberculosis/genética , Reacción en Cadena de la Polimerasa/métodos , Ganglios Linfáticos/patología , Ganglios Linfáticos/microbiología , AncianoRESUMEN
Objectives: To investigate the clinical epidemiological and drug resistance (DR) characteristics of lymph node tuberculosis (LNTB) in Hunan Province which locates in South-central China, and to provide scientific clues for effective prevention and treatment of LNTB. Methods: We retrospectively collected LNTB patients with Mycobacterium tuberculosis culture positive at Hunan Chest Hospital, the biggest TB reference hospital in South-central China, from January 2013 to December 2021. The multiple demographic, clinical and drug susceptibility data of patients were collected from the hospital's electronic patient records. Descriptive statistical methods, Chi-square test and logistic regression analysis were employed as statistical methods. Results: Of the 577 LNTB cases, 373 (64.64%) were males, 352 (61.01%) were farmers; majority (161, 33.10%) aged at 20-29 years old; 147 (25.48%) had simple LNTB, 350 (60.66%) had LNTB combined with pulmonary TB (PTB) (defined as LNTB-PTB), and 80 (13.86%) had LNTB combined with other extrapulmonary TB (EPTB) (defined as LNTB-EPTB). A total of 345 (59.79%, 345/577) LNTB patients had cervical node infection, and the simple LNTB patients (81.63%, 120/147) had higher proportion of this infection than LNTB-PTB (51.71%, 181/350) and LNTB-EPTB (55.00%, 44/80) (both p values <0.017), respectively. LNTB-EPTB was more inclined to have abdominal tuberculous LNs (20%, 16/80) and at least four tuberculous lesions (22.50%, 18/80) than simple LNTB and LNTB-PTB. Seventy-seven (13.34%) and 119 (20.62%) were resistant to rifampicin (RIF) and isoniazid (INH), respectively; 72 (12.48%) were multi-drug resistant (MDR), and a total of 150 (26.00%) were DR (resistant to at least one of RIF, INH, ethambutol and streptomycin). LNTB patients aged 30-34 and 50-54 years old (compared to those aged <30 years) were independent predictors of RIF resistance (RR) (ORs were 3.47 and 2.83, respectively; 95% CIs were 1.64-7.35 and 1.08-7.46, respectively). Conclusion: Our study disclosed the epidemiological and DR characteristics of LNTB in Hunan Province, China. High LNTB prevalence was found in younger people while high RR LNTB prevalence was found in older ones, suggesting that we should conduct further studies to clarify the occurrence of RR in LNTB, meanwhile, strengthen the diagnoses and treatments of LNTB to prevent the emergence of RR.
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Antituberculosos , Mycobacterium tuberculosis , Tuberculosis Ganglionar , Tuberculosis Resistente a Múltiples Medicamentos , Humanos , China/epidemiología , Masculino , Femenino , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Antituberculosos/uso terapéutico , Antituberculosos/farmacología , Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis Ganglionar/epidemiología , Tuberculosis Ganglionar/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adulto Joven , Adolescente , Anciano , Pruebas de Sensibilidad Microbiana , Farmacorresistencia BacterianaRESUMEN
BACKGROUND: The most common form of extrapulmonary tuberculosis (TB) is tuberculous lymphadenitis, which constitutes about 30-40% of all extrapulmonary TB cases. A new diagnostic method like the nucleic acid amplification test (NAAT) is a very sensitive and rapid test for diagnosing tuberculous cervical lymphadenopathy. It also detects rifampicin sensitivity among positive patients. OBJECTIVES: (1) To evaluate the diagnostic yield of TrueNAT for detecting Mycobacterium tuberculosis bacteria in the fine-needle aspirated samples of cervical lymph nodes compared with Ziehl-Neelsen (ZN) staining; (2) to evaluate the diagnostic yield of TrueNAT for diagnosis of tuberculosis through comparison with the cytology report of fine-needle aspiration (FNA) sample of cervical lymph node and with necrotic cervical lymph node on ultrasonography (USG) neck. MATERIALS AND METHODS: A total of 50 patients enrolled in this prospective study from January to December 2022. Demographic profile and clinical history were noted. Fine-needle aspirate samples were sent for TrueNAT assay, cytological examination, and ZN staining. USG neck was done for necrotic findings in the cervical lymph nodes. RESULTS: The TrueNAT positivity rate was 70%. TrueNAT sensitivity and specificity were assessed according to the cytology report, acid-fast bacilli (AFB) positivity on ZN stain, and the finding of necrosis in the cervical lymph node on the USG neck. The sensitivity and specificity of the TrueNAT assay were 80.49 and 77.78%, respectively, in accordance with necrosis on FNA cytology; 17.14 and 93.33%, respectively, in accordance with AFB positivity on ZN stain; and 74.29 and 33.33%, respectively, in accordance with lymph node necrosis on USG neck. CONCLUSION: The TrueNAT assay should be used as an adjunctive test in addition to the conventional cytological examination of the FNA sample of lymph nodes for the rapid diagnosis of tuberculosis. It also detects rifampicin resistance simultaneously.
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Ganglios Linfáticos , Mycobacterium tuberculosis , Técnicas de Amplificación de Ácido Nucleico , Sensibilidad y Especificidad , Tuberculosis Ganglionar , Humanos , Tuberculosis Ganglionar/diagnóstico , Técnicas de Amplificación de Ácido Nucleico/métodos , Femenino , Masculino , Adulto , Biopsia con Aguja Fina/métodos , Estudios Prospectivos , Ganglios Linfáticos/patología , Ganglios Linfáticos/microbiología , Mycobacterium tuberculosis/aislamiento & purificación , Mycobacterium tuberculosis/genética , Persona de Mediana Edad , Cuello , Adulto Joven , Inmunocompetencia , AdolescenteRESUMEN
INTRODUCTION: Tuberculous lymphadenitis (TBLN) is an infection of the lymph node caused by Mycobacterium tuberculosis. Histological diagnoses of presumptive patients are often accompanied by cytomorphological features. However, the sensitivities of these features are often precluded by the variable degrees of narrative similarities compared to other diagnostic modalities. OBJECTIVE: The aim of this study was to investigate and compare the cytomorphological and clinical features of presumptive TBLN patients with bacteriological detection methods. METHODS: A similar cohort of TBLN patients from our previous study who were enrolled prospectively from the ALERT Specialized Hospital, Addis Ababa, Ethiopia, was considered for this analysis. SPSS version 26 was used for data analysis. Descriptive analysis was conducted to characterize the study population using the independent variable and presented with frequency tables. The chi-square test was used to measure the association. A P-value of < 0.05 was considered statistically significant. RESULTS: Using FNAC, 60/126 (47.6%) of the participants were reported to have features consistent with TB. Of the total FNAC-positive cases, many (30/60 and 27/60) showed pattern B (caseous necrosis only) and pattern C (epithelioid granuloma with caseous necrosis), respectively. Strong concordance was observed in Pattern A (abundant caseous necrosis with few epithelioid macrophages) followed by patterns B and C with GeneXpert and MGIT culture (P value < 0.001). Night sweats and alcohol intake were shown to correlate with positive cases as reported by FNAC (P value = 0.008 respectively), GeneXpert (P value = 0.02 & 0.001), and culture methods (P-value = < 0.001 & 0.002). CONCLUSION: Cytomorphological features, particularly patterns A, B, and C, could be considered in the diagnosis of TBLN given their comparable outcomes with bacteriological detection methods. On another note, we recommend that due care and attention be given when treating TBLN patients based solely on clinical presentation, as these diagnostics may be prone to false results, leading to inappropriate administration of anti-TB drugs and other consequences.
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Mycobacterium tuberculosis , Tuberculosis Ganglionar , Humanos , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/microbiología , Tuberculosis Ganglionar/patología , Masculino , Femenino , Adulto , Estudios Transversales , Mycobacterium tuberculosis/aislamiento & purificación , Adulto Joven , Etiopía , Adolescente , Persona de Mediana Edad , Ganglios Linfáticos/patología , Ganglios Linfáticos/microbiología , Biopsia con Aguja Fina , Niño , Estudios Prospectivos , Anciano , Técnicas Bacteriológicas/métodosRESUMEN
BACKGROUND: Tuberculosis (TB) lymphadenitis is the most common form of extra-pulmonary TB, and the treatment duration is six months. This non-inferiority based randomized clinical trial in South India evaluated the efficacy and safety of a four-month ofloxacin containing regimen in tuberculosis lymphadenitis (TBL) patients. METHODS: New, adult, HIV-negative, microbiologically and or histopathologically confirmed superficial lymph node TB patients were randomized to either four-month oflaxacin containing test regimen [ofloxacin (O), isoniazid (H), rifampicin (R), pyrazinamide (Z) -2RHZO daily/ 2RHO thrice-weekly] or a six-month thrice-weekly control regimen (2HRZ, ethambutol/4RH). The treatment was directly observed. Clinical progress was monitored monthly during and up to 12 months post-treatment, and thereafter every three months up to 24 months. The primary outcome was determined by response at the end of treatment and TB recurrence during the 24 months post-treatment. RESULTS: Of the 302 patients randomized, 298 (98.7%) were eligible for modified intention-to-treat (ITT) analysis and 294 (97%) for per-protocol (PP) analysis. The TB recurrence-free favourable response in the PP analysis was 94.0% (95% CI: 90.1-97.8) and 94.5% (95% CI: 90.8-98.2) in the test and control regimen respectively, while in the ITT analysis, it was 92.7% and 93.2%. The TB recurrence-free favourable response in the test regimen was non-inferior to the control regimen 0.5% (95% CI: -4.8-5.9) in the PP analysis based on the 6% non-inferiority margin. Treatment was modified for drug toxicity in two patients in the test regimen, while one patient had a paradoxical reaction. CONCLUSION: The 4-month ofloxacin containing regimen was found to be non-inferior and as safe as the 6-month thrice-weekly control regimen.
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Antituberculosos , Ofloxacino , Tuberculosis Ganglionar , Humanos , Ofloxacino/administración & dosificación , Ofloxacino/efectos adversos , Ofloxacino/uso terapéutico , Adulto , Masculino , Femenino , Tuberculosis Ganglionar/tratamiento farmacológico , Antituberculosos/uso terapéutico , Antituberculosos/efectos adversos , Antituberculosos/administración & dosificación , Resultado del Tratamiento , Persona de Mediana Edad , India , Rifampin/uso terapéutico , Rifampin/administración & dosificación , Rifampin/efectos adversos , Adulto Joven , Isoniazida/uso terapéutico , Isoniazida/administración & dosificación , Isoniazida/efectos adversos , Quimioterapia Combinada , Pirazinamida/uso terapéutico , Pirazinamida/administración & dosificación , Pirazinamida/efectos adversos , Etambutol/uso terapéutico , Etambutol/administración & dosificación , Etambutol/efectos adversos , Esquema de Medicación , AdolescenteRESUMEN
Objective: To evaluate the sensitivity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) puncture to obtain intrathoracic lymph node samples combined with Xpert MTB/RIF (Xpert) detection for the diagnosis of intrathoracic lymph node tuberculosis. Methods: From March 2018 to June 2021, 106 patients [55 males and 51 females, age (45.1±18.6) years] with suspected intrathoracic lymph node tuberculosis and EBUS-TBNA were collected in Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, including 64 patients with subsequent diagnosis of intrathoracic lymph node tuberculosis and 42 patients without tuberculosis. Xpert test and traditional etiology test were performed on the patients' intrathoracic lymph node puncture specimens. The positive results of different detection methods and different methods were analyzed, and the influencing factors of Xpert independent detection positive were analyzed by univariate and multivariate logistic regression. Results: The sensitivity of Xpert was 65.6% (95%CI: 52.7%-77.1%), the specificity was 97.6% (95%CI: 87.4%-99.9%), the positive predictive value was 97.7% (95%CI: 85.7%-99.7%), the negative predictive value was 65.1% (95%CI: 57.0%-72.4%). The positive rate of Xpert alone (65.6%, 42/64) was not significantly different from that of MGIT960, histopathology and Xpert combined detection (70.3%, 45/64) (P<0.05). Multivariate logistic regression analysis showed that the location of the diseased lymph nodes in the mediastinum (OR=5.84, 95%CI: 1.112-30.704, P=0.037), necrosis in the lymph nodes (OR=6.32, 95%CI: 1.460-27.384, P=0.014), and the axial depth of the lymph nodes≥17 mm (OR=6.61, 95%CI: 1.408-30.969, P=0.017) were the promoting factors for the positive Xpert test. Conclusions: EBUS-TBNA combined with Xpert detection has a high clinical diagnostic value for intrathoracic lymph node tuberculosis. When the number of puncture samples is small, Xpert detection can be preferred. The positive rate of Xpert detection can be improved by selecting lymph nodes with mediastinal lesions, lymph nodes necrosis, and axial lymph nodes depth≥17 mm for puncture.
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Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Ganglios Linfáticos , Sensibilidad y Especificidad , Tuberculosis Ganglionar , Humanos , Masculino , Femenino , Persona de Mediana Edad , Tuberculosis Ganglionar/diagnóstico , Ganglios Linfáticos/patología , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , AdultoRESUMEN
INTRODUCTION: Tuberculosis (TB) affecting the head-and-neck area can often resemble cancer, leading to misdiagnosis and delayed treatment. A better understanding of this condition is necessary for early diagnosis and prompt treatment initiation. This study examines the clinical and pathological characteristics of different types of TB in the head-and-neck region. METHODS: This retrospective study analyzed patients diagnosed with TB in the head-and-neck region at a health center between January 1, 2018, and January 1, 2024. The study population consisted of patients who were diagnosed with TB of the head and neck. RESULTS: The study analyzed data from 30 patients, comprising 14 (47%) males and 16 (53%) females, all of whom tested negative for HIV. Most cases (15, 50%) were observed in the age group of 15-24 years, with 5 (15.6%) subjects falling in the age bracket of 0-14 years. Among the types of lesions detected, cervical tubercular adenitis was the most frequently observed lesion, found in 22 (73%) subjects. Females are more susceptible to cervical tubercular adenitis, while males are more likely to experience laryngeal TB. CONCLUSION: The clinical manifestation of TB affecting the head-and-neck region can exhibit a diverse range of symptoms, which may lead to misinterpretation and diagnostic errors. Therefore, health-care practitioners must understand and include the condition in differential diagnoses.
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Cuello , Humanos , Masculino , Femenino , Estudios Retrospectivos , Adolescente , Adulto , Adulto Joven , Niño , Preescolar , Lactante , Persona de Mediana Edad , Cuello/patología , Cuello/microbiología , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/patología , Tuberculosis Ganglionar/microbiología , Tuberculosis/microbiología , Tuberculosis/diagnóstico , Tuberculosis/patología , Cabeza/microbiología , Cabeza/diagnóstico por imagen , Tuberculosis Laríngea/diagnóstico , Tuberculosis Laríngea/patología , Anciano , Recién NacidoRESUMEN
BACKGROUND: Extrapulmonary tuberculosis (EPTB) makes for 25% of all instances of tuberculosis (TB) patients. The enigmatic clinical presentation of EPTB makes identification difficult since it simulates other chronic conditions such as neoplastic and inflammatory disorders and could culminate in treatment that is either insufficient or not required. For an affirmative and confirmed diagnosis, a substantial level of suspicion is imperative. The paucibacillary feature of EPTB makes diagnosis extremely difficult and necessitates the use of many diagnostic methods to arrive at a precise diagnosis. In December 2010, the World Health Organization recommended using GeneXpert/cartridge-based nucleic acid amplification test (CBNAAT) for the initial assessment of suspected cases of EPTB. Furthermore, fine-needle aspiration cytology (FNAC), Ziehl-Neelsen (ZN) stain, and the CBNAAT have to be utilized to exclude other possible origins of granulomatous inflammation. The goal of the current investigation is to comprehend how FNAC and ZN stains relate to CBNAAT and their diagnostic value. METHODS: The evaluation included all suspected instances of tubercular lymphadenopathy, and adequate aspirates were obtained from the site of the enlarged cervical lymph nodes. Smears were made following FNAC and stained with ZN stain as well as hematoxylin and eosin stain. Simultaneously, CBNAAT and culture evaluations were conducted on the same aspirates. This cross-sectional study took place at a tertiary care center and encompassed 200 individuals with clinical manifestations of EPTB. RESULTS: There were 200 cases of suspected tubercular lymphadenitis (TBLN). According to the FNAC results, TBLN was detected in 71 (47.6%) of these 200 cases, followed by necrotizing lymphadenitis in 56 (37.5%), chronic caseating granulomatous lymphadenitis in 47 (31.5%), and reactive lymphadenitis in 26 (17.4%). They were correlated with CBNAAT results, which showed that all instances of tuberculous lymphadenitis, 85.71% of cases of necrotizing lymphadenitis, 55.32% of cases of chronic caseating granulomatous lymphadenitis, and 2 (7.69%) cases of reactive lymphadenitis were CBNAAT positive. CONCLUSION: CBNAAT should be utilized with FNAC and ZN staining to diagnose EPTB. The CBNAAT assay demonstrated a significant advantage in the identification of previously unidentified FNAC patients. Despite being a simple diagnostic tool, FNAC has a lower specificity and significantly lower precision than CBNAAT in correctly identifying cases of EPTB because it exhibits similar cytomorphological characteristics with lesions that are not associated with TB.
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Mycobacterium tuberculosis , Tuberculosis Ganglionar , Humanos , Femenino , Masculino , Biopsia con Aguja Fina , Adulto , Persona de Mediana Edad , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/microbiología , Tuberculosis Ganglionar/patología , Adolescente , Adulto Joven , Mycobacterium tuberculosis/aislamiento & purificación , Mycobacterium tuberculosis/genética , Ganglios Linfáticos/microbiología , Ganglios Linfáticos/patología , Anciano , Técnicas de Amplificación de Ácido Nucleico/métodos , Coloración y Etiquetado/métodos , Linfadenopatía/microbiología , Linfadenopatía/patología , Niño , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: Tuberculous lymphadenitis (TBLN) is the most common infectious etiology of peripheral lymphadenopathy in adults, in Turkiye. This study aimed to identify the demographic, clinical, and laboratory variables that differentiate TBLN from non-tuberculous lymphadenitis (NTBLN), as well as the etiology of lymphadenopathy in adults. METHODOLOGY: Patients who were over 18 years old and were referred to the infectious disease outpatient clinics with complaints of swollen peripheral lymph nodes, and who underwent lymph node biopsy between 1 January 2010 and 1 March 2021, were included in this multicenter, nested case-control study. RESULTS: A total of 812 patients at 17 tertiary teaching and research hospitals in Turkiye were included in the study. TBLN was the most frequent diagnosis (53.69%). The proportion of patients diagnosed with TBLN was higher among females; and among those who had a higher erythrocyte sedimentation rate, positive purified protein derivative test, and positive interferon-gamma release test result (p < 0.05). However, TBLN was less frequent among patients with generalized lymphadenopathy, bilateral lymphadenopathy, axillary lymphadenopathy, inguinal lymphadenopathy, hepatomegaly, splenomegaly, leukocytosis, and moderately increased C reactive protein levels (p < 0.05). CONCLUSIONS: Identifying the variables that predict TBLN or discriminate TBLN from NTBLN will help clinicians establish optimal clinical strategies for the diagnosis of adult lymphadenopathy.
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Tuberculosis Ganglionar , Humanos , Tuberculosis Ganglionar/diagnóstico , Femenino , Masculino , Adulto , Estudios de Casos y Controles , Persona de Mediana Edad , Adulto Joven , Turquía/epidemiología , Ganglios Linfáticos/patología , Adolescente , Linfadenopatía/diagnóstico , Linfadenopatía/etiología , Anciano , Ensayos de Liberación de Interferón gamma/métodosRESUMEN
AIMS: To retrospectively analyze the diagnostic efficacy of Xpert MTB/RIF (Xpert) in lymph node tuberculosis (LNTB). METHODS: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) of Xpert, pathological examination and culture for LNTB were calculated. RESULTS: 421 suspected LNTB cases were categorized into the LNTB group (377 cases) and non-LNTB group (44 cases). The sensitivities of Xpert, pathological examination, and culture were 72.15%, 20.69%, 30.24%, respectively, with NPVs of 29.53%, 12.83%, 14.33%. The AUC values were 0.861, 0.603, 0.651, respectively. The sensitivity of Xpert varied across sample types: tissue (64.73%), puncture fluid (74.42%), and pus (96.05%). For specific lymph node locations, the sensitivity was head-and-neck (72.51%), mediastinal (84.21%), and axillary (45.83%). CONCLUSIONS: Xpert demonstrates high diagnostic value for LNTB, particularly in pus samples. It also performs better in mediastinal and head-and-neck lymph node samples compared to axillary lymph node samples.
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Mycobacterium tuberculosis , Sensibilidad y Especificidad , Tuberculosis Ganglionar , Humanos , Estudios Retrospectivos , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/microbiología , Femenino , Masculino , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/aislamiento & purificación , Adulto , Persona de Mediana Edad , Ganglios Linfáticos/microbiología , Ganglios Linfáticos/patología , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/normas , Anciano , Valor Predictivo de las Pruebas , Adulto JovenRESUMEN
INTRODUCTION: Proper diagnosis of tuberculosis (TB) lymphadenitis is critical for its treatment and prevention. Fine needle aspirate cytology (FNAC) is the mainstay method for the diagnosis of TB lymphadenitis in Ethiopia; however, the performance of FNAC has not been evaluated in the Eastern Region of Ethiopia. This study aimed to evaluate the performance of FNAC and Ziehl-Neelsen (ZN) staining compared with that of GeneXpert for the diagnosis of TB lymphadenitis. METHODS: Fine needle aspiration (FNA) specimens collected from 291 patients suspected of having TB lymphadenitis were examined using FNAC, ZN, and GeneXpert to diagnose TB lymphadenitis. Gene-Xpert was considered the reference standard method for comparison. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficient were determined using SPSS version 25. RESULTS: The sensitivity, specificity, PPV, and NPV of ZN for diagnosing TB lymphadenitis were 73.2%, 97.4%, 96.2%, and 80.1% respectively. There was poor agreement between ZN and GeneXpert (Kappa=-0.253). The sensitivity, specificity, PPV, and NPV of FNAC were 83.3%, 94.8%, 93.5%, and 86.3% respectively. There was moderate agreement between the FNAC and GeneXpert (Kappa = 0.785). CONCLUSION: The fine needle aspiration cytology (FNAC) is a more sensitive test for the diagnosis of TB lymphadenitis than ZN. The FNAC showed a moderate agreement with the GeneXpert assay. This study recommends the FNA GeneXpert MTB/RIF test in preference to FNAC for the diagnosis of TB lymphadenitis to avoid a missed diagnosis of smear-negative TB lymphadenitis.
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Sensibilidad y Especificidad , Coloración y Etiquetado , Tuberculosis Ganglionar , Humanos , Biopsia con Aguja Fina/métodos , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/patología , Tuberculosis Ganglionar/microbiología , Femenino , Masculino , Adulto , Adulto Joven , Persona de Mediana Edad , Coloración y Etiquetado/métodos , Adolescente , Etiopía , Mycobacterium tuberculosis/aislamiento & purificación , Mycobacterium tuberculosis/genética , Niño , Anciano , CitologíaRESUMEN
We present the case of a patient with HIV and tuberculosis (TB) coinfection who initially developed paradoxical TB immune reconstitution inflammatory syndrome (TB-IRIS) post-antituberculous treatment and post-antiretroviral therapy initiation. Despite being managed effectively, lymphadenitis recurred as many as three times over the course of several years. Due to consistent culture-negative lymph node biopsies, the recurring lymphadenitis was eventually deemed inflammatory rather than microbiological recurrences. Cessation of anti-TB treatment led to symptom remission followed by a long asymptomatic period, corroborating the immunological nature of the episodes. However, 5 and 6 years after cessation of anti-TB treatment, respectively, lymphadenitis returned. In both instances, her symptoms regressed without treatment with anti-TB drugs. This case underscores the complexities of managing TB-IRIS and the necessity of differentiating between paradoxical TB-IRIS and other paradoxical reactions for appropriate treatment decisions. Recognition of such distinctions is crucial in guiding effective therapeutic interventions in TB-HIV coinfection scenarios.
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Antituberculosos , Infecciones por VIH , Síndrome Inflamatorio de Reconstitución Inmune , Linfadenitis , Recurrencia , Humanos , Síndrome Inflamatorio de Reconstitución Inmune/diagnóstico , Femenino , Antituberculosos/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Linfadenitis/microbiología , Adulto , Coinfección , Tuberculosis Ganglionar/tratamiento farmacológico , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/complicacionesRESUMEN
Cervical lymph node metastasis is an important determinant of cancer stage and the selection of an appropriate treatment plan for patients with head and neck cancer. Therefore, metastatic cervical lymph nodes should be effectively differentiated from lymphoma, tuberculous lymphadenitis, and other benign lymphadenopathies. The aim of this work is to describe the performance of Doppler ultrasound and superb microvascular imaging (SMI) in evaluating blood flow information of cervical lymph nodes. In addition, the features of flow imaging in metastatic lymph nodes, lymphoma, and tuberculous lymphadenitis were described. Compared with Doppler ultrasound, SMI, the latest blood flow imaging technology, could detect more blood flow signals because the sensitivity, specificity, and accuracy of SMI in the diagnosis of cervical lymph node disease were higher. This article summarizes the value of Doppler ultrasound and SMI in evaluating cervical lymph node diseases and focuses on the diagnostic performance of SMI.
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Ganglios Linfáticos , Metástasis Linfática , Cuello , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/irrigación sanguínea , Cuello/irrigación sanguínea , Cuello/diagnóstico por imagen , Metástasis Linfática/diagnóstico por imagen , Ultrasonografía Doppler/métodos , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Microvasos/diagnóstico por imagen , Tuberculosis Ganglionar/diagnóstico por imagen , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Recently, extra-pulmonary tuberculosis (EPTB) has been increasingly reported in Bhutan, rising from 26% in 2001 to 39% in 2010. In 2016, almost half (49%) of all reported TB cases were classified as EPTB. Thus, this study was conducted to understand the epidemiology and identify risk factors contributing to increasing notification of EPTB in Bhutan. METHODS: A case-control study was conducted by recruiting all 110 cases of nationally notified EPTB (Extrapulmonary bacteriologically confirmed/EPBC) as cases and 235 Pulmonary TB (Pulmonary bacteriologically confirmed/PBC) as controls. Data were collected on socio-demography, clinical and diagnostic, behavioral and lifestyle and environmental exposures using a structured questionnaire between April and September, 2018. RESULTS: The median age of the cases was 25 years, ranged 9-79 years. Lymphatic TB was predominant (n = 78; 70.91%) followed by genitourinary TB (n = 4 (3.64%). The likelihood of EPTB decreased with increase in age (p = 0.023). The odds of EPTB in females was 1.65 times higher than the males (p = 0.038). Increase in Body Mass Index (adjusted odds ratio (AOR): 1.1; 95% confidence interval (CI): 1.052-1.200) and urban residency were (AOR 1.6; 95% CI 1.016-2.805) were found to have higher odds of developing EPTB. CONCLUSION: Females, urban residents, and those with higher BMI are at increased risk of developing EPTB. These at-risk groups can be used to target limited public health resources to control EPTB in Bhutan.
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Tuberculosis Extrapulmonar , Tuberculosis Ganglionar , Masculino , Femenino , Humanos , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Estudios de Casos y Controles , Salud Pública , Bután/epidemiología , Factores de Riesgo , Tuberculosis Ganglionar/epidemiología , Estudios Retrospectivos , DemografíaRESUMEN
La tuberculosis es una enfermedad infectocontagiosa cuya forma de presentación más frecuente es la pulmonar; la afectación abdominal es poco frecuente, por lo que su diagnóstico continúa siendo un desafío. Las manifestaciones clínicas de la tuberculosis abdominal así como sus hallazgos en el examen físico suelen ser inespecíficos y, en muchas ocasiones, similares a los de otras patologías, por lo que es fundamental considerarla entre los diagnósticos diferenciales. Se presenta el caso clínico de un paciente de sexo masculino, de 15 años de edad, hospitalizado por un síndrome febril prolongado asociado a dolor abdominal, diarrea, sudoración nocturna y pérdida de peso
Tuberculosis is an infectious disease which most commonly compromises the respiratory system, whereas abdominal involvement is rare, thus its diagnosis is a challenge. The clinical manifestations of abdominal tuberculosis as well as its physical examination findings are usually non-specific and, frequently, similar to those of other diseases, so it is critical to consider abdominal tuberculosis among the differential diagnoses. Here we report the clinical case of a 15-year-old male patient hospitalized for a prolonged febrile syndrome associated with abdominal pain, diarrhea, night sweats, and weight loss.