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Harya SA, Nhungo CJ, Lori JM, Mitamo AA, Mkony CA, Ogweyo P. Isolated testicular tuberculosis mimicking testicular malignancy in a 45-year-old male treated at a tertiary hospital. Case report and literature review. Int J Surg Case Rep 2024; 117:109511. [PMID: 38471216 PMCID: PMC10945242 DOI: 10.1016/j.ijscr.2024.109511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Tuberculosis is prevalent in African countries especially in sub-Saharan Africa where HIV/AIDS is common. While Testicular tuberculosis is uncommon in the young as well as the elderly, pulmonary tuberculosis is commonly observed in these populations. History, physical examination, scrotal ultrasonography, and fine needle biopsy are important in diagnosis of suspected cases of testicular tuberculosis. Anti-TB therapy is the mainstay of treatment to ensure complete resolution of the lesion. However, in a few cases, orchidectomy is required for both diagnosis and treatment. When treating testicular tuberculosis, it is crucial to do a thorough assessment and investigations to exclude testicular malignancy because tuberculosis can present similarly to a testicular tumor. CASE PRESENTATION We report a rare case of right sided isolated testicular tuberculosis in a 45-year-old male who came with right sided testicular pain and swelling. Blood workups and testicular tumor markers were all normal, scrotal ultrasound reported right heterogenous testicular mass with avascular areas of necrosis and septated fluid collections in the tunica vaginalis with features suggestive of testicular tumor. Right orchiectomy through inguinal approach was done, findings included testicular mass with pus pockets and caseous necrosis occupying the whole testis. Specimen was sent for histopathology which revealed chronic granulomatous inflammation, most likely tuberculosis, and ZN stain confirmed the diagnosis of testicular tuberculosis. In accordance with national TB guidelines, the patient had anti-TB medication for six months, and after 12-months serial follow-up, the patient had completely recovered. CLINICAL DISCUSSION Genitourinary tuberculosis is the second most common form of extrapulmonary TB after lymph node tuberculosis. 0.5 % of genitourinary TB involves the testes; On the other hand, isolated testicular TB as presented in our patient, is extremely uncommon, thus may mimic other testicular conditions including testicular tumor, so the diagnosis is challenging. It is important to accurately diagnose testicular TB and differentiate it from other scrotal pathologies especially testicular malignancy as the management is totally different. Testicular tuberculosis is diagnosed by tissue Cytology using FNAC or after an orchidectomy. It requires early, regular, full course combined anti-tuberculosis treatment. The drug treatment method uses three to four anti-tuberculosis drugs for 6-9 months. Surgical treatment is necessary if there is no response to drug treatment or in cases of abscess formation. CONCLUSION Testicular TB is a curable disease, but its diagnosis remains challenging. It is often missed owing to its non- specific symptoms. Thus, testicular TB should be suspected in patients with a notion of contagion or history of tuberculosis. Some of the radiological features are highly suggestive of testicular TB. FNAB could prevent unnecessary orchidectomy. In our case, the presentation was typically mimicking a testicular cancer and the patient underwent trans inguinal orchiectomy, and histology and ZN stain confirmed the diagnosis followed by subsequent six-month anti TB therapy.
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Affiliation(s)
| | - Charles John Nhungo
- Department of Urology, Muhimbili National Hospital, Dar es salaam, Tanzania; Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Joseph Martin Lori
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Amini Alexandre Mitamo
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Charles A Mkony
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Praxeda Ogweyo
- Department of Pathology, Muhimbili National Hospital, Dar es Salaam, Tanzania
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Suen P, Assaad M, Mishiyev D, Narula N, Xue W, Chalhoub M. Rare capture: The detection of synchronous diffuse large B-cell lymphoma and lung adenocarcinoma diagnosed by effusion cytology. Respir Med Case Rep 2023; 43:101852. [PMID: 37124057 PMCID: PMC10131125 DOI: 10.1016/j.rmcr.2023.101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/13/2023] [Indexed: 05/02/2023] Open
Abstract
The diagnosis of two primary synchronous malignancies in a single pleural effusion cytology specimen is exceedingly rare. We describe, to the best of our knowledge, the first reported case of lung adenocarcinoma and suspected relapse of Diffuse Large B-Cell Lymphoma (DLBCL) diagnosed from a solitary effusion sample.
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Affiliation(s)
- Phyllis Suen
- Department of Pulmonary and Critical Care, Northwell Health Staten Island University Hospital, Staten Island, NY, 10305, USA
- Corresponding author.
| | - Marc Assaad
- Department of Internal Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, 10305, USA
| | - Danil Mishiyev
- Department of Internal Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, 10305, USA
| | - Naureen Narula
- Department of Pulmonary and Critical Care, Northwell Health Staten Island University Hospital, Staten Island, NY, 10305, USA
| | - Wei Xue
- Department of Pathology and Laboratory Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, 10305, USA
| | - Michel Chalhoub
- Department of Pulmonary and Critical Care, Northwell Health Staten Island University Hospital, Staten Island, NY, 10305, USA
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Chaudhary N, Trehan S, Janardhan M, Khanna G. Mammary Analogue Secretory Carcinoma of Submandibular Gland: A Case Report with Review of the Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:6059-6064. [PMID: 36742691 PMCID: PMC9895156 DOI: 10.1007/s12070-021-02714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023] Open
Abstract
Secretory carcinoma (SC) is a rare salivary gland tumor and has been recently included in the fourth edition of the World Health Organization classification of head and neck tumors. To understand the histopathologic findings and clinical behavior of mammary analogue secretory carcinoma (MASC) of the submandibular gland in a 23 year old female. MASC is an intriguing and rare malignant salivary gland tumor first described in 2010. It shares histologic, immunohistochemical and genetic features with secretory carcinoma of the breast. The clinical behavior of MASC ranges from slowly growing tumors to aggressive tumors that can cause widespread metastasis. Many cases of MASC were discovered in archived cases previously classified as pleomorphic adenoma, acinic cell carcinoma, mucoepidermoid carcinoma, and adenocarcinoma. They are only a few reported in submandibular gland. MASC is a newly recognized variant of salivary gland malignancy. Further research is needed to better delineate its overall prevalence and to define an appropriate treatment algorithm for this new clinical entity.
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Affiliation(s)
- Neena Chaudhary
- Department of Otorhinolaryngology and Head and Neck Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sandeep Trehan
- Department of Otorhinolaryngology and Head and Neck Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Meghana Janardhan
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Geetika Khanna
- Department of Otorhinolaryngology and Head and Neck Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Kitagawa K, Mitoro A, Tomooka F, Asada S, Fujinaga Y, Nishimura N, Kaji K, Kawaratani H, Akahane T, Ozutsumi T, Kaneko M, Fujimoto Y, Tsuji Y, Enomoto M, Takeda S, Murata K, Kubo T, Iwai S, Koizumi A, Shibamoto A, Suzuki J, Tanaka M, Matsuda T, Yorioka N, Masuda H, Takami M, Yoshiji H. Diagnostic yield of liquid-based cytology in serial pancreatic juice aspiration cytological examination. DEN OPEN 2022; 3:e177. [PMID: 36304177 PMCID: PMC9593257 DOI: 10.1002/deo2.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/25/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
Objectives Serial pancreatic juice aspiration cytological examination (SPACE) via endoscopic retrograde cholangiopancreatography is a useful diagnostic method for early‐stage pancreatic cancer, such as carcinoma in situ that are difficult to diagnose by endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA). However, the diagnostic accuracy of SPACE is low, which is attributed to problems regarding specimen treatment. Hence, we evaluated the diagnostic efficacy of liquid‐based cytology (LBC) in pancreatic juice cytology for pancreatic cancer. Methods We retrospectively analyzed 24 patients with suspected pancreatic cancer that was difficult to diagnose by endoscopic ultrasound‐guided fine needle aspiration who underwent SPACE using LBC between April 2017 and April 2021. Results The most common reason for performing SPACE was localized stenosis of the main pancreatic duct without a mass. Eleven patients were diagnosed with malignancy after surgical resection, nine of whom had pancreatic ductal adenocarcinoma. Ten patients were diagnosed as benign after a follow‐up of more than 1 year. The nine cases of malignancy were diagnosed before surgical resection by SPACE using LBC, with a sensitivity of 81.8% and specificity of 100%. The overall diagnostic accuracy was 91.7%. A total of 152 LBC examinations were performed via SPACE, with an adequate sample collection rate of 88.9%. No adverse events, including acute pancreatitis, occurred after endoscopic retrograde cholangiopancreatography. Conclusion SPACE with LBC offers good diagnostic efficacy in patients with pancreatic cancer that is difficult to diagnose by endoscopic ultrasound‐guided fine needle aspiration.
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Affiliation(s)
- Koh Kitagawa
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Akira Mitoro
- Division of EndoscopyNara Medical UniversityNaraJapan
| | | | - Shohei Asada
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | | | - Kosuke Kaji
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | - Takemi Akahane
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | - Miki Kaneko
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Yuki Fujimoto
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Yuki Tsuji
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | - Soichi Takeda
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Koji Murata
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Takahiro Kubo
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Satoshi Iwai
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | | | - Junya Suzuki
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Misako Tanaka
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Takuya Matsuda
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | - Hiroyuki Masuda
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | - Hitoshi Yoshiji
- Department of GastroenterologyNara Medical UniversityNaraJapan
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5
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Mukhida S, Vyawahare CR, Mirza SB, Gandham NR, Khan S, Kannuri S, Bhaumi S. Role of GeneXpert MTB/RIF assay for the diagnosis of cervical lymph node tuberculosis and rifampicin resistance. Tzu Chi Med J 2022; 34:418-422. [PMID: 36578636 PMCID: PMC9791852 DOI: 10.4103/tcmj.tcmj_86_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/03/2022] [Accepted: 07/20/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives Tuberculosis (TB) of lymph node (TB lymphadenitis) is one of the most common forms of extrapulmonary TB (EPTB) whose diagnosis is critically challenging. Although new diagnostic methods have been developed, especially in patients without a history of TB, the cervical tuberculous lymphadenitis diagnosis is still elusive. This study assessed the applicability of GeneXpert in early diagnosis of EPTB, especially cervical lymphadenopathy. Materials and Methods The study was conducted in a tertiary care hospital from January 2018 to December 2020 at the department of microbiology. All the samples of cervical lymph node tissue and lymph node aspirate were followed as per the routine protocol for mycobacterial identification. The sample was divided into two parts: one was used for the new molecular-based GeneXpert MTB/RIF assay and the second one was tested by direct and concentrated acid-fast bacilli microscopy by Z-N staining and culture for the detection of MTB. Results Among the 145 samples tested, the GeneXpert detected the DNA of MTB in 89 samples (61.37%), whereas the culture test was positive in 42 (28.93%) specimens. GeneXpert also detected 7 rifampicin resistance cases. GeneXpert sensitivity and specificity results were assessed according to culture results. The sensitivity and specificity of the GeneXpert assay were 85.71% and 48.54%, respectively. Conclusion GeneXpert MTB/RIF should be used in conjunction with clinical presentation and other molecular investigation in nonrespiratory specimens.
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Affiliation(s)
- Sahjid Mukhida
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre (D. Y. Patil Vidyapeeth), Pune, Maharashtra, India
| | - Chanda R. Vyawahare
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre (D. Y. Patil Vidyapeeth), Pune, Maharashtra, India,Address for correspondence: Dr. Chanda R. Vyawahare, Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre (D. Y. Patil Vidyapeeth), Pimpri, Pune - 411 018, Maharashtra, India. E-mail:
| | - Shahzad Beg Mirza
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre (D. Y. Patil Vidyapeeth), Pune, Maharashtra, India
| | - Nageswari R. Gandham
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre (D. Y. Patil Vidyapeeth), Pune, Maharashtra, India
| | - Sameena Khan
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre (D. Y. Patil Vidyapeeth), Pune, Maharashtra, India
| | - Sriram Kannuri
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre (D. Y. Patil Vidyapeeth), Pune, Maharashtra, India
| | - Shalini Bhaumi
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre (D. Y. Patil Vidyapeeth), Pune, Maharashtra, India
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Salih AM, Abdulla BA, Abdullah AM, Kakamad FH, Hassan ZH, Ali RK, Kakamad SH. Osteoclast-like giant cell tumor of the parotid gland; a case report with literature review. Ann Med Surg (Lond) 2022; 77:103509. [PMID: 35432991 PMCID: PMC9006646 DOI: 10.1016/j.amsu.2022.103509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Abdulwahid M. Salih
- College of Medicine, University of Sulaimani, Sulaimani, Iraq
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | - Berwn A. Abdulla
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Ari M. Abdullah
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
- Sulaimani Teaching Hospital, Sulaimani, Kurdistan, Iraq
| | - Fahmi H. Kakamad
- College of Medicine, University of Sulaimani, Sulaimani, Iraq
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
- Corresponding author. Doctor City, Building 11, Apartment 50, Sulaimani, Iraq.
| | - Zana H. Hassan
- College of Dentistry, University of Sulaimani, Sulaimani, Iraq
| | | | - Suhaib H. Kakamad
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
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Uno K, Iyoshi S, Yoshihara M, Kitami K, Mogi K, Fujimoto H, Sugiyama M, Koya Y, Yamakita Y, Nawa A, Kanayama T, Tomita H, Enomoto A, Kajiyama H. Metastatic Voyage of Ovarian Cancer Cells in Ascites with the Assistance of Various Cellular Components. Int J Mol Sci 2022; 23:4383. [PMID: 35457198 PMCID: PMC9031612 DOI: 10.3390/ijms23084383] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 12/16/2022] Open
Abstract
Epithelial ovarian cancer (EOC) is the most lethal gynecologic malignancy and has a unique metastatic route using ascites, known as the transcoelomic root. However, studies on ascites and contained cellular components have not yet been sufficiently clarified. In this review, we focus on the significance of accumulating ascites, contained EOC cells in the form of spheroids, and interaction with non-malignant host cells. To become resistant against anoikis, EOC cells form spheroids in ascites, where epithelial-to-mesenchymal transition stimulated by transforming growth factor-β can be a key pathway. As spheroids form, EOC cells are also gaining the ability to attach and invade the peritoneum to induce intraperitoneal metastasis, as well as resistance to conventional chemotherapy. Recently, accumulating evidence suggests that EOC spheroids in ascites are composed of not only cancer cells, but also non-malignant cells existing with higher abundance than EOC cells in ascites, including macrophages, mesothelial cells, and lymphocytes. Moreover, hetero-cellular spheroids are demonstrated to form more aggregated spheroids and have higher adhesion ability for the mesothelial layer. To improve the poor prognosis, we need to elucidate the mechanisms of spheroid formation and interactions with non-malignant cells in ascites that are a unique tumor microenvironment for EOC.
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Affiliation(s)
- Kaname Uno
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, 223-62 Lund, Sweden
| | - Shohei Iyoshi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
- Spemann Graduate School of Biology and Medicine, University of Freiburg, 79104 Freiburg, Germany
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
| | - Kazuhisa Kitami
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
| | - Kazumasa Mogi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
| | - Hiroki Fujimoto
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
- Discipline of Obstetrics and Gynecology, Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia
| | - Mai Sugiyama
- Bell Research Center, Department of Obstetrics and Gynecology Collaborative Research, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (M.S.); (Y.K.); (A.N.)
| | - Yoshihiro Koya
- Bell Research Center, Department of Obstetrics and Gynecology Collaborative Research, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (M.S.); (Y.K.); (A.N.)
| | - Yoshihiko Yamakita
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
- Bell Research Center, Department of Obstetrics and Gynecology Collaborative Research, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (M.S.); (Y.K.); (A.N.)
| | - Akihiro Nawa
- Bell Research Center, Department of Obstetrics and Gynecology Collaborative Research, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (M.S.); (Y.K.); (A.N.)
| | - Tomohiro Kanayama
- Department of Tumor Pathology, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan; (T.K.); (H.T.)
| | - Hiroyuki Tomita
- Department of Tumor Pathology, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan; (T.K.); (H.T.)
| | - Atsushi Enomoto
- Department of Pathology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan;
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
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Tarmohamed M, Mremi A, Mkwizu E, Paschal J, Sadiq A, Msuya D. Isolated gallbladder tuberculosis in an 84-year old man: A rare case report. Int J Surg Case Rep 2021; 87:106471. [PMID: 34628333 PMCID: PMC8515389 DOI: 10.1016/j.ijscr.2021.106471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Isolated gallbladder tuberculosis is extremely rare even in endemic regions posing diagnostic challenges as the presentation mimics other gallbladder diseases such as cholecystitis and gallbladder carcinoma. Preoperative suspicion index is negligible with most cases being diagnosed postoperatively from resected specimen. CASE PRESENTATION Herein, we report an elderly man who presented with jaundice, and was clinically diagnosed with gallbladder carcinoma. DISCUSSION Histopathology of resected gallbladder revealed gallbladder tuberculosis. No features of tuberculous infection were found elsewhere. CONCLUSION Healthcare providers should have a high index of suspicion particularly for patients in endemic areas presenting with cholecystitis to obtain a pre-operative diagnosis.
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Affiliation(s)
- Murad Tarmohamed
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Kilimanjaro, Tanzania; Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania.
| | - Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Kilimanjaro, Tanzania; Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania
| | - Elifuraha Mkwizu
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Kilimanjaro, Tanzania; Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania
| | - Joel Paschal
- Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania
| | - Adnan Sadiq
- Department of Radiology, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Kilimanjaro, Tanzania; Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania
| | - David Msuya
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Kilimanjaro, Tanzania; Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania
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Zhu D, Zhu L, Wu J, Wu L, Li J, Luo H, Yang K, Liu G, Quo X, Dong F, Xu J. Metanephric adenoma: association between the imaging features of contrast-enhanced ultrasound and clinicopathological characteristics. Gland Surg 2021; 10:2490-2499. [PMID: 34527561 DOI: 10.21037/gs-21-437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/12/2021] [Indexed: 11/06/2022]
Abstract
Background This study aimed to improve the understanding of metanephric adenoma (MA) by retrospective analysis of contrast-enhanced ultrasound (CEUS) findings and clinicopathological characteristics of MAs. Methods Gray-scale ultrasound (US) and CEUS findings of 7 adult MA patients, confirmed by postoperative pathology, were summarized via collection of clinicopathological and ultrasonographic imaging data, including tumor location, size, echo intensity, color flow, presence or absence of calcification, and liquefactive necrosis, contrast-enhanced pattern, enhancement characteristics, and contrast wash-out compared with adjacent parenchyma, and the presence or absence of a pseudocapsule. Histopathological analyses, including hematoxylin and eosin (HE) and immunohistochemical (IHC) staining, were conducted with the EnVision method. Results All 7 participants were female, aged 29-73 years (mean age, 54 years), with flank pain (3/7). All tumors were solid (7/7) with sizes of 2.0-5.0 cm (mean diameter, 3.07 cm), including 4 in the left kidney, 3 in the right kidney, 2 in the renal pelvis, and 5 in the renal parenchyma. On the gray-scale US, MA was shown as hypoechoic (4/7), slightly hyperechoic (2/7), isoechoic (1/7), and with a defined border. The morphology was regular and rounded (7/7), internal echogenicity was homogeneous (5/7), and no calcification was seen (7/7). The CEUS showed clear boundaries (7/7), homogeneous isodensity (5/7), with calcification (0/7), necrosis (2/11), heterogeneous hyperattenuation (2/7), pseudocapsule (2/7), and medullary phase fast wash-out (7/7). The surgical methods were radical nephrectomy (4/7) and partial nephrectomy (3/7). The duration of follow-up period for all participants was 3-74 months, and no local or distant recurrences were found. The IHC staining showed that most tumor cells were positive for WT1, cytokeratins AE1/AE3, vimentin, and CD57, and exhibited focal positivity for CK7, while negative for CD10, AMACR, and CK720. The proliferative index (Ki-67) was 2-3%. Conclusions On gray-scale US, MA appears as a solid nodule with a well-defined boundary, regular morphology, and homogeneous echogenicity; CEUS shows slow progression and slightly lower homogeneous enhancement and fast wash-out in the medullary phase. These findings may provide insight into the progression of MA and aid in the development of diagnostic and therapeutic strategies.
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Affiliation(s)
- Dongmei Zhu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China.,Department of Ultrasound, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Lin Zhu
- Department of Ultrasound, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China.,Department of Geriatric General Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ji Wu
- Department of Urology Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Linghu Wu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
| | - Jian Li
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
| | - Hao Luo
- Department of Ultrasound, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Keen Yang
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
| | - Gang Liu
- Department of Ultrasound, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaoguang Quo
- Department of Pathology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Fajin Dong
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
| | - Jinfeng Xu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
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10
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Hurkmans DP, Tamminga M, van Es B, Peters T, Karman W, van Wijck RTA, van der Spek PJ, Tauber T, Los M, van Schetsen A, Vu T, Hiltermann TJN, Schuuring E, Aerts JGJV, Chen S, Groen HJM. Molecular data show conserved DNA locations distinguishing lung cancer subtypes and regulation of immune genes. Lung Cancer 2020; 146:341-349. [PMID: 32645666 DOI: 10.1016/j.lungcan.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Non-small-cell lung cancer exhibits a range of transcriptional and epigenetic patterns that not only define distinct phenotypes, but may also govern immune related genes, which have a major impact on survival. METHODS We used open-source RNA expression and DNA methylation data of the Cancer Genome Atlas with matched non-cancerous tissue to evaluate whether these pretreatment molecular patterns also influenced genes related to the immune system and overall survival. RESULTS The distinction between lung adenocarcinoma and squamous cell carcinoma are determined by 1083 conserved methylation loci and RNA expression of 203 genes which differ for >80 % of patients between the two subtypes. Using the RNA expression profiles of 6 genes, more than 95 % of patients could be correctly classified as having either adeno or squamous cell lung cancer. Comparing tumor tissue with matched normal tissue, no differences in RNA expression were found for costimulatory and co-inhibitory genes, nor genes involved in cytokine release. However, genes involved in antigen presentation had a lower expression and a wider distribution in tumor tissue. DISCUSSION Only a small number of genes, influenced by DNA methylation, determine the lung cancer subtype. The antigen presentation of cancer cells is dysfunctional, while other T cell immune functions appear to remain intact.
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Affiliation(s)
- Daan P Hurkmans
- Erasmus University Medical Center, Departments of Pulmonary Diseases, Internal Medicine and Pathology, Bioinformatic Unit, Dr. Molewaterplein 40, 3015 GD, the Netherlands.
| | - Menno Tamminga
- University of Groningen and University Medical Center Groningen, Departments of Pulmonary Diseases and Pathology and Medical Biology, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - Bram van Es
- Otravo B.V., Suikersilo-West 41, 1165 MP, Amsterdam-Halfweg, the Netherlands.
| | - Tom Peters
- PricewaterhouseCoopers Advisory NV, Thomas R. Malthusstraat 5, 1066 JR, Amsterdam, the Netherlands.
| | - Wouter Karman
- PricewaterhouseCoopers Advisory NV, Thomas R. Malthusstraat 5, 1066 JR, Amsterdam, the Netherlands.
| | - Rogier T A van Wijck
- Erasmus University Medical Center, Departments of Pulmonary Diseases, Internal Medicine and Pathology, Bioinformatic Unit, Dr. Molewaterplein 40, 3015 GD, the Netherlands.
| | - Peter J van der Spek
- Erasmus University Medical Center, Departments of Pulmonary Diseases, Internal Medicine and Pathology, Bioinformatic Unit, Dr. Molewaterplein 40, 3015 GD, the Netherlands.
| | - Tjebbe Tauber
- ABN-AMRO, Foppingadreef 22, 1102 BS Amsterdam, the Netherlands.
| | - Maureen Los
- PricewaterhouseCoopers Advisory NV, Thomas R. Malthusstraat 5, 1066 JR, Amsterdam, the Netherlands.
| | - Anouk van Schetsen
- PricewaterhouseCoopers Advisory NV, Thomas R. Malthusstraat 5, 1066 JR, Amsterdam, the Netherlands.
| | - Thu Vu
- PricewaterhouseCoopers Advisory NV, Thomas R. Malthusstraat 5, 1066 JR, Amsterdam, the Netherlands.
| | - T Jeroen N Hiltermann
- University of Groningen and University Medical Center Groningen, Departments of Pulmonary Diseases and Pathology and Medical Biology, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - Ed Schuuring
- University of Groningen and University Medical Center Groningen, Departments of Pulmonary Diseases and Pathology and Medical Biology, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - Joachim G J V Aerts
- Erasmus University Medical Center, Departments of Pulmonary Diseases, Internal Medicine and Pathology, Bioinformatic Unit, Dr. Molewaterplein 40, 3015 GD, the Netherlands.
| | - Sissy Chen
- PricewaterhouseCoopers Advisory NV, Thomas R. Malthusstraat 5, 1066 JR, Amsterdam, the Netherlands.
| | - Harry J M Groen
- University of Groningen and University Medical Center Groningen, Departments of Pulmonary Diseases and Pathology and Medical Biology, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
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11
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Bennani K, Khattabi A, Akrim M, Mahtar M, Benmansour N, Essakalli Hossyni L, Karkouri M, Cherradi N, El Messaoudi MD, Lahlou O, Cherkaoui I, Khader Y, Maaroufi A, Ottmani SE. Evaluation of the Yield of Histopathology in the Diagnosis of Lymph Node Tuberculosis in Morocco, 2017: Cross-Sectional Study. JMIR Public Health Surveill 2019; 5:e14252. [PMID: 31599732 PMCID: PMC6819008 DOI: 10.2196/14252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/24/2019] [Accepted: 08/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The frequency of occurrence of extrapulmonary tuberculosis (EPTB) has been increasing globally over the last two decades. In Morocco, EPTB cases account for 46% of the patients reported with a new episode of tuberculosis (TB). Lymph node TB (LNTB) is the most common form of EPTB. In line with the guidelines of the National TB Program, the diagnosis is mainly based on clinical evidence, including histopathology. OBJECTIVE This study aimed to evaluate the yield of histopathology testing in the diagnosis of LNTB. METHODS This cross-sectional, prospective study was conducted among patients with cervical lymph node who were enrolled in the study from November 2016 to May 2017 in three regions of Morocco. We compared the outcomes of histopathological testing with those of bacteriology. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of histopathology testing were calculated. Culture and Xpert tests were used as the gold standard Laboratoty Testing. RESULTS A total of 262 patients were enrolled in this study. The Se, Sp, PPV, and NPV of histopathology testing were 95.6% (129/135), 64.6% (82/127), 74.1% (129/174), and 93.2% (82/88), respectively, in the presence of granuloma with or without caseous necrosis and were 84.4% (114/135), 74.8% (95/127), 78.1% (114/146), and 81.9% (95/116), respectively, in the presence of granuloma with caseous necrosis. The granuloma with caseous necrosis was associated with increased PPV and Sp of histopathology testing (P<.05). CONCLUSIONS The presence of the granuloma with caseous necrosis in the histopathological examination had significantly improved the yield of histopathology testing for the diagnosis of LNTB. The findings recommend to maintain histopathology testing in establishing the LNTB diagnosis and to explore other techniques to improve it.
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Affiliation(s)
- Kenza Bennani
- Direction of Epidemiology and Diseases Control, Ministry of Health, Rabat, Morocco.,Morocco Field Epidemiology Training Program, Rabat, Morocco
| | - Asmae Khattabi
- Morocco Field Epidemiology Training Program, Rabat, Morocco.,Ecole nationale de Santé publique, Rabat, Morocco
| | - Mohammed Akrim
- Morocco Field Epidemiology Training Program, Rabat, Morocco.,Ecole nationale de Santé publique, Rabat, Morocco
| | - Mohamed Mahtar
- Otorhinolaryngology Department, Hôpital du 20 Aôut, Casablanca, Morocco
| | | | | | - Mehdi Karkouri
- Histopathology Laboratory, Hôpital Ibn Rochd, Casablanca, Morocco
| | - Nadia Cherradi
- Histopathology Laboratory, Hôpital des Spécilaités, Rabat, Morocco
| | | | - Ouafae Lahlou
- Tuberculosis National Reference Laboratory, Institut national d'Hygiène, Rabat, Morocco
| | - Imad Cherkaoui
- Direction of Epidemiology and Diseases Control, Ministry of Health, Rabat, Morocco
| | - Yousef Khader
- Department of Public Health, Jordan University of Science and Technology, Amman, Jordan
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12
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Ng DL, Balassanian R. Granulomatous inflammation diagnosed by fine-needle aspiration biopsy. J Am Soc Cytopathol 2019; 8:317-323. [PMID: 31636024 DOI: 10.1016/j.jasc.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Fine-needle aspiration biopsy (FNAB) is a minimally invasive biopsy technique and an important tool for diagnosing infectious diseases. Rapid onsite evaluation allows for triage for ancillary testing, including microbiologic cultures. We aimed to determine the etiology of granulomatous inflammation diagnosed by FNAB by correlating with culture results and clinical history. MATERIALS AND METHODS A 16-year retrospective review of cases diagnosed as "granulomatous inflammation" or "granuloma" was performed at the Departments of Pathology at the Zuckerberg San Francisco General Hospital and Trauma Center and University of California, San Francisco. RESULTS A total of 339 FNABs diagnosed as granulomatous inflammation were identified. Necrotizing granulomatous inflammation was present in 117 of 339 cases (34.5%) and non-necrotizing granulomatous inflammation was present in 222 of 339 cases (65.5%). A pathogen was detected in 100 of 339 (29.5%) FNABs by either cytomorphology, special stains, or culture, or a combination of more than one test. Of the 100 pathogen-positive cases, necrotizing granulomatous inflammation was seen in 50 of 100 (50%) and non-necrotizing granulomatous inflammation was identified in 50 of 100 (50%) cases. Culture results were available in 239 cases and positive in 70 (29%). Positive culture results included 40 of 239 (17%) cases with Mycobacterium tuberculosis complex, 15 of 239 (6.3%) with atypical mycobacterial species, 6 of 239 (3%) with Coccidioides immitis, 2 of 239 (<1%) with Histoplasma capsulatum, and 2 of 239 with Talaromyces marneffei (<1%). CONCLUSIONS Granulomatous inflammation is a nonspecific finding and suggests a broad range of disease processes, ranging from infection to malignancy. FNAB is an excellent minimally invasive technique that allows for ancillary testing critical for definitive diagnosis.
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Affiliation(s)
- Dianna L Ng
- Department of Pathology, University of California, San Francisco, California.
| | - Ronald Balassanian
- Department of Pathology, University of California, San Francisco, California
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13
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Muthu V, Gupta N, Dhooria S, Sehgal IS, Prasad KT, Aggarwal AN, Agarwal R. Role of cytomorphology in differentiating sarcoidosis and tuberculosis in subjects undergoing endobronchial ultrasound-guided transbronchial needle aspiration. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2019; 36:209-216. [PMID: 32476956 DOI: 10.36141/svdld.v36i3.8175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/19/2019] [Indexed: 12/25/2022]
Abstract
Background The role of cytomorphology in differentiating sarcoidosis from tuberculosis is not fully elucidated. Herein, we evaluate the utility of cytological features in differentiating between these two diseases in subjects undergoing endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). Methods Retrospective analysis of subjects who underwent EBUS-TBNA and had a final diagnosis of sarcoidosis or tuberculosis. The final diagnosis was based on the clinicoradiological features, microbiology and clinical course during follow-up (including response to treatment) at six months. A cytologist blinded to the clinical details and microbiology examined the aspirates. The primary outcome was the diagnostic accuracy of cytologist's impression to diagnose sarcoidosis as compared to the final diagnosis. Results 179 (145 sarcoidosis, 34 tuberculosis) subjects were included. Granuloma was identified in 135 (75.4%) subjects; amongst these, the cytologist made a correct diagnosis in 62.2% cases, misdiagnosed 28.9% cases, and in 8.9% cases differentiating sarcoidosis from tuberculosis was not possible. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the cytologist in diagnosing sarcoidosis was 62%, 64%, 90%, and 25%, respectively. The identification of a non-necrotic granuloma, along with a negative TST and the lack of endosonographic features favouring tuberculosis (heterogeneous echotexture and coagulation necrosis sign), provided the best specificity (97%) and PPV (99%) to diagnose sarcoidosis. Conclusion Sarcoidosis cannot be reliably differentiated from tuberculosis based on cytomorphology alone. A combination of clinical features, endosonography, cytology and microbiology is required for accurate diagnosis.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, and.,Authors VM and NG contributed equally to the manuscript and are the joint first authors
| | - Nalini Gupta
- Department of Cytology and Gynaecological Pathology; Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.,Authors VM and NG contributed equally to the manuscript and are the joint first authors
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14
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Selepe MM, van Wyk AC, Hoek KGP, Prince Y, van Helden PD, Warren RM, Wright CA. Papanicolaou induced fluorescence, Ziehl-Neelsen and Auramine O stains on lymph node fine needle aspiration biopsy specimens from children: A comparative study. Diagn Cytopathol 2018; 46:589-592. [PMID: 29722172 DOI: 10.1002/dc.23956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/17/2018] [Accepted: 04/09/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The rapid diagnosis of extrapulmonary tuberculosis in children remains challenging. The presence of enlarged lymph nodes provides an opportunity to obtain diagnostic material through fine needle aspiration biopsy (FNAB). Mycobacterial culture, traditionally the reference standard, has a slow turnaround time and PCR-based methods are not widely available in developing countries. Direct visualization of mycobacteria on microscopy can be a rapid method to confirm the diagnosis. This study compared three staining methods to visualize mycobacteria. METHODS Hundred FNAB specimens from persistently enlarged lymph nodes in children, clinically suspicious for tuberculosis, were evaluated for the presence of mycobacteria by three staining methods: Papanicolaou induced fluorescence (PIF) and Auramine O staining using fluorescence microscopy and Ziehl-Neelsen (ZN) staining using conventional light microscopy. These methods were evaluated against mycobacterial culture. RESULTS PIF positivity was 30%, with 38% and 48% for Auramine O and ZN respectively. The combined ZN/PIF positivity was 56%. The highest diagnostic accuracy (73%) was demonstrated by ZN alone and in combination with PIF, with PIF alone showing the lowest (49%) accuracy. Although the combined test showed the highest sensitivity, it had the lowest specificity, while ZN was significantly more sensitive than both other staining modalities. No statistical difference in specificity was seen among the tests. CONCLUSION This study suggests that Auramine O staining on previously ZN stained slides does not significantly improve diagnostic accuracy. While currently widely available methods of direct visualization of mycobacteria suffer from low sensitivity, the ZN stain remains a useful diagnostic test, particularly in resource-constrained countries.
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Affiliation(s)
- Malesiba Mampotoko Selepe
- Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Abraham Christoffel van Wyk
- Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Kim Gilberte Pauline Hoek
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,PathCare Reference Laboratory, South Africa
| | - Yvonne Prince
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Paul David van Helden
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Robin Mark Warren
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Colleen Anne Wright
- Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Lancet Laboratories, South Africa
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15
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16
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Successful Introduction of Fine Needle Aspiration Biopsy for Diagnosis of Pediatric Lymphadenopathy. Pediatr Infect Dis J 2017; 36:811-814. [PMID: 28030523 DOI: 10.1097/inf.0000000000001521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Accurate and rapid diagnosis of extrapulmonary nodal tuberculosis in children is of paramount importance. This retrospective study performed at Tygerberg Hospital using data from the laboratory records between January 1, 2004 and June 30, 2014 demonstrates how since the introduction laboratory-run FNAB service; fine needle aspiration biopsy has become an acceptable and routine diagnostic procedure for triage of pediatric lymphadenopathy.
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17
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Abstract
Tuberculous lymphadenitis is the most common extrapulmonary manifestation of disseminated tuberculosis (TB). It is considered to be the local manifestation of the systemic disease that has disseminated to local lymph nodes, but a high index of suspicion is needed for the diagnosis, because there are several infectious and noninfectious diseases that can mimic the same clinical picture. In recent years, different diagnostic methods have been introduced, including fine-needle aspiration cytology, which has emerged as a simple outpatient diagnostic procedure that replaced the complete excisional node biopsy, and a number of molecular methods which have greatly improved diagnostic accuracy. This chapter covers the most actual knowledge in terms of epidemiology, clinical manifestations, pathogenesis, and treatment and emphasizes current trends in diagnosis of tuberculous lymphadenitis. TB parotid gland involvement is extremely rare, even in countries in which TB is endemic. Because of the clinical similarity, parotid malignancy and other forms of parotid inflammatory disease always take priority over the rarely encountered TB parotitis when it comes to differential diagnosis. As a result, clinicians often fail to make a timely diagnosis of TB parotitis when facing a patient with a slowly growing parotid lump. This chapter highlights the most important features of this uncommon disease.
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18
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Field AS, Geddie WR. Role of fine needle aspiration biopsy cytology in the diagnosis of infections. Diagn Cytopathol 2016; 44:1024-1038. [PMID: 27555237 DOI: 10.1002/dc.23568] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/04/2016] [Indexed: 12/11/2022]
Abstract
The role of fine needle aspiration biopsy (FNAB) cytology in diagnosing infections has expanded due to the increase in the number of immune compromised patients and the increasing role of FNAB in the developing world where infection is a major cause of illness. FNAB has become the first procedural test in cases where the clinical and imaging findings suggest an infectious lesion or where there is a differential diagnosis of infection or metastatic or primary tumor. This applies to FNAB of palpable or image directed or deep seated lesions accessed by EUS and EBUS. This article details a recommended approach and technique for FNAB of infectious lesions, and discusses the role of rapid on site evaluation and the application of ancillary testing including the rapidly expanding array of molecular tests based on FNAB material. The utility of recognizing suppurative and granulomatous infectious patterns in FNAB direct smears, and the specific cytomorphological features on routine Papanicolaou and Giemsa stains and on special stains of FNAB smears is described for a large number of bacterial, fungal, viral, parasitic, and protozoan infections. The role of cytopathologists is to now train cytopathologists in sufficient numbers to provide FNAB services, teach trainee cytopathologists and cytotechnologists, and to encourage our clinical colleagues to use FNAB in the diagnosis of infections and other lesions to the benefit of patients and the medical system. Diagn. Cytopathol. 2016;44:1024-1038. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Andrew S Field
- Department of Anatomical Pathology, St. Vincent's Hospital and Notre Dame University Medical School, Sydney, Australia
| | - William R Geddie
- Department of Anatomical Pathology, University Health Network, Toronto, Canada
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19
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Bholla M, Kapalata N, Masika E, Chande H, Jugheli L, Sasamalo M, Glass TR, Beck HP, Reither K. Evaluation of Xpert® MTB/RIF and Ustar EasyNAT™ TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania: a prospective descriptive study. BMC Infect Dis 2016; 16:246. [PMID: 27268404 PMCID: PMC4895953 DOI: 10.1186/s12879-016-1578-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 05/20/2016] [Indexed: 01/11/2023] Open
Abstract
Background Fine needle aspiration biopsy has become a standard approach for diagnosis of peripheral tuberculous lymphadenitis. The aim of this study was to compare the performance of Xpert MTB/RIF and Ustar EasyNAT TB IAD nucleic acid amplification assays, against acid-fast bacilli microscopy, cytology and mycobacterial culture for the diagnosis of TB lymphadenitis in children from a TB-endemic setting in Tanzania. Methods Children of 8 weeks to 16 years of age, suspected of having TB lymphadenitis, were recruited at a district hospital in Tanzania. Fine needle aspirates of lymph nodes were analysed using acid-fast bacilli microscopy, liquid TB culture, cytology, Xpert MTB/RIF and EasyNAT. Latent class analysis and comparison against a composite reference standard comprising “culture and/or cytology” was done, to assess the performance of Xpert MTB/RIF and EasyNAT for the diagnosis of TB lymphadenitis. Results Seventy-nine children were recruited; 4 were excluded from analysis. Against a composite reference standard of culture and/or cytology, Xpert MTB/RIF and EasyNAT had a sensitivity and specificity of 58 % and 93 %; and 19 % and 100 % respectively. Relative to latent class definitions, cytology had a sensitivity of 100 % and specificity of 94.7 %. Conclusions Combining clinical assessment, cytology and Xpert MTB/RIF may allow for a rapid and accurate diagnosis of childhood TB lymphadenitis. Larger diagnostic evaluation studies are recommended to validate these findings and on Xpert MTB/RIF to assess its use as a solitary initial test for TB lymphadenitis in children.
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Affiliation(s)
- Maira Bholla
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, 4001, Basel, Switzerland. .,Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania.
| | - Neema Kapalata
- National TB and Leprosy Clinic, Temeke District Hospital, P.O. Box 45232, Dar es Salaam, Tanzania
| | - Edward Masika
- National TB and Leprosy Clinic, Temeke District Hospital, P.O. Box 45232, Dar es Salaam, Tanzania
| | - Hassan Chande
- Department of Histopathology, Muhimbili University of Health and Allied Sciences, P.O. Box 65000, Dar es Salaam, Tanzania.,The Aga Khan Hospital, P.O. Box 2289, Dar es Salaam, Tanzania
| | - Levan Jugheli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland.,Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania
| | | | - Tracy R Glass
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Hans-Peter Beck
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland.,Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania
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20
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Michelow P, Omar T, Field A, Wright C. The cytopathology of mycobacterial infection. Diagn Cytopathol 2016; 44:255-62. [PMID: 26800030 DOI: 10.1002/dc.23410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/24/2015] [Indexed: 02/01/2023]
Abstract
Mycobacterial infection, tuberculosis (TB) in particular, remains one of the world's deadliest communicable diseases in adults and particularly in children, in low and middle income countries. The combination of human immunodeficiency virus (HIV) and TB is often lethal with TB accounting for 25% of deaths in the HIV population. One of the cornerstones for reducing the TB epidemic is early case detection using high quality diagnostic techniques. Cytology, especially fine needle aspiration biopsy (FNAB) is able to diagnose mycobacterial infection in a rapid and cost-effective manner without requiring surgery, thus allowing appropriate management to be quickly instituted. Confirmatory ancillary tests can effectively be performed on cytologic material. In this review, the pertinent cytomorphology of mycobacterial infection in various exfoliative and FNAB specimens is presented, in both immunocompetent and immunosuppressed patients. In the immunosuppressed, the typical cytomorphology of caseating granulomatous inflammation may not be seen but suppurative necrotic inflammation, mycobacterial spindle pseudotumour or a specimen comprised entirely of necrosis may be seen instead. This review includes discussion of currently available ancillary tests that can be performed on cytologic specimens.
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Affiliation(s)
- Pamela Michelow
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Tanvier Omar
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Andrew Field
- Department of Anatomical Pathology, St Vincent's Hospital, and Notre Dame University Medical School, Sydney, Australia
| | - Colleen Wright
- Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town and National Health Laboratory Service, Port Elizabeth, South Africa
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21
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Tadesse M, Abebe G, Abdissa K, Aragaw D, Abdella K, Bekele A, Bezabih M, Apers L, de Jong BC, Rigouts L. GeneXpert MTB/RIF Assay for the Diagnosis of Tuberculous Lymphadenitis on Concentrated Fine Needle Aspirates in High Tuberculosis Burden Settings. PLoS One 2015; 10:e0137471. [PMID: 26366871 PMCID: PMC4569183 DOI: 10.1371/journal.pone.0137471] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 08/17/2015] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The diagnosis of tuberculous lymphadenitis (TBL) remains challenging. The routinely used methods (cytology and smear microscopy) have sub-optimal sensitivity. Recently, WHO recommends GeneXpert to be used as the initial diagnostic test in patients suspected of having extra-pulmonary tuberculosis (EPTB). However, this was a conditional recommendation due to very low-quality evidence available and more studies are needed. In this study we evaluated the performance of Xpert for the diagnosis of TBL on concentrated fine needle aspirates (FNA) in Southwest Ethiopia. METHODS FNA was collected from presumptive TBL cases. Two smears were prepared from each aspirate and processed for cytology and conventional microscopy. The remaining aspirate was treated with N-acetyl-L-cysteine-NaOH and centrifuged for 15minutes at 3000g. The concentrated sediment was used for culture and Xpert test. Capilia TB-Neo test was used to differentiate M. tuberculosis complex (MTBC) from non-tuberculous mycobacteria (NTM). Composite bacteriological methods (culture and/or smear microscopy) were considered as a reference standard. RESULT Out of 143 enrolled suspects, 64.3% (92/143) were confirmed TBL cases by the composite reference standard (CRS). Xpert detected M. tuberculosis complex (MTBC) in 60.1% (86/143) of the presumptive TBL cases. The sensitivity of Xpert compared to CRS was 87.8% [95% CI: 81.0-94.5] and specificity 91.1% [95% CI: 82.8-99.4]. The sensitivity was 27.8% for smear microscopy and 80% for cytology compared to CRS. Cytology showed the lowest specificity (57.8%). Xpert was positive in 4 out of 45 culture- and smear-negative cases. Among 47 cytomorphologically non-TBL cases, 15 were positive on Xpert. More than half of Xpert-positive cases were in the range of very low cut-off threshold values (28 CONCLUSION Xpert test showed a high sensitivity and specificity for the diagnosis of TBL on concentrated FNA samples. In addition, Xpert offered rapid detection of rifampicin-resistant M. tuberculosis strains from lymph node aspirates.
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Affiliation(s)
- Mulualem Tadesse
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
- Mycobacteriology Research Center, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Gemeda Abebe
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
- Mycobacteriology Research Center, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia
| | - Ketema Abdissa
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Dossegnaw Aragaw
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
- Mycobacteriology Research Center, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia
| | - Kedir Abdella
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
- Mycobacteriology Research Center, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia
| | - Alemayehu Bekele
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Mesele Bezabih
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Ludwig Apers
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bouke C. de Jong
- Mycobacteriology Unit, Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Leen Rigouts
- Mycobacteriology Unit, Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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Abdissa K, Tadesse M, Abdella K, Bekele A, Bezabih M, Abebe G. Diagnostic performance of fluorescent light-emitting diode microscopy for tuberculous lymphadenitis in a high-burden setting. Trop Med Int Health 2015; 20:1543-1548. [PMID: 26250964 DOI: 10.1111/tmi.12585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Diagnosis of tuberculous lymphadenitis using fine-needle aspiration cytology is a simple and safe but low-specificity method, whereas conventional smear microscopy has variable sensitivity due to low bacterial load. We evaluated the diagnostic performance of fluorescent light-emitting diode (LED) microscopy on routinely collected fine-needle aspirates from tuberculous lymphadenitis presumptive cases. METHODS Fine-needle aspirates were collected from patients clinically suspected of having tuberculous lymphadenitis as part of routine diagnosis. Smear preparation was performed from the aspirate and processed for cytology, conventional Ziehl-Neelsen and LED microscopy. The remaining aspirate was processed for culture on Lowenstein-Jensen media. Capilia TB-Neo test was used to differentiate M. tuberculosis complex from non-tuberculous mycobacteria. RESULT A total of 144 tuberculous lymphadenitis presumptive cases were included. 66.7% (96/144) were positive for M. tuberculosis complex on culture. Only one isolate was identified as non-tuberculous mycobacteria. The detection rates of Ziehl-Neelsen and LED microscopy were 18.8% (27/144) and 34% (49/144), respectively. As compared to culture, sensitivity was 25.0% [95% CI: 16.3-33.7] for Ziehl-Neelsen microscopy and 45.8% [95% CI: 35.9-55.8] for LED microscopy. The specificity was 93.8% [95% CI: 86.9-100] for Ziehl-Neelsen microscopy and 89.6% [95% CI: 80.9-98.2] for LED microscopy. LED microscopy showed a statistically significant increase in sensitivity and similar specificity compared to Ziehl-Neelsen microscopy. Mean reading time of positive slides was 2.62 min/slide for Ziehl-Neelsen and 1.60 min/slide for LED microscopy. Cytology showed sensitivity of 82.3% and specificity of 54.2%. LED microscopy detected TB bacilli in 33.3% of cases cytologically classified as suppurative abscess. CONCLUSION The LED microscopy for tuberculous lymphadenitis had significantly higher sensitivity and shorter screening time than Ziehl-Neelsen microscopy. Use of LED microscopy among cases classified as suppurative abscess on fine-needle aspirate cytology improves evidence-based diagnosis of presumptive tuberculous lymphadenitis cases. Moreover, LED microscopy could be considered as an alternative approach in settings where fine-needle aspirate cytology is impractical.
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Affiliation(s)
- Ketema Abdissa
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Mulualem Tadesse
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.,Mycobacteriology Research Center, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia
| | - Kedir Abdella
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.,Mycobacteriology Research Center, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia
| | - Alemayehu Bekele
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Mesele Bezabih
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Gemeda Abebe
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.,Mycobacteriology Research Center, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia
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Hamzaoui A. [Childhood tuberculosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:168-180. [PMID: 24932504 DOI: 10.1016/j.pneumo.2014.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 03/12/2014] [Accepted: 03/15/2014] [Indexed: 06/03/2023]
Abstract
Childhood TB is an indication of failing TB control in the community. It allows disease persistence in the population. Mortality and morbidity due to TB is high in children. Moreover, HIV co-infection and multidrug-resistant diseases are as frequent in children as in adults. Infection is more frequent in younger children. Disease risk after primary infection is greatest in infants younger than 2 years. In case of exposure, evidence of infection can be obtained using the tuberculin skin test (TST) or an interferon-gamma assay (IGRA). There is no evidence to support the use of IGRA over TST in young children. TB suspicion should be confirmed whenever possible, using new available tools, particularly in case of pulmonary and lymph node TB. Induced sputum, nasopharyngeal aspiration and fine needle aspiration biopsy provide a rapid and definitive diagnosis of mycobacterial infection in a large proportion of patients. Analysis of paediatric samples revealed higher sensitivity and specificity values of molecular techniques in comparison with the ones originated from adults. Children require higher drugs dosages than adults. Short courses of steroids are associated with TB treatment in case of respiratory distress, bronchoscopic desobstruction is proposed for severe airways involvement and antiretroviral therapy is mandatory in case of HIV infection. Post-exposure prophylaxis in children is a highly effective strategy to reduce the risk of TB disease. The optimal therapy for treatment of latent infection with a presumably multidrug-resistant Mycobacterium tuberculosis strain is currently not known.
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Affiliation(s)
- A Hamzaoui
- Pavillon B, hôpital Abderrahmen-Mami, 2080 Ariana, Tunisie.
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24
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Abstract
BACKGROUND Diagnosis of tuberculosis in children is challenging and fine needle aspiration biopsy (FNAB) is used worldwide in the diagnosis of palpable masses including peripheral lymphadenopathy. Recent studies of the use of nucleic acid amplification such as the Xpert MTB/RIF test on FNAB in adult patients have shown considerable promise. Xpert MTB/RIF allows for the rapid diagnosis of Mycobacterium tuberculosis and identification of rifampicin susceptibility. Studies to date have been predominantly performed in adults. This study aims to determine the accuracy of Xpert MTB/RIF for the detection of M. tuberculosis complex in FNAB from children with clinically suspected mycobacterial lymphadenitis. METHODS Prospective hospital-based study of children <13 years referred for FNAB at Tygerberg hospital and Dora Nginza hospital, South Africa, for suspected mycobacterial lymphadenitis. Aspirates were performed and the results of the Xpert MTB/RIF test were compared with liquid (mycobacterial growth indicator tube) culture and cytology. RESULTS FNABs were collected from 110 children and 38 (35%) cases were excluded. Of the 72 cases included in the study, 32 were positive for M. tuberculosis complex on Xpert MTB/RIF, 36 on cytology and 25 were culture positive for M. tuberculosis complex. Compared with the combined reference standard (cytomorphology suggestive of mycobacterial disease with direct visualization of the organism and/or bacteriological culture), Xpert MTB/RIF identified 32 of 40 cases as positive with a sensitivity and a specificity of 80% and 93.8%, respectively. CONCLUSIONS FNAB and Xpert MTB/RIF enable a rapid diagnosis in pediatric mycobacterial lymphadenitis, expediting appropriate treatment and potentially preventing morbidity and mortality.
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Correlation of various techniques in diagnosis of tuberculous lymphadenitis on fine needle aspiration cytology. PATHOLOGY RESEARCH INTERNATIONAL 2013; 2013:824620. [PMID: 24171137 PMCID: PMC3793291 DOI: 10.1155/2013/824620] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 11/25/2022]
Abstract
Objective. To study the correlation of cytomorphological features in fine needle aspiration smears from patients suspected of having tuberculous lymphadenitis with Ziehl-Neelsen staining (ZN), auramine-rhodamine staining (ARS), and autofluorescence (AF). Methods. A total of 145 lymph nodes were aspirated, 3 air-dried smears were stained with Giemsa, Ziehl-Neelsen, and auramine-rhodamine stains, and 1 smear was wet fixed for Papanicolaou staining. Needle washes were incubated in Lowenstein-Jensen medium for culture. Papanicolaou and auramine-rhodamine stained smears were examined under fluorescent microscope using a blue excitation filter (450–480 nm). Results. Ninety aspirates were reported on cytomorphology as suggestive of tuberculous lymphadenitis. Smear positivity for Mycobacteria by Ziehl-Neelsen method was 26.67% (24/90), while positivity increased to 34.44% (31/90) by auramine-rhodamine and 42.22% (38/90) on autofluorescence. Culture was positive in 27.78% (25/90) aspirates. Using culture as the reference method, the statistical values of ZN, ARS, and AF were as follows: sensitivity 80.0%, 88.0%, 96.0%; specificity 93.85%, 86.15%, 78.46%; positive predictive values 83.33%, 70.97%, 63.16%; and negative predictive values 92.42%, 94.92%, 98.08%, respectively. Conclusion. There is a definite advantage of autofluorescence over Ziehl-Neelsen and auramine-rhodamine which is to detect Mycobacteria, being more sensitive as well as an inexpensive technique. Autofluorescence can be a useful addition to routine cytology for early diagnosis and effective treatment.
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Cuevas LE, Petrucci R, Swaminathan S. Tuberculosis diagnostics for children in high-burden countries: what is available and what is needed. Paediatr Int Child Health 2012; 32 Suppl 2:S30-7. [PMID: 23394756 DOI: 10.1179/2046904712z.00000000076] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The diagnosis of childhood tuberculosis (TB) is complex and most of the new diagnostics for TB are for adults. AIMS To review the performance of TB diagnostics and their suitability to its characteristics in young children. METHODS Expert opinion and review of the literature. MAIN FINDINGS The lack of a sufficient number of research studies on TB diagnostics for children hinders the preparation of systematic literature reviews. Information on test performance in children is often extrapolated from studies in adults and there is a dearth of evidence of test performance in children. Approaches to shorten the time required for diagnosis (by using a variety of specimens) are needed and there is preliminary evidence that such schemes are feasible. Diagnostics based on smear microscopy such as LED-FM, serological tests and IGRAS are unlikely to improve the diagnosis of active TB in children. Liquid and the MODS culture methods are more sensitive than solid culture, and new methods to detect mycobacterium nucleic acid or its components such as TrDNA fragments, LAMP assays and Xpert MTB/RIF have good potential to increase the number of cases confirmed. These tests should be evaluated in specimens which are easily accessible in children such as fine-needle aspiration biopsy, urine, blood and stools. INTERPRETATION The evaluation of new diagnostic tests for TB in children is overdue. The lack of suitable diagnostic tests hinders the proper management of children, the assessment of the real burden of childhood TB, evaluation of the efficacy of new treatments and vaccines and, ultimately, the development of effective control interventions.
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Affiliation(s)
- Luis E Cuevas
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland.
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Recomendaciones de la Sociedad Española de Infectología Pediátrica sobre el diagnóstico y tratamiento de las adenitis por micobacterias no tuberculosas. An Pediatr (Barc) 2012; 77:208.e1-208.e12. [DOI: 10.1016/j.anpedi.2012.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 12/28/2022] Open
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Joshi P, Singh M, Bhargava A, Singh M, Mehrotra R. Autofluorescence--an important ancillary technique for the detection of Mycobacterium tuberculosis: revisited. Diagn Cytopathol 2012; 41:330-4. [PMID: 22351040 DOI: 10.1002/dc.21860] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 09/13/2011] [Indexed: 11/10/2022]
Abstract
Tuberculosis is one of the oldest diseases known to affect humans and is caused by Mycobacterium tuberculosis. Lymph nodes are the most common site of extrapulmonary involvement. Tuberculous lymphadenitis can be presumptively diagnosed morphologically on fine-needle aspiration biopsy of lymph nodes. Additional tests like Ziehl-Neelsen (ZN) stain for detection of acid fast bacilli, fluorescence, and molecular markers are often employed for confirmation of diagnosis. However, culture is essential for obtaining a definitive diagnosis. Unfortunately, culture is time consuming and expensive. Newer investigative methods are required. The efficacy of autofluorescence in the diagnosis of tuberculous lymphadenitis was evaluated for this purpose. Fine-needle aspiration biopsies were collected from patients with a clinical diagnosis of tuberculous lymphadenitis. Cytomorphological examination, ZN staining, autofluorescence, and culture were performed on all specimens. ZN staining was positive in 37.5% (30/80) of cases, while autofluorescence was positive in 57.5% (46/80) of patients and was found to have 81.8% specificity, 95% sensitivity, and a positive predictive value of 82.6%. This technique allowed rapid and early diagnosis of tuberculous lymphadenitis in a number of patients, permitting early institution of appropriate therapy.
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Affiliation(s)
- Parul Joshi
- Department of Pathology, Moti Lal Nehru Medical College, Allahabad, India
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29
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Fontanilla JM, Barnes A, von Reyn CF. Current diagnosis and management of peripheral tuberculous lymphadenitis. Clin Infect Dis 2012; 53:555-62. [PMID: 21865192 DOI: 10.1093/cid/cir454] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Peripheral tuberculous lymphadenitis accounts for ~10% of tuberculosis cases in the United States. Epidemiologic characteristics include a 1.4:1 female-to-male ratio, a peak age range of 30-40 years, and dominant foreign birth, especially East Asian. Patients present with a 1-2 month history of painless swelling of a single group of cervical lymph nodes. Definitive diagnosis is by culture or nucleic amplification of Mycobacterium tuberculosis; demonstration of acid fast bacilli and granulomatous inflammation may be helpful. Excisional biopsy has the highest sensitivity at 80%, but fine-needle aspiration is less invasive and may be useful, especially in immunocompromised hosts and in resource-limited settings. Antimycobacterial therapy remains the cornerstone of treatment, but response is slower than with pulmonary tuberculosis; persistent pain and swelling are common, and paradoxical upgrading reactions may occur in 20% of patients. The role of steroids is controversial. Initial excisional biopsy deserves consideration for both optimal diagnosis and management of the otherwise slow response to therapy.
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Affiliation(s)
- Jose-Mario Fontanilla
- Joan C Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
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30
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Achkar JM, Lawn SD, Moosa MYS, Wright CA, Kasprowicz VO. Adjunctive tests for diagnosis of tuberculosis: serology, ELISPOT for site-specific lymphocytes, urinary lipoarabinomannan, string test, and fine needle aspiration. J Infect Dis 2011; 204 Suppl 4:S1130-41. [PMID: 21996695 PMCID: PMC3192548 DOI: 10.1093/infdis/jir450] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The diagnostic gold standard for active tuberculosis (TB) is the detection of Mycobacterium tuberculosis (MTB) by culture or molecular methods. However, despite its limited sensitivity, sputum smear microscopy is still the mainstay of TB diagnosis in resource-limited settings. Consequently, diagnosis of smear-negative pulmonary and extrapulmonary TB remains challenging in such settings. A number of novel or alternative techniques could provide adjunctive diagnostic use in the context of difficult-to-diagnose TB. These may be especially useful in certain patient groups such as persons infected with human immunodeficiency virus (HIV) and children, who are disproportionably affected by smear-negative and extrapulmonary disease and who are also most adversely affected by delays in TB diagnosis and treatment. We review a selection of these methods that are independent of nucleic acid amplification techniques and could largely be implemented in resource-limited settings in current or adapted versions. Specifically, we discuss the diagnostic use and potential of serologic tests based on detection of antibodies to MTB antigens; interferon gamma release assays using site-specific lymphocytes; detection of lipoarabinomannan, a glycolipid of MTB, in urine; the string test, a novel technique to retrieve lower respiratory tract samples; and fine needle aspiration biopsy of lymph nodes.
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Affiliation(s)
- Jacqueline M Achkar
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
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Xpert MTB/RIF for rapid diagnosis of tuberculous lymphadenitis from fine-needle-aspiration biopsy specimens. J Clin Microbiol 2011; 49:3967-70. [PMID: 21880965 DOI: 10.1128/jcm.01310-11] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This study demonstrates the excellent diagnostic accuracy of the Xpert MTB/RIF test in patients with tuberculous lymphadenitis. The test sensitivity and specificity were 96.7% (95% confidence interval [CI], 86.6 to 100%) and 88.9% (95% CI, 69.6 to 100%), respectively, and it correctly identified 6/6 (100%) of the cytology smear-negative/culture-positive cases and 1 of 2 (50%) rifampin-resistant cases.
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Schubert PT, Cotton MF, Wright CA. Cytomorphological patterns of M. bovis BCG and M. tuberculosis on fine needle aspiration biopsies: Does HIV make a difference? Diagn Cytopathol 2011; 39:264-9. [DOI: 10.1002/dc.21378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Field AS, Geddie W, Zarka M, Sayed S, Kalebi A, Wright CA, Banjo A, Desai M, Kaaya E. Assisting cytopathology training in medically under-resourced countries: defining the problems and establishing solutions. Diagn Cytopathol 2011; 40:273-81. [PMID: 21309011 DOI: 10.1002/dc.21620] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 11/13/2010] [Indexed: 12/26/2022]
Abstract
Cytology is able to deliver rapid accurate diagnoses with minimal equipment and laboratory infrastructure at minimal cost, and this is especially so for fine needle biopsy (FNB), which is a powerful diagnostic tool in medically resource-poor environments, where histopathology laboratories are small in number and poorly supported financially. The crucial element in the development of cytology services is to train a sufficient number of well trained cytopathologists and cytotechnologists to create a 'critical mass' of personnel who not only provide routine diagnostic services, but also can train an ever expanding number of pathologists, cytotechnologists, and health workers. A review of practical programs to train cytopathologists and cytotechnologists in their own countries will be presented, including a recent series of FNB and cytology tutorials run in sub Saharan Africa. The need for local cytopathology programs and the potential for both local and visiting cytopathologists to provide a faculty will be discussed, as well as a range of possible programs which can bring African pathologists and trainee pathologists to Western institutions for periods of their training. Ideally, the regional Societies of Cytology, including the recently formed West African Society of Cytology, will establish their own diagnostic protocols, training programs, syllabuses, examinations and accreditation and career pathways for both cytopathologists and cytotechnologists, and organize tutorials where they will invite overseas faculty to contribute. Crucially, these new societies will empower cytopathologists and cytotechnologists to approach health services and governments to state the need for cytology services as a cost-effective accurate diagnostic service that enhances patient care.
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Affiliation(s)
- A S Field
- Department of Anatomical Pathology, St Vincent's Hospital, Sydney, Australia.
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M. tuberculosis in Lymph Node Biopsy Paraffin-Embedded Sections. Tuberc Res Treat 2011; 2011:127817. [PMID: 22567262 PMCID: PMC3335535 DOI: 10.1155/2011/127817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/01/2011] [Accepted: 10/17/2011] [Indexed: 11/17/2022] Open
Abstract
Background. Tuberculosis lymphadenitis is one of the most common forms of all extrapulmonary tuberculosis. Objective. To evaluate the magnitude of M. tuberculosis from lymph node biopsy paraffin-embedded sections among suspected patients visiting the Jimma University Specialized Hospital. Method. A cross-sectional study design of histological examination among lymph node biopsy paraffin-embedded sections by Ziehl-Neelsen and hematoxylin/eosin staining technique was conducted from December, 2009, to October, 2010, at the Department of Medical Laboratory Science and Pathology. Result. Histopathological examination of the specimens by hematoxylin and eosin staining technique revealed the presence of granulomas. But for the caseation and necrosis they were present in 85% cases of nodal tissue biopsies. From those, 56.7% were from females. The presence of acid-fast bacilli was microscopically confirmed by ZN staining in 37 (61.7%) of the nodal tissue biopsies. Conclusion and Recommendation. Tuberculosis lymphadenitis is significantly more common in females. Hence, attention should be given for control and prevention of extrapulmonary tuberculosis.
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Gupta N, Sharma K, Barwad A, Sharma M, Rajwanshi A, Dutta P, Sharma A. Thyroid tuberculosis - role of PCR in diagnosis of a rare entity. Cytopathology 2010; 22:392-6. [DOI: 10.1111/j.1365-2303.2010.00830.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Human immunodeficiency virus and tuberculosis coinfection in children: challenges in diagnosis and treatment. Pediatr Infect Dis J 2010; 29:e63-70. [PMID: 20651637 DOI: 10.1097/inf.0b013e3181ee23ae] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The burden of childhood tuberculosis (TB) is influenced by the human immunodeficiency virus (HIV) epidemic and this dangerous synergy affects various aspects of both diseases; from pathogenesis and the epidemiologic profile to clinical presentation, diagnosis, treatment, and prevention. HIV-infected infants and children are at increased risk of developing severe forms of TB. The TB diagnosis is complicated by diminished sensitivity and specificity of clinical features and diagnostic tools like the tuberculin skin test and chest x-ray. Although alternative ways of pulmonary sampling and the development of interferon-γ assays have shown to lead to some improvement of TB diagnosis in HIV-infected children, new diagnostic tools are urgently needed. Coadministration of anti-TB treatment and antiretroviral drugs induces severe complications, and this highlights the need to define optimal treatment regimens. Practical implementation of these regimens in TB control programs should be combined with isoniazid preventive therapy in TB-exposed HIV-infected children. The risk of severe complications after Bacille Calmette-Guérin vaccination of HIV-infected children emphasizes the need for new nonviable vaccines. This article reviews the current status of pediatric HIV-TB coinfection with specific emphasis on the diagnosis and treatment.
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Wright CA, Hoek KGP, Marais BJ, van Helden P, Warren RM. Combining fine-needle aspiration biopsy (FNAB) and high-resolution melt analysis to reduce diagnostic delay in Mycobacterial lymphadenitis. Diagn Cytopathol 2010; 38:482-8. [PMID: 19894259 DOI: 10.1002/dc.21223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Tuberculous lymphadenitis is the most common cause of extra-pulmonary tuberculosis (TB) in developing countries. Lymphadenitis caused by non-tuberculous mycobacteria (NTM) requires consideration, particularly in immunocompromised patients and children in developed countries. Fine-Needle Aspiration Biopsy (FNAB) offers a valuable specimen collection technique, but culture confirmation, mycobacterial speciation and drug resistance testing (if indicated) is often unavailable in TB endemic areas and result in unacceptable diagnostic delay. We evaluated the diagnostic value of high-resolution DNA melting (HRM) analysis in the diagnosis of mycobacterial lymphadenopathy using FNAB and an inexpensive transport medium. Specimens were collected from patients referred to the FNAB Clinic at Tygerberg Hospital (June 2007-May 2008) with clinical mycobacterial lymphadenitis. Cytology, culture, and HRM were performed on all specimens. The reference standard for disease was defined as positive cytology (morphological evidence plus mycobacterial visualization) and/or a positive culture. Specimens were collected from 104 patients and mycobacterial disease was confirmed in 54 (51.9%); 52 Mycobacterium tuberculosis, 1 Mycobacterium Bovis BCG and 1 NTM. Cytology was positive in 83.3% (45/54) and culture in 72.2% (39/54) of patients. HRM identified 57.4% (31/54) of cases. By using the defined reference standard, we recorded 94.0% specificity and 51.9% sensitivity (positive predictive value 90.3%) with HRM analysis.HRM analysis allowed rapid and species specific diagnosis of mycobacterial lymph adenitis in the majority of patients, permitting early institution of appropriate therapy. Optimization of this technique requires further study.
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Affiliation(s)
- Colleen A Wright
- Division of Anatomical Pathology, Department of Pathology, Stellenbosch University and NHLS Tygerberg, Tygerberg, South Africa.
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Zar HJ, Connell TG, Nicol M. Diagnosis of pulmonary tuberculosis in children: new advances. Expert Rev Anti Infect Ther 2010; 8:277-88. [PMID: 20192682 DOI: 10.1586/eri.10.9] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The global burden of childhood pulmonary TB has been underappreciated, in part due to difficulties in obtaining microbiological confirmation of disease. Most HIV-uninfected children can be diagnosed using a combination of clinical and epidemiological features, tuberculin skin testing and chest radiography, as represented in different scoring systems. However, accurate microbiologic diagnosis has become increasingly important for timely use of effective treatment. Mycobacterial culture confirms the diagnosis of TB and provides drug susceptibility data but is not available in most areas with a high TB prevalence. Moreover, culture has poor sensitivity in children who usually have paucibacillary disease. The HIV epidemic has made definitive diagnosis even more challenging due to nonspecific clinical and radiological signs. In high HIV-prevalence areas, scoring systems have been especially variable, lacking sensitivity and specificity. Newer methods for diagnosis are aimed either at detecting the organism or a specific host immune response. Methods for organism detection have focused on collection of better samples, improved culture techniques, molecular methods or antigen detection. Recent advances include the use of sputum induction for obtaining a more reliable specimen, faster and more sensitive culture methods, and rapid detection of the organism and drug resistance based on nucleic acid amplification. Improved methods for detecting a specific host response have largely focused on the use of IFN-g release assays. Even with newer methods, accurately diagnosing childhood TB may be challenging. Greater efforts to obtain a microbiologic diagnosis should be made in children, even in primary care settings. Further research to develop a more accurate, cost-effective and simple diagnostic test for childhood TB is urgently needed.
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Affiliation(s)
- Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.
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Iwnetu R, van den Hombergh J, Woldeamanuel Y, Asfaw M, Gebrekirstos C, Negussie Y, Bekele T, Ashenafi S, Seyoum B, Melaku K, Yamuah L, Tilahun H, Tadesse Z, Aseffa A. Is tuberculous lymphadenitis over-diagnosed in Ethiopia? Comparative performance of diagnostic tests for mycobacterial lymphadenitis in a high-burden country. ACTA ACUST UNITED AC 2010; 41:462-8. [PMID: 19382003 DOI: 10.1080/00365540902897697] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ethiopia reports the third highest number of extrapulmonary TB cases globally, most of which are lymph node TB (TBLN). We investigated the performance of the available diagnostic tests for TBLN. Fine needle aspirate (FNA) and excision biopsy samples from affected lymph nodes were collected from 150 consenting patients with suspected TBLN visiting regional hospitals in Ethiopia. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of histopathology against culture as reference was 92%, 88%, 97% and 77% and of FNA cytology (FNAC) 76%, 88%, 100% and 55%, respectively. Naked eye examination of FNA had 67% sensitivity and 64% specificity. HIV coinfection did not diminish the performance of macroscopic examination, Ziehl-Neelsen stain, histology or cytology examinations. When any positive result in ZN, histopathology or culture was considered confirmatory, clinical diagnosis could be confirmed in 85% of the patients, suggesting that TBLN is over-diagnosed in up to 15% of cases. With combined criteria as reference standard, the sensitivity, specificity, PPV and NPV of FNAC was 72%, 100%, 100% and 55%, respectively. FNAC is a practical tool that can improve the diagnosis of TBLN in high-burden settings. Over-diagnosis alone cannot explain the high burden of LNTB in Ethiopia.
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Affiliation(s)
- Rahel Iwnetu
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
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Cervical tuberculous lymphadenitis in the elderly: comparative diagnostic findings. The Journal of Laryngology & Otology 2009; 123:1343-7. [PMID: 19958562 DOI: 10.1017/s0022215109990880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients suspected of having cervical tuberculous lymphadenitis are diagnosed using investigations such as fine needle aspiration cytology and the polymerase chain reaction for Mycobacterium tuberculosis. However, these investigations are intended for primary tuberculosis infection. The majority of cervical tuberculous lymphadenitis cases in the elderly are thought to be caused by reactivation. OBJECTIVE The aims of this study were (1) to examine the efficacy of fine needle aspiration cytology, polymerase chain reaction and blood tests in the diagnosis of cervical tuberculous lymphadenitis caused by reactivation, and (2) to clarify any differences when compared with primarily infected cervical tuberculous lymphadenitis cases. MATERIALS AND METHODS Thirty-three elderly patients with neck lumps underwent excisional biopsy from 2003 to 2008. The efficacy of fine needle aspiration cytology was examined by comparing the results of excisional biopsy with those of fine needle aspiration cytology performed at the initial medical examination for cases of suspected tuberculous disease. Furthermore, the leucocyte count and C-reactive protein concentration were compared for cases of cervical tuberculous lymphadenitis versus cases of malignant lymphoma. RESULTS Although nine cases were diagnosed with cervical tuberculous lymphadenitis using excisional biopsy, only one of these had been suspected based on fine needle aspiration cytology results. Three cases with tuberculous lymphadenitis were suspected of having malignant lymphoma on initial examination. There was no significant difference in the leucocyte count and C-reactive protein concentration, comparing cases of tuberculous lymphadenitis versus malignant lymphoma. CONCLUSION Unlike the primary infection often seen in endemic areas, the diagnosis of early stage tuberculous lymphadenitis of the swelling type caused by reactivation in elderly people is difficult to confirm unless excisional biopsy is performed. In elderly patients with neck lumps, cervical tuberculous lymphadenitis should be included in the differential diagnosis.
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Clinical practice: diagnosis of childhood tuberculosis. Eur J Pediatr 2009; 168:1285-90. [PMID: 19396462 DOI: 10.1007/s00431-009-0988-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 04/01/2009] [Indexed: 10/20/2022]
Abstract
Childhood tuberculosis (TB) represents an important part of the disease burden, yet its diagnosis remains challenging. This review summarizes the clinical, radiological, and bacteriological approaches to diagnose TB infection and disease in children. Fever (possibly intermittent or low grade), weight loss or failure to thrive, and a persistent cough for >2 weeks are the most important clinical signs for pulmonary tuberculosis. Extra-pulmonary TB, which might occur in over 40% of the patients, can have in addition some specific clinical symptoms or signs. Chest radiographs provide important information in many patients and advanced imaging can be applied in case of (and should be restricted to) inconclusive diagnosis. The Mantoux test is positive in up to 70% of non-immunocompromised TB patients, whereas HIV co-infection or malnourishment results in a lower reactivity. Evidence of an adult TB index case is clue for diagnosis of childhood TB in low-endemic countries. Bacteriological confirmation remains difficult and is useful for doubtful cases or when drug resistance is suspected.
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