1887

Abstract

Tuberculosis is a major public health problem in India and other developing countries and has formed a lethal partnership with AIDS. It often presents a diagnostic challenge especially when clinical presentation is suggestive but bacteriological proof is lacking. The objective of this study was to compare the various diagnostic techniques in clinically suspected cases of tubercular lymph nodes and to find a suitable, cost-effective but sensitive and specific method for diagnosis. A total of 100 cases were recruited for the study. Fine needle aspiration cytology was done in all cases and the smears prepared were processed for Giemsa, Ziehl–Neelsen's, Kinyoun and Papanicolaou stains. Parts of the aspirated materials were assessed by fluorescent staining, culture and PCR. Seventy-four percent of aspirates were positive by fluorescent stain while only 22 % were positive by culture. PCR could be performed in 55 cases, out of which 22 (40 %) were positive. When compared to culture, the sensitivity and specificity of PCR were found to be 89.5 % and 86.1 %, respectively. Fluorescent stain was found to be the most sensitive (81.8 %) of the conventional methods but showed poor specificity (28.2 %). Interestingly, PCR detected 80 % of smear-negative but culture-positive cases.

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2005-09-01
2024-03-29
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References

  1. Appling D., Miller R. H. 1981; Mycobacterium cervical lymphadenopathy: 1981 update. Laryngoscope 91:1259–1266
    [Google Scholar]
  2. Arora B., Arora D. R. 1990; Fine needle aspiration cytology in diagnosis of tuberculous lymphadenitis. Indian J Med Res 91:189–192
    [Google Scholar]
  3. Baek C. H., Kim S. I., Ko Y. H., Chu K. C. 2000; Polymerase chain reaction detection of Mycobacterium tuberculosis from fine-needle aspirate for the diagnosis of cervical tuberculous lymphadenitis. Laryngoscope 110:30–34 [CrossRef]
    [Google Scholar]
  4. Bailey T. M., Akhtar M., Ali A. M. 1985; Fine needle aspiration biopsy in the diagnosis of tuberculosis. Acta Cytol 29:732–736
    [Google Scholar]
  5. Banavaliker J. N., Bhalotra B., Sharma D. C. 1998; Identification of Mycobacterium tuberculosis by Polymerase Chain Reaction in clinical specimens. Indian J Tuberc 45:15–18
    [Google Scholar]
  6. Braunstein H., Adriano S. M. 1961; Fluorescent stain for tubercle bacilli in histological sections: Diagnostic efficiency in granulomatous lymph nodes. Am J Clin Pathol 36:37–40
    [Google Scholar]
  7. Clarridge J. E., Shawar R. M., Shinnick T. M., Plikaytis B. B. 1993; Large-scale use of polymerase chain reaction for detection of Mycobacterium tuberculosis in a routine mycobacteriology laboratory. J Clin Microbiol 31:2049–2056
    [Google Scholar]
  8. Dewit D., Maartens G., Steyn L. 1992; A comparative study of the polymerase chain reaction and conventional procedures for the diagnosis of tuberculous pleural effusion. Tuber Lung Dis 73:262–267 [CrossRef]
    [Google Scholar]
  9. Ersoz C., Polat A., Serin M. S., Soylu L., Demircan O. 1998; Fine needle aspiration (FNA) cytology in tuberculous lymphadenitis. Cytopathology 9:201–207 [CrossRef]
    [Google Scholar]
  10. Finch P. J., Millard F. J., Maxwell J. D. 1991; Risk of tuberculosis in immigrant Asians: culturally acquired immunodeficiency?. Thorax 46:1–5 [CrossRef]
    [Google Scholar]
  11. Finfer M., Perchick A., Burstein D. E. 1991; Fine needle aspiration biopsy diagnosis of tuberculous lymphadenitis in patients with and without the acquired immune deficiency syndrome. Acta Cytol 35:325–332
    [Google Scholar]
  12. Gadre D. V., Singh U. R., Saxena K., Bhatia A., Talwar V. 1991; Diagnosis of tubercular cervical lymphadenitis by FNAC, microscopy and culture. Indian J Tuberc 38:25–27
    [Google Scholar]
  13. Goel M. M., Ranjan V., Dhole T. N., Srivastava A. N., Mehrotra A., Kushwaha M. R., Jain A. 2001; Polymerase chain reaction vs.conventional diagnosis in fine needle aspirates of tuberculous lymph nodes. Acta Cytol 45:333–340 [CrossRef]
    [Google Scholar]
  14. Gong G., Lee H., Kang G. H., Shim Y. H., Huh J., Khang S. K. 2002; Nested PCR for diagnosis of tuberculous lymphadenitis and PCR-SSCP for identification of rifampicin resistance in fine-needle aspirates. Diagn Cytopathol 26:228–231 [CrossRef]
    [Google Scholar]
  15. Grange J. M. 1989; The rapid diagnosis of paucibacillary tuberculosis. Tubercle 70:1–4 [CrossRef]
    [Google Scholar]
  16. Gupta A. K., Nayar M., Chandra M. 1992; Critical appraisal of fine needle aspiration cytology in tuberculous lymphadenitis. Acta Cytol 36:391–394
    [Google Scholar]
  17. Gupta S. K., Chugh T. D., Sheikh Z. A., al-Rubah N. A. 1993; Cytodiagnosis of tuberculous lymphadenitis: a correlative study with microbiologic examination. Acta Cytol 37:329–332
    [Google Scholar]
  18. Holodniy M., Kim S., Katzenstein D., Konrad M., Groves E., Merigan T. C. 1991; Inhibition of human immunodeficiency virus gene amplification by heparin. J Clin Microbiol 29:676–679
    [Google Scholar]
  19. Hooper A. A. 1972; Tuberculous peripheral lymphadenitis. Br J Surg 59:353–359 [CrossRef]
    [Google Scholar]
  20. Kidane D., Olobo J. O., Habte A., Negesse Y., Aseffa A., Abate G., Yassin M. A., Bereda K., Harboe M. 2002; Identification of the causative organism of tuberculous lymphadenitis in Ethiopia by PCR. J Clin Microbiol 40:4230–4234 [CrossRef]
    [Google Scholar]
  21. Kim S. S., Chung S. M., Kim J. N., Lee M. A., Ha E. H. 1996; Application of PCR from the fine needle aspirates for the diagnosis of cervical tuberculous lymphadenitis. J Korean Med Sci 11:127–132 [CrossRef]
    [Google Scholar]
  22. Krishnaswami H., Koshi G., Kulkarni K. G., Job C. K. 1972; Tuberculous lymphadenitis in south India - a histopathological and bacteriological study. Tubercle 53:215–220 [CrossRef]
    [Google Scholar]
  23. Kumar N., Tiwari M. C., Verma K. 1998; AFB staining in cytodiagnosis of tuberculosis without classical features: a comparison of Ziehl–Neelsen and fluorescent methods. Cytopathology 9:208–214 [CrossRef]
    [Google Scholar]
  24. Lau S. K., Wei W. I., Hsu C., Engzell U. C. 1990; Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy. J Laryngol Otol 104:24–27 [CrossRef]
    [Google Scholar]
  25. Manitchotpisit B., Kunachak S., Kulapraditharom B., Sura T. 1999; Combined use of fine needle aspiration cytology and polymerase chain reaction in the diagnosis of cervical tuberculous lymphadenitis. J Med Assoc Thai 82:363–368
    [Google Scholar]
  26. McClure D. M. 1953; The development of fluorescence microscopy for tubercle bacilli and its use as an adjunct to histological routine. J Clin Pathol 6:273–281 [CrossRef]
    [Google Scholar]
  27. Pamra S. P., Mathur G. P. 1974; A cooperative study of tuberculous cervical lymphadenitis. Indian J Med Res 62:1631–1646
    [Google Scholar]
  28. Schluger N. W., Kinney D., Harkin T. J., Rom W. N. 1994; Clinical utility of the polymerase chain reaction in diagnosis of infections due to Mycobacterium tuberculosis . Chest 105:1116–1121 [CrossRef]
    [Google Scholar]
  29. Shankar P., Manjunath N., Lakshmi R., Aditi B., Seth P. Shriniwas 1990; Identification of Mycobacterium tuberculosis by polymerase chain reaction. Lancet 335:423– 423
    [Google Scholar]
  30. Singh K. K., Muralidharn M., Kumar A., Chattopadhyaya T. K., Kapila K., Singh M. K., Sharma S. K., Jain N. K., Tyagi J. S. 2000; Comparison of in house polymerase chain reaction with conventional techniques for the detection of Mycobacterium tuberculosis DNA in granulomatous lymphadenopathy. J Clin Pathol 53:355–361 [CrossRef]
    [Google Scholar]
  31. Slavik T., Wolfaardt M., VanZyl H., Simson I. W. 1996; HIV-1 infection in patients with tuberculous lymphadenitis. S Afr Med J 86:92– 92
    [Google Scholar]
  32. Van Sooligen D., Hermans P., de Haas W., van Embben J. D. 1995 RFLP analysis of mycobacteria. Manual for fingerprinting of M. tuberculosis strains Bilthoven, The Netherlands: National Institute of Public Health and Environmental Protection;
    [Google Scholar]
  33. WHO 2002; Global Tuberculosis Control: Surveillance, Planning, Financing. WHO Report 2002 . Geneva: World Health Organization; http://www.who.int/docstore/gtb/publications/globrep02/downloadpage.html
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