Diagnostic de la tuberculose ganglionnaire périphérique en Tunisie

Service des maladies infectieuses, CHU Hédi Chaker, Sfax, Tunisie; Laboratoire d’anatomopathologie, CHU Habib Bourguiba, Sfax, Tunisie; Laboratoire d’hygiène, CHU Hédi Chaker, Sfax, Tunisie
Médecine et Maladies Infectieuses (Impact Factor: 0.91). 02/2010; DOI: 10.1016/j.medmal.2009.10.014

ABSTRACT ObjectiveThe aim of the study was to evaluate the contribution of microbiology, cytology, and anatomopathology in 50 cases of peripheral tuberculous lymphadenitis.MethodologyOur patients underwent bacteriological tests and cytology and/or histopathology for lymphadenitis.ResultsZiehl-Neelsen stains and cultures were positive in only 29.7% and 10.8% of cases respectively. The diagnosis was confirmed by cytology in 31.3% of cases (10/32) and by histology in 58.6% of cases (27/46). Granulomas were observed in 46.8% (15/32) of needle aspirates and 76% (35/46) of surgical biopsies.ConclusionOur study reveals a weak contribution of conventional microbiological techniques. Cytology remains the procedure of choice in endemic countries. Excisional biopsy may be performed in case of doubt.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This prospective study evaluated the performance of the Amplified Mycobacterium Tuberculosis Direct Test (MTD) for the diagnosis of lymph node tuberculosis in Djibouti, Republic of Djibouti. Of 197 specimens sampled from 153 patients, 123 were from 95 tuberculous patients. The sensitivity and specificity of MTD were 93 and 100%, respectively. The sensitivity of culture was 89%.
    Journal of Clinical Microbiology 01/2005; 42(12):5921-2. · 4.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate patient profiles, diagnostic approaches, and treatment strategies in patients with lymph node tuberculosis. Demographic data, diagnostic findings, and therapies were retrospectively analyzed in 60 patients with lymph node tuberculosis who were hospitalized between 1992 and 1999. Thirty percent (n = 18) of patients were natives, and 70% were immigrants (n = 42). The cervical lymph nodes were most frequently involved (63.3%), followed by the mediastinal lymph nodes (26.7%) and the axillary lymph nodes (8.3%). All patients (except one patient who was HIV-positive) showed a positive response to tuberculin skin testing. Lymph node excision and fine-needle aspiration (FNA) were similarly effective in obtaining sufficient material for histologic and microbiological analysis. Mycobacterium tuberculosis was identified in 43.3% of patients by microbiological testing, and culture methods showed the highest sensitivity. Despite standard treatment, the initial enlargement of the lymph nodes occurred in 20% of patients and local complications occurred in 10%. Lymph node tuberculosis is still an important issue in developed countries and has to be considered in differential diagnosis. The best approach appears to be a combination of skin testing and FNA. Negative results in the identification of M tuberculosis do not exclude the diagnosis of lymph node tuberculosis.
    Chest 05/2002; 121(4):1177-82. · 7.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the usefulness of the devR based polymerase chain reaction (PCR) in the detection of Mycobacterium tuberculosis in lymph node aspirates and tissues of lymphadenitis and to compare PCR with conventional diagnostic techniques. Coded specimens of fine needle aspirates and biopsies from 22 patients with tuberculous lymphadenitis, 14 patients with non-tubercular lymphadenitis, and nine patients with granulomatous lymphadenitis were processed and subjected to analysis by PCR, smear microscopy, M tuberculosis culture, histology, and cytology. Tuberculous lymphadenitis was correctly diagnosed by PCR in 18 patients, by culture in five patients, by histology in 13 patients, and by cytology in seven patients. PCR gave two false positive results in 14 patients with non-tubercular lymphadenitis. The sensitivity of the conventional techniques was significantly higher with biopsies (17 of 22 specimens; 77%) than with fine needle aspirates (nine of 22 specimens; 41%). However, the sensitivity of PCR was not significantly higher with biopsies (68%) in comparison with fine needle aspirates (55%). The sensitivity of either biopsy PCR or fine needle aspirate PCR was not significantly different from that of either histology combined with culture or cytology combined with culture. The overall combined specificity of PCR was 86%. Mycobacterium tuberculosis DNA was detected in six of nine patients with granulomatous lymphadenitis. PCR is the most sensitive single technique available to date for the demonstration of M tuberculosis in specimens derived from patients with a clinical suspicion of tuberculous lymphadenitis. The value of PCR lies in its use as an adjunct test in the diagnosis of tuberculous lymphadenitis, particularly in those patients where conventional methods fail. Because fine needle aspiration is not an invasive procedure, it is the procedure of choice, and PCR should be performed initially on these samples. Excisional biopsy histology and PCR should be recommended only for patients in whom fine needle aspirate PCR is negative or when there is discrepancy with the clinical impression.
    Journal of Clinical Pathology 06/2000; 53(5):355-61. · 2.55 Impact Factor