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Title: Dilemmas in the Diagnosis of Lymph Node Enlargement in Ethiopia: A Study from Four Sites with High Notification of Lymph Node Tuberculosis
Authors: Rahel, Iwnetu
Copyright: 2005
Date Added: 19-Apr-2008
Publisher: Addis Ababa University
Abstract: The proportion of extra-pulmonary tuberculosis has risen to over a third of the cases of tuberculosis in Ethiopia. The majority of this form of tuberculosis is reported as lymph node tuberculosis (LNTB). We evaluated the national algorithm currently in use for the diagnosis of lymph node enlargement in Ethiopia. One hundred and fifty suspected cases of lymph node tuberculosis, aged 5-65 years, with extra-inguinal lymphadenopathy were recruited following the national algorithm, from October 2004 to August 2005. Out of these individuals, 117 (78%) were diagnosed as LNTB on positive culture of fine needle (FNA) and/or biopsy specimens. FNA cytology (FNAC) and histopathology detected 88 (75%) and 105 (97%) of the culture proven LNTB patients, respectively. Eighty percent of DNA extracted from biopsy tissues gave signal for M. tuberculosis. All of the strains isolated from culture were identified as M. tuberculosis. Ziehl-Neelsen (ZN) staining of FNA and biopsy smears detected acid fast bacilli (AFB) in 28% and 25% of the patients, respectively. Macroscopic caseation in excised lymph node and aspirated material was found to be comparable with 79 (68%) of the nodes and 78 (67%) of the fine needle aspirates demonstrating caseation. Statistically significant association was found between the presence of caseation and the diagnosis of LNTB in both types of specimens (p=0.002). Combination of FNAC, ZN staining of FNA materials and macroscopic examination of aspirates detected 112 (96%) of the culture proven LNTB patients. The proportion of HIV seropositive individuals among the culture proven LNTB patients were 24%. There was statistically significant association between urban residence (p=0.002), female gender (p=0.006) and HIV in LNTB patients. There was no statistically significant association between LNTB and HIV. We found that the currently used algorithm detects a significant amount of culture proven LNTB patients even though it suffers from shortcomings. It is hoped that this will encourage wider consultation to review and revise the existing algorithm and improve LNTB diagnosis and reporting nationwide.
Description: A Thesis Submitted in Partial Fulfilment of the Degree of Master of Science in Medical Microbiology
URI: http://hdl.handle.net/123456789/591
Appears in:Thesis - Medical Microbiology

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