Fine-needle aspiration for diagnosis of tuberculous lymphadenitis in children in Bangui, Central African Republic

BMC Pediatrics

Gustave Bobossi²  Brigitte Gicquel¹  Catherine Pierre-Audigier¹  Leen Rigouts⁴  Alexandre Manirakiza³  F Yango³  G Zandanga³  Jean Chrusostome Gody²  Narcisse Beyam³  Minime-Lingoupou Fanny³ 

[1] Unité de Génétique Mycobactérienne, Institut Pasteur, Paris, France;Hôpital pédiatrique de Bangui, Bangui, CAR;Laboratoire des Mycobactéries, Institut Pasteur de Bangui, Bangui, Central African Republic (CAR;Mycobacteriology Unit, Institute of Tropical Medicine, and Department of Pharmaceutical, Veterinary and Biomedical Sciences, University of Antwerp, Antwerp, Belgium

关键词: Diagnosis;    Fine needle aspiration;    Lymphadenitis;    Tuberculosis;   

Others  :  1170595
DOI  :  10.1186/1471-2431-12-191

 received in 2012-07-09, accepted in 2012-12-07,  发布年份 2012

【 摘 要 】

Background

Tuberculosis (TB) is a major cause of childhood morbidity and mortality in developing countries. One of the main difficulties is obtaining adequate specimens for bacteriological confirmation of the disease in children.

The aim of this study is to evaluate the adequacy of fine-needle aspiration (FNA) for the diagnosis of TB.

Methods

In a prospective study conducted at the paediatric hospital in Bangui in 2007–2009, we used fine-needle aspiration to obtain samples for diagnosis of TB from 131 children aged 0–17 years with persistent lymphadenitis.

Results

Fine-needle aspiration provided samples that could be used for bacteriological confirmation of TB. Ziehl-Neelsen staining for acid-fast bacilli was positive in 42.7% of samples, and culture identified TB in 67.2% of cases. Of 75 samples that were stain-negative, 49 (65.3%) were culture-positive, while 12 stain-positive samples remained culture-negative. Ten of the 12 stain-positive, culture-negative samples were from patients who had received previous antimicrobial therapy. With regard to phenotypic drug susceptibility, 81/88 strains (91.1%) were fully susceptible to isoniazid, rifampicin, ethambutol and streptomycin, six (6.8%) were resistant to one drug, and one multidrug-resistant strain was found.

Conclusions

Fine-needle aspiration is simple, cost-effective and non-invasive and can be performed by trained staff. Combined with rapid molecular diagnostic tests, fine-needle aspirates could improve the diagnosis of TB and provide valuable information for appropriate treatment and drug resistance.

【 授权许可】

   
2012 Fanny et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Chintu C, et al.: Lung diseases at necropsy in African children dying from respiratory illnesses: a descriptive necropsy study. Lancet 2002, 360(9338):985-990.
• [2]Marais BJ, et al.: Tuberculosis in women and children. Lancet 2010, 375(9731):2057-2059.
• [3]WHO: Combating tuberculosis in children. Geneva: World Health Organization; 2011. http://www.who.int/tb/challenges/childhood_tb_informationsheet.pdf webcite.
• [4]WHO: Combating tuberculosis in children. Geneva: World Health Organization; 2011. http://www.who.int/whosis/whostat/2011/en/index.html webcite.
• [5]Health Ministry of CAR: Annual report. Bangui; 2010.
• [6]Kassa-Kelembho E, et al.: Surveillance of drug-resistant childhood tuberculosis in Bangui, Central African Republic. Int J Tuberc Lung Dis 2004, 8(5):574-578.
• [7]Shingadia D, Novelli V: Diagnosis and treatment of tuberculosis in children. Lancet Infect Dis 2003, 3(10):624-632.
• [8]Cruz AT, Starke JR: Clinical manifestations of tuberculosis in children. Paediatr Respir Rev 2007, 8(2):107-117.
• [9]Sreeramareddy CT, et al.: Clinico-epidemiological profile and diagnostic procedures of pediatric tuberculosis in a tertiary care hospital of western Nepal–a case-series analysis. BMC Pediatr 2010, 10:57. BioMed Central Full Text
• [10]Marais B: Hesseling AC, Jaspan H, The burden of childhood tuberculosis and accuracy of community-based surveillance data. Int J Tuberc Lung Dis 2006, 10:259-263.
• [11]Wright CA, Warren RM, Marais BJ: Fine needle aspiration biopsy: an undervalued diagnostic modality in paediatric mycobacterial disease. Int J Tuberc Lung Dis 2009, 13(12):1467-1475.
• [12]WHO: WHO guidelines for diagnosis. New Delhi: WHO Regional Office for South-East Asia; 2010. http://www.searo.who.int/en/Section10/Section2097/Section2106_10681.htm webcite.
• [13]Canetti G, Rist N, Grosset J: Measurement of sensitivity of the tuberculous bacillus to antibacillary drugs by the method of proportions. Methodology, resistance criteria, results and interpretation. Rev Tuberc Pneumol (Paris) 1963, 27:217-272.
• [14]Knox J, et al.: Diagnosis of tuberculous lymphadenitis using fine needle aspiration biopsy. Intern Med J 2012.
• [15]Von Paleske A: Lymph node aspirates in tuberculosis diagnosis: New challenges, new solutions--a study of 156 patients. Nachrichten Heute; 2011. http://oraclesyndicate.twoday.net/stories/lymph-node-aspirates-in-tuberculosis webcite.
• [16]van Wyk AC, et al.: The use of light-emitting diode fluorescence to diagnose mycobacterial lymphadenitis in fine-needle aspirates from children. Int J Tuberc Lung Dis 2011, 15(1):56-60.
• [17]Koeck JL, et al.: Epidemiology of resistance to antituberculosis drugs in Mycobacterium tuberculosis complex strains isolated from adenopathies in Djibouti. Prospective study carried out in 1999]. Med Trop (Mars) 2002, 62(1):70-72.
• [18]Minime-Lingoupou F, et al.: Relatively low primary drug resistance to anti tuberculosis drugs in Bangui and Bimbo (Central African Republic). Int J Tuberc Lung Dis 2011, 15(5):657-661.
• [19]Vadwai V, et al.: Xpert MTB/RIF: a new pillar in diagnosis of extrapulmonary tuberculosis? J Clin Microbiol 2011, 49(7):2540-2545.
• [20]Ligthelm LJ, et al.: Xpert MTB/RIF for rapid diagnosis of tuberculous lymphadenitis from fine-needle-aspiration biopsy specimens. J Clin Microbiol 2011, 49(11):3967-3970.
• [21]Boehme CC, et al.: Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med 2010, 363(11):1005-1015.
• [22]WHO: WHO endorses new rapid tuberculosis test 2010. Geneva, World Health Organization. 2010. http://www.who.int/tb/features_archive/new_rapid_test/en webcite.