title: Diagnosis of tuberculous lymphadenitis in Butajira, rural Ethiopia.
abstract: Tuberculous lymphadenitis (TBLN) is a diagnostic challenge in sub-Saharan Africa, where there is a high rate of human immunodeficiency virus (HIV) infection. This study aimed to find ways to improve the diagnosis in Butajira, rural Ethiopia, where TBLN constitutes 40% of the total tuberculosis (TB) diagnosis. Among 147 clinically suspected cases, 107 (72.8%) were confirmed as TBLN by fine-needle aspiration (FNA) cytology and acid-fast bacillus (AFB) smear examination. Of the remaining 40 cases, denoted non-tuberculous lymphadenitis (NTBLN) after this smear examination, 37 (92.5%) showed a cytological pattern with neutrophil aggregates. The clinical manifestations were similar and cervical lymph nodes were the most affected in these 2 groups. 24 of the 107 TBLN cases (22.4%) and 9 (22.5%) of the other cases were seropositive for HIV infection (p > 0.5). FNA cytology combined with AFB smear examination is a good alternative to histology in rural Ethiopia where the expertise in taking biopsies is very limited. Polymerase chain reaction for Mycobacterium tuberculosis complex DNA was positive in 15 of 23 cases tested with NTBLN cytology, showing that an additional independent criterion for the presence of M. tuberculosis is needed for diagnosis in lymphadenitis cases of this kind. These findings could help to strengthen the diagnostic algorithm suggested by the National TB Control Program.
authors.affiliation: Southern Region Health Bureau, Awassa, Ethiopia
authors.forename: Mohammed Ahmed
authors.initials: MA
authors.lastname: Yassin
authors.forename: Joseph Okao
authors.initials: JO
authors.lastname: Olobo
authors.forename: Dawit
authors.initials: D
authors.lastname: Kidane
authors.forename: Yohannes
authors.initials: Y
authors.lastname: Negesse
authors.forename: Ezra
authors.initials: E
authors.lastname: Shimeles
authors.forename: Azeb
authors.initials: A
authors.lastname: Tadesse
authors.forename: Abebech
authors.initials: A
authors.lastname: Demissie
authors.forename: Sven
authors.initials: S
authors.lastname: Britton
authors.forename: Morten
authors.initials: M
authors.lastname: Harboe
authors.forename: Abraham
authors.initials: A
authors.lastname: Aseffa
authors.forename: Getahun
authors.initials: G
authors.lastname: Abate
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D004269:DNA, Bacterial / Q000032:analysis; D003906:Developing Countries; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006679:HIV Seropositivity; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D012720:Severity of Illness Index; D014374:Tuberculin Test; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D004269:DNA, Bacterial