Haematogenous dissemination of tuberculous lymphadenitis.
OBJECTIVE
To determine whether Mycobacterium tuberculosis infection spreads through the blood to different lymph-node groups in patients with tuberculous lymphadenitis.


METHODS
Prospective analytical study.


METHODS
The patients were recruited, managed and followed at the lymphodenopathy clinic, Central Police Hospital, Burr, Khartoum, Sudan.


METHODS
Fifty two sequential patients were enrolled. Thirty patients with FNAC diagnosis of tuberculous lymphadenitis and positive PCR for M. tuberculosis complex had a mean age of 26.9 +/- 11.2 years and similar male, female affection. Nine patients with FNAC tuberculous lymphadenitis, but negative PCR had a slightly higher mean age (32.6 +/- 18.2 years) with similar male: female proportions. Patients with reactive lymphadenopathy (9/52) were older than patients with tuberculous lymphadenitis with a mean age of 45 +/- 24.6 years.


RESULTS
None of the patients were positive for HIV or had clinical or radiological evidence of pulmonary tuberculosis. M. tuberculosis DNA was detected in the blood samples of 30/39 (77%) patients with tuberculous lymphadenitis, but in none of the cases with reactive or malignant lymphadenopathy. The presence of M. tuberculosis DNA correlated strongly to multiple lymph-node involvement [OR (odds ratio) = 96.7, 95% confidence interval (CI) 9.0 - 1,039] and to caseating-granulomatous and predominantly necrotic cytomorphological categories [OR = 70, 95% confidence interval (CI) 7.0 - 703].


CONCLUSIONS
M. tuberculosis most probably disseminates through the blood from one node group to the other in patients with tuberculous lymphadenitis.
Sharafeldin
G S
GS
National Health Laboratory, Federal Ministry of Health, Khartoum, Sudan.
Khalil
E A G
EA
El Hag
I A
IA
Elsiddig
K E
KE
Elsafi
M E M O
ME
Aijafari
A S A
AS
Elnour
A A
AA
Hussein
A M
AM
Elkhidir
I M
IM
El-Hassan
A M
AM
D000328:Adult; D044963:Biopsy, Fine-Needle; D016001:Confidence Intervals; D004269:DNA, Bacterial / Q000097:blood; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D016017:Odds Ratio; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D013397:Sudan; D014388:Tuberculosis, Lymph Node / Q000097:blood* / Q000473:pathology
D004269:DNA, Bacterial