Tuberculosis or tularemia? A molecular study in cervical lymphadenitis.
BACKGROUND
Over the last two to three decades there has been a marked decrease in certain bacterial infections in Turkey. One of them is tuberculosis. Of note, statistics published by the Turkish Ministry of Health (MoH) show decreasing pulmonary tuberculosis (PTB), but on the other hand, increasing extrapulmonary tuberculosis (EPTB). The most common form of EPTB is tuberculous cervical lymphadenitis (TCL). The increase in the number of TCL cases despite the decline in cases of PTB is seen as a paradoxical issue. In contrast there has been an increase in the number of oropharyngeal tularemia cases in the last decade in Turkey. The aim of this study was to draw attention to the importance of differentiating between TCL and tularemia lymphadenitis, because these diseases may have a similar histopathological appearance.


METHODS
Thirty-two cases diagnosed as TCL were identified from the archives of a pathology laboratory (Patomer Pathology Laboratory, Bursa, Turkey). PCR tests for Francisella tularensis and Mycobacterium tuberculosis were carried out on the paraffin tissue blocks of these cases. At the same time, statistical data on PTB and EPTB for the period 1996-2010 were retrieved from the MoH and reviewed. Statistics related to tularemia, which has been diagnosed since 1988 and has been increasing in the last 10 years, were obtained from the Department of Zoonoses of the MoH.


RESULTS
Six out of 32 (19%) cases who had previously been diagnosed with 'casseifying granulomatous lymphadenitis consistent with tuberculosis' were found to be positive for tularemia by PCR test of the cervical lymph nodes.


CONCLUSIONS
Oropharyngeal tularemia should be kept in mind in the differential diagnosis of cervical lymphadenitis in widespread geographic regions of the Northern Hemisphere, including the Asian continent. In particular, if granulomatous inflammation with necrosis is seen histopathologically, tularemia should be excluded before making the diagnosis of TCL.
Pathology Laboratory, Bursa Military Hospital, Bursa, Turkey.
Sükrü
S
Yıldırım
Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpaşa Training Hospital, Istanbul, Turkey. Electronic address: vedatturhan@yahoo.com.
Vedat
V
Turhan
Department of Medical Microbiology, Kocaeli University, Kocaeli, Turkey.
Aynur
A
Karadenizli
Department of Internal Medicine, GATA Haydarpaşa Training Hospital, Istanbul, Turkey.
Yalçın
Y
Önem
Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpaşa Training Hospital, Istanbul, Turkey.
Ergenekon
E
Karagöz
Department of Infectious Diseases and Clinical Microbiology, Samsun 19 Mayıs University, Samsun, Turkey.
Cafer
C
Eroğlu
Department of Tuberculosis and Chest Diseases, GATA Haydarpaşa Training Hospital, Istanbul, Turkey.
Faruk
F
Çiftçi
D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005604:Francisella tularensis / Q000302:isolation & purification; D006801:Humans; D008199:Lymphadenitis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis* / Q000473:pathology; D014406:Tularemia / Q000175:diagnosis* / Q000473:pathology; D014421:Turkey; D055815:Young Adult
Cervical lymphadenitis; Francisella tularensis; Mycobacterium tuberculosis; Oropharyngeal tularemia; PCR; Tuberculosis; Tularemia