Yassin Mohammed Ahmed, Olobo Joseph Okao, Kidane Dawit, Negesse Yohannes, Shimeles Ezra, Tadesse Azeb, Demissie Abebech, Britton Sven, Harboe Morten, Aseffa Abraham, Abate Getahun
Southern Region Health Bureau, Awassa, Ethiopia
Scand J Infect Dis. 2003;35(4):240-3. doi: 10.1080/00365540310004027.
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.
结核性淋巴结炎（TBLN）在撒哈拉以南非洲地区是一个诊断难题，该地区人类免疫缺陷病毒（HIV）感染率很高。本研究旨在寻找方法，以改善在埃塞俄比亚农村布塔吉拉的诊断情况，在该地TBLN占结核病（TB）总诊断数的40%。在147例临床疑似病例中，107例（72.8%）经细针穿刺（FNA）细胞学检查和抗酸杆菌（AFB）涂片检查确诊为TBLN。在其余40例病例中，经该涂片检查后诊断为非结核性淋巴结炎（NTBLN），其中37例（92.5%）呈现出中性粒细胞聚集的细胞学模式。这两组的临床表现相似，且颈部淋巴结受影响最为严重。107例TBLN病例中有24例（22.4%），其他病例中有9例（22.5%）HIV感染血清学检测呈阳性（p>0.5）。在埃塞俄比亚农村，活检专业技术非常有限，FNA细胞学检查联合AFB涂片检查是组织学检查的一个很好的替代方法。在23例经NTBLN细胞学检查的病例中，15例结核分枝杆菌复合群DNA聚合酶链反应呈阳性，这表明在这类淋巴结炎病例的诊断中，需要另一个独立的标准来确定结核分枝杆菌的存在。这些发现有助于加强国家结核病控制规划所建议的诊断算法。
