结核还是野兔热？颈部淋巴结炎的分子研究。

Tuberculosis or tularemia? A molecular study in cervical lymphadenitis.

机构信息

Pathology Laboratory, Bursa Military Hospital, Bursa, Turkey.

Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpaşa Training Hospital, Istanbul, Turkey.

出版信息

Int J Infect Dis. 2014 Jan;18:47-51. doi: 10.1016/j.ijid.2013.09.004. Epub 2013 Oct 22.

DOI:10.1016/j.ijid.2013.09.004

PMID:24239221

Abstract

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.

摘要

背景

在过去的二三十年中，土耳其的某些细菌感染明显减少。其中之一是结核病。值得注意的是，土耳其卫生部（MoH）公布的统计数据显示，肺结核（PTB）减少，但另一方面，肺外结核病（EPTB）增加。EPTB 最常见的形式是结核性颈淋巴结炎（TCL）。尽管 PTB 病例减少，但 TCL 病例数的增加被视为一个矛盾的问题。相反，在过去十年中，土耳其口腔土拉菌病的病例数有所增加。本研究旨在提请人们注意区分 TCL 和土拉菌病性淋巴结炎的重要性，因为这两种疾病可能具有相似的组织病理学表现。

方法

从一家病理实验室（土耳其布尔萨的 Patomer 病理实验室）的档案中确定了 32 例诊断为 TCL 的病例。对这些病例的石蜡组织块进行了弗朗西斯菌和结核分枝杆菌的 PCR 检测。同时，从 MoH 检索了 1996 年至 2010 年期间关于 PTB 和 EPTB 的统计数据，并进行了审查。从 MoH 动物传染病系获得了自 1988 年以来一直在增加的近 10 年来诊断出的土拉菌病的相关统计数据。