Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.
Aix Marseille Université, IRD, APHM, VITROME, IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.
Eur J Clin Microbiol Infect Dis. 2018 Jun;37(6):1179-1186. doi: 10.1007/s10096-018-3238-2. Epub 2018 Mar 29.
Molecular methods have been considered to be the gold standard for the diagnosis of infectious lymphadenitis. However, culture remains critical in the case of low bacterial concentrations. We used molecular assays and culture to examine fresh lymph node biopsies from patients with suspected infectious lymphadenopathy. We analyzed 1762 lymph node biopsies of which 522 (30%) samples were found positive by real-time PCR; the most commonly amplified bacteria were Bartonella henselae (n = 438, 84%), Francisella tularensis (n = 46, 9%), and Mycobacterium spp. (n = 29, 6%). PCR amplification and sequencing of the 16S rDNA were positive for 359 (20%) lymph node specimens including mainly B. henselae (n = 167, 47%), Staphylococcus spp. (n = 77, 21%), and Streptococcus spp. (n = 41, 11%). In total, 351 lymph nodes were cultured on agar plates and 77 (22%) were positive. Significantly more lymph nodes infected by Gram-positive easy-growing agents were diagnosed by culture (n = 45) than by 16S rDNA PCR (p = 0.02). Culture remains critical for the diagnosis of easy-growing bacteria and mycobacteria; clinicians should be aware that a negative molecular result does not imply absence of infection.
分子方法被认为是诊断感染性淋巴结炎的金标准。然而，在细菌浓度较低的情况下，培养仍然至关重要。我们使用分子检测法和培养法检查了疑似感染性淋巴结病患者的新鲜淋巴结活检样本。我们分析了 1762 份淋巴结活检样本，其中 522 份（30%）实时 PCR 检测为阳性；最常扩增的细菌是汉赛巴尔通体（n=438，84%）、土拉弗朗西斯菌（n=46，9%）和分枝杆菌属（n=29，6%）。359 份（20%）淋巴结标本的 16S rDNA PCR 扩增和测序呈阳性，主要包括汉赛巴尔通体（n=167，47%）、葡萄球菌属（n=77，21%）和链球菌属（n=41，11%）。总共在琼脂平板上培养了 351 个淋巴结，其中 77 个（22%）为阳性。通过培养（n=45）诊断的易生长革兰阳性菌感染的淋巴结明显多于 16S rDNA PCR（p=0.02）。培养对于易生长细菌和分枝杆菌的诊断仍然至关重要；临床医生应该意识到，阴性的分子结果并不意味着没有感染。
