Raja Raadhika, Sreeramulu P N, Dave Prakash, Srinivasan D
Department of Surgery, Sri Devaraj Urs Medical College (Sri Devaraj Urs Academy of Higher Education and Research), Kolar, India.
J Clin Tuberc Other Mycobact Dis. 2020 Nov 19;21:100204. doi: 10.1016/j.jctube.2020.100204. eCollection 2020 Dec.
The most prevalent clinical entity of extra pulmonary tuberculosis is tuberculous lymphadenitis. However, it resembles other granulomatous conditions pathologically and obtaining tissue for microbiological diagnosis is also difficult. Thus it is a challenging task for diagnosis and early initiation of management. Fine needle aspiration cytology and biopsy are the diagnostic methods generally used to obtain the lymph node samples for histopathological and microbiological diagnosis. Mycobacterium culture on Lowenstein-Jensen medium remains the gold standard for definitive diagnosis, but its major limitations is a prolonged turn-around time of 2-4 weeks. The GeneXpert Mtuberculosis/RIF assay is a novel molecular diagnostic method for rapid diagnosis of tuberculosis and rifampicin resistance in clinical specimens.
This was a cross sectional analytical study conducted on 67 cases of suspected tubercular lymphadenitis at R.L Jalappa Hospital and Research Centre, Tamaka, Kolar. The study was carried out between December 2017 to June 2019. The samples were collected using excision biopsy and subjected to GeneXpert Mtuberculosis/RIF assay and histopathology. Further, sensitivity, specificity, positive predictive value and negative predictive value was measured and compared with histopathology.
The average age of the patients was 37.04 ± 19.27 and majority was males. The lymph nodes were predominantly present in cervical region. Histopathology analysis reveals 46 positive cases of tuberculosis Lymphadenitis and GeneXpert Mtuberculosis/RIF assay detects 42 cases of tuberculosis Lymphadenitis. In the present study, GeneXpert Mtuberculosis/RIF assay had a sensitivity of 82.60% and specificity of 85% when compared to histopathology. Further the PPV and NPV was found to be 92.68% and 68% respectively. GeneXpert Mtuberculosis/RIF showed 2 cases of rifampicin resistance out of 67 cases. In this study, the GeneXpert Mtuberculosis/RIF showed the results in 0.79 days.
The present study showed that GeneXpert Mtuberculosis/RIF is a simple and reliable technique for diagnosing tuberculosis Lymphadenitis with high specificity and sensitivity as compared histopathology. Further, the methods elicit rapid diagnosis and also detected rifampicin resistance. It is thus a reliable and useful diagnostic modality in rapid detection of the causative agent and initiation of appropriate category anti-tubercular therapy when necessary.
肺外结核病最常见的临床类型是结核性淋巴结炎。然而，其在病理上与其他肉芽肿性疾病相似，获取组织进行微生物学诊断也很困难。因此，诊断和尽早开始治疗是一项具有挑战性的任务。细针穿刺细胞学检查和活检是通常用于获取淋巴结样本以进行组织病理学和微生物学诊断的方法。在罗-琴培养基上进行分枝杆菌培养仍然是确诊的金标准，但其主要局限性是周转时间长达2-4周。GeneXpert MTB/RIF检测是一种用于临床标本中结核病快速诊断和利福平耐药性检测的新型分子诊断方法。
这是一项在科拉尔塔马卡的R.L贾拉帕医院和研究中心对67例疑似结核性淋巴结炎患者进行的横断面分析研究。研究于2017年12月至2019年6月进行。通过切除活检采集样本，并进行GeneXpert MTB/RIF检测和组织病理学检查。此外，测量了敏感性、特异性、阳性预测值和阴性预测值，并与组织病理学结果进行比较。
患者的平均年龄为37.04±19.27岁，大多数为男性。淋巴结主要分布在颈部区域。组织病理学分析显示46例结核性淋巴结炎阳性病例，GeneXpert MTB/RIF检测发现42例结核性淋巴结炎病例。在本研究中，与组织病理学相比，GeneXpert MTB/RIF检测的敏感性为82.60%，特异性为85%。此外，阳性预测值和阴性预测值分别为92.68%和68%。在67例病例中，GeneXpert MTB/RIF检测出2例利福平耐药病例。在本研究中，GeneXpert MTB/RIF检测结果在0.79天内得出。
本研究表明，与组织病理学相比，GeneXpert MTB/RIF是一种诊断结核性淋巴结炎的简单可靠技术，具有高特异性和敏感性。此外，该方法能快速诊断，还能检测出利福平耐药性。因此，它是一种在快速检测病原体和必要时启动适当类别的抗结核治疗方面可靠且有用的诊断方式。
