Molecular detection of Mycobacterium tuberculosis and its relationship to histopathological diagnosis in paraffin-embedded lymph node tissues
Keywords:Tuberculosis, Tuberculous lymphadenitis, TBL, Sudan
Background: Tuberculous lymphadenitis (TBL) is one of the most common forms of extra pulmonary tuberculosis (EPTB) worldwide, with difficulty in its diagnosis. And since in the Sudan, the routinely used method for diagnosis is conventional histopathology, the aim of this study was to confirm the histopathological diagnosis by polymerase chain reaction (PCR).
Methods: In this study 718 lymph node (LN) biopsies were retrieved, of which 161 were diagnosed as TBL (histopathological evidences). PCR technique was performed for all 161 positive samples to detect the IS6110 sequence of M. tuberculosis as well as to obtain the sensitivity and specificity of morphological diagnosis.
Results: Out of 161 specimens 135 (84%) were found to be positive with PCR, the remaining 26 (16%) were negative.
Conclusions: Although PCR indicated high sensitivity it can’t be a substitute for conventional histopathology in the diagnosis of tuberculous lymphadenitis in tissue.
Van den Broek J, Mfinanga S, Moshiro C, O'Brien R, Mugomela A, Lefi M. Impact of human immunodeficiency virus infection on the outcome of treatment and survival of tuberculosis patients in Mwanza, Tanzania. Int J Tuberc Lung Dis. 1998;2:547-52.
Small PM, Schecter GF, Goodman PC, Sande MA, Chaisson RE, Hopewell PC.. Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. N Engl J Med. 1991;324:289-94.
Gupta AK, Nayar M, Chandra M. Critical appraisal of fine needle aspiration cytology in tuberculous lymphadenitis. Acta Cytologica. 1992;36(3):391-4.
World Health organization (WHO).Tuberculosis. Available at:http://www.who.int/ mediacentre/ factsheets/fs104/en/index.html, 2010.
Public Health Agency of Canada. International Tuberculosis Incidence Rates. Available at: http://www.phac-aspc.gc.ca/tbpc-latb/itir-eng.php, 2012.
National tuberculosis control program (NTCP). Ministry of Health Sana’a Yemen. Annual Health Report 2003.
Vincent BY, William AK, Allan HG. Blueprints Medicine, Blackwell. 3rd edition, 2003.
Tekke M, Rahu M, Loit H M, Baburin A. Risk factors for pulmonary tuberculosis in Estonia. International Journal of Tuberculosis and Lung Disease. 2002;6(10):887-94.
Jasmer RM, Nahid P, Hopewell PC. Clinical practice, Latent tuberculosis infection. N Engl J. Med. 2002;347(23):1860-6.
Mfinanga SG, Morkve O, Sviland L. Patient knowledge, practices and challenges to health care system in early diagnosis of mycobacterial adenitis. East Afr Med J. 2005;82:173-80.
Grange JM. The rapid diagnosis of paucibacillary tuberculosis. Tubercle. 1989;70(1):1-4.
Amand ALS, Frank D N, De Groote M A, Basaraba RJ, Orme IM, Pace NR. Use of specific rRNA oligonucleotide probes for microscopic detection of Mycobacterium tuberculosis in culture and tissue specimens. J Clin Microbiol. 2005;43:5369-71.
Finfer MA, Burstein DE. Fine needle aspiration biopsy diagnosis of tuberculous lymphadenitis in patients with and without the acquired immune deficiency syndrome. Acta Cytologica. 1991;35(3): 325-32.
Woodard BH, Rosenberg S, Farnham R, Adams DO. Incidence and nature of primary granulomatous inflammation in surgically removed material. American Journal of Surgical Pathology. 1992;6(2):119-29.
Kumar N, Tiwari MC, Verma K. AFB staining in cytodiagnosis of tuberculosis without classical features: a comparison of Ziehl-Neelsen and fluorescent methods. Cytopathology. 1998;9(3):208-14.
Lake AM, Oski FA. Peripheral lymphadenopathy in childhood. Ten-year experience with excisional biopsy. American Journal of Diseases of Children. 1978;132(4):357-9.
Fatmi TI, Jamal Q. A morphological study of chronic granulomatous lymphadenitis with the help of special stains. Pakistan Journal of Medical Sciences. 2002;18(1):48-51.
Hussain GA, Akram S, Ibrahim G. Screening for Tuberculosis and Its Histological Pattern in Patients with Enlarged Lymph Node. SAGE-Hindawi Access to Research Pathology Research International. 2011;2011:Article ID 417635.
Chakaravorty S, Sen MK. Diagnosis of extra pulmonary tuberculosis by smear, culture, and PCR using universal sample processing technology. J Clin Microbiol. 2005;43:4357-62.
Therese KL, Jayanthi U, Madhavan HN. Application of nested polymerase chain reaction (nPCR) using MPB 64 gene primers to detect Mycobacterium tuberculosis DNA in clinical specimens from extrapulmonary tuberculosis patients. Indian J Med Res. 2005;122:165-70.
Park DY, Kim JY, Choi KU, Lee JS, Lee CH, Sol MY, et al. Comparison of polymerase chain reaction with histopathological features for diagnosis of tuberculosis in formalin-fixed, paraffin-embedded histologic specimens. Arch Pathol Lab Med. 2003;127:326-30.
Verma P, Jain1 A, Kumar S. Evaluation of Polymerase Chain Reaction (PCR) using hupB gene in diagnosis of tuberculosis in fine needle aspiration. Indian J Tuberc. 2010;57:128-33.
Chen YM, Lee PY, Su WJ, Perng RP. Lymph node tuberculosis: 7-year experience in veterans general hospital, Taipei, Taiwan. Tubercle and Lung Disease. 1992;73(6):368-71.
Nomani K, KaziB M, Ahmad K, Karamat KA.. Frequency of tuberculous cervical lymphadenitis detection at a single laboratory in Islamabad. Journal of the College of Physicians and Surgeons—Pakistan. 2007;7(7):410-2.