HOW DOES CLINICAL DIAGNOSIS OF MYCOBACTERIAL ADENITIS CORRELATE WITH HISTOLOGICAL FINDINGS?
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East African Public Health Association
Abstract
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Objective: To describe and compare histopathological findings with
clinical criteria in diagnosis of TB adenitis. Methods: Lymph node
biopsies were obtained from 213 patients. Specimens were processed for
culture and histopathologic examination, using standard methods. One
hundred blocks with good preservation of tissue morphology were
selected for detailed histological examination. Results: About 75% of
213 patients had granulomas. In the remaining 25%, neither
histopathological nor microbiological evidence of mycobacterial disease
was found. Of 100 blocks selected for detailed examination, 79 blocks
had granulomatous changes. The granulomas were well organised in 24%,
mixed in 33%, and poorly organised in 43%. Langhans giant cells and
acid-fast bacilli were observed in 88.6% and 21.5% of the 79 blocks,
respectively. Cultured specimens were positive in about 10% of 79
biopsy specimens. Conclusions: Histological evidence of mycobacterial
disease was only found in three quarters of patients that were
clinically diagnosed and started on empirical treatment for tuberculous
adenitis. Neither histological nor mycobacteriological evidence was
found in a quarter of the patients who were already on treatment for
TB, basing on clinical criteria. These findings call for new research
on simple diagnostic tools for patients who seek care for symptoms of
extra-pulmonary TB.
Keywords
Tuberculosis adenitis, Granuloma, Treatment, Tanzania
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