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Aims and Obctives: To compare FNAC, microscopy (ZN staining), histopathology and CBNAAT for diagnosis of head and neck tuberculosis, and to evaluate efficacy of CBNAAT in early diagnosis of tuberculosis in head and neck region. Materials and methods: This prospective study was carried out in the department of otorhinolaryngology, JLN Medical College and attached hospital, Ajmer from August 2020 to September 2022. Thorough history and clinical examination of all patients presented with neck swelling was done. All relevant investigations including chest x-ray, mantoux test, ESR, FNAC, ZN staining, CBNAAT and histopathology were done and their efficacy was compared. Results: Sensitivity and specificity of CBNAAT in detecting extra pulmonary tuberculosis was 85.19% and 91.30% respectively, and diagnostic accuracy was consistent with findings of FNAC and ZN staining (p < 0.001) for diagnosis of cervical lymphadenopathy. Conclusion: CBNAAT has a promising role in early diagnosis of head and neck tuberculosis as well as other cases of smear negative tuberculosis such as MDR TB and TB-HIV and is optimal for the diagnosis of lymph node tuberculosis and helps in early identification and initiation of treatment. Sensitivity of CBNAAT scored twice as high in comparison with microscopy thus doubling the proportion of rapid diagnoses with important effect on the patient's outcome. [ABSTRACT FROM AUTHOR]

Hoarseness of voice due to unilateral vocal cord palsy as the first clinical presentation of tuberculosis (TB) has been rarely reported. A 15-year-old female presented with a sole history of hoarseness of voice for the past 4 months. Axial computed tomography (CT) at the level of vocal cords revealed dilation of the left laryngeal ventricle with ipsilateral deviation of arytenoid cartilage (sail sign), suggestive of left vocal cord palsy. Thoracic CT revealed multiple necrotic mediastinal lymphadenopathy, which on endoscopic ultrasound-guided biopsy confirmed TB. She was started on regular antitubercular therapy, and her voice significantly improved after 1 month. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a potentially curable disease that is a leading cause of death globally. While it typically affects the lungs, this disease may involve many extra-pulmonary sites, particularly in patients with risk factors. Extra-pulmonary TB often mimics a variety of different diseases, posing a diagnostic dilemma. Imaging aids in early diagnosis of TB, especially in patients with non-specific or atypical symptoms found at extra-pulmonary infra-thoracic locations. Imaging also helps guide appropriate laboratory investigation, monitor disease progress, and response to treatment. This review aims to highlight the imaging spectrum of TB affecting the infra-thoracic region, that is, gastrointestinal tract, abdominal lymph nodes, peritoneal cavity, intra-abdominal solid organs, and urogenital system. [ABSTRACT FROM AUTHOR]

Background and Objectives: The incidence of tuberculosis lymphadenopathy (TBLA) is increasing, and diagnostic procedures lack sensitivity and are often highly invasive. TBLA may be asymptomatic, and differential diagnosis with other adenopathies (ADPs) is difficult. We evaluated a blood-cell interferon-γ release assay (IGRA) with two different stage-specific mycobacterial antigens for the differential diagnosis of ADP suspected of mycobacterial origin. Methods: Twenty-one patients were included and divided into three groups: (1) cervical/axillar ADP (n = 8), (2) mediastinal ADP (n = 10), and (3) disseminated ADP (n = 3). The mycobacterial antigens used for the IGRA were the heparin-binding haemagglutinin (HBHA) and the early-secreted antigenic target-6 (ESAT-6), a latency-associated antigen and a bacterial replication-related antigen, respectively. Diagnosis of TBLA based on microbiological results and/or response to anti-TB treatment was obtained for 15 patients. Results: An IGRA profile highly suggestive of active TB (higher IFN-γ response to ESAT-6 compared to HBHA) was found for 3/6 TBLA patients from group 1, and for all the TBLA patients from groups 2 and 3, whereas this profile was not noticed in patients with a final alternative diagnosis. Conclusion: These results highlight the potential value of this combined HBHA/ESAT-6 IGRA as a triage test for the differential diagnosis of ADP. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to determine the clinical manifestations and epidemiology of extrapulmonary tuberculosis (EPTB) of the head and neck in the otorhinolaryngeal regions. There is an increase in the incidence of EPTB in recent years because of increase in immunocompromised states and development of resistant bacteria. The clinical symptoms and signs of EPTB of the otorhinolaryngeal regions overlap with that of malignancies and other diseases in otorhinolaryngology thereby requiring correct early diagnosis so as to avoid unnecessary surgeries and procedures with initiation of appropriate anti tuberculous treatment under RNTCP. Study design: Our prospective study was done on 45 patients who attended the ENT OPD at a tertiary care centre in Southern India over a period of 18 months with diagnosed EPTB of the otorhinolaryngeal regions. Results: The study included 29 (64.4%) patients who presented with cervical lymphadenopathy, 11 (24.4%) patients with tuberculous laryngitis, 3 (6.6%) patients with tuberculous otitis media and 1 each with nasal and oral cavity tuberculosis. In our study 6 (13.3%) patients had co-existing pulmonary tuberculosis, 8 (18%) had diabetes, 5 (11%) had past history of tuberculosis and 7 (16%) had contact with patient with tuberculosis. Conclusion: A high index of suspicion of EPTB must be kept among patients where (i) the clinical symptoms are out of proportion to the signs, (ii) common treatment fails or (iii) there is persistence or recurrence of symptoms despite therapy. The challenge is in confirming diagnosis which requires histopathological examination (HPE) of the tissue specimen. The timely diagnosis and initiation of anti tuberculous treatment (ATT) as per RNTCP helps in complete recovery thereby reducing morbidity. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of isolated mediastinal tuberculosis (TB) can be challenging. Endobronchial ultrasound (EBUS) increases the diagnostic yield by direct sonographic visualization of mediastinal and hilar lymph nodes. With the advent of molecular techniques such as Gene Xpert, their addition to the cytology and cultures increases the diagnostic yield and detection of rifampicin resistance (RR) which helps change the effective therapeutic regimen immediately. Materials and Methods: Prospective analysis of all patients undergoing EBUS-guided transbronchial needle aspiration (EBUS-TBNA) with a clinical possibility of TB in isolated mediastinal lymphadenopathy patients at a tertiary care referral center between June 2016 and January 2018. All patients had at least five passes from each node of which two passes from each lymph node sampled in 2 ml of saline for culture and Gene Xpert for microbiologic, pathologic, and molecular analysis as per hospital protocol. Results: Out of 60 patients, 44 were diagnosed to have mediastinal tuberculous lymphadenitis, 8 sarcoidosis, 2 malignancies, and 6 reactive lymphadenitis. TBNA cytology was positive in 40/44 patients (90.9%), out of which 18 patients were culture positive with the sensitivity of 100%, specificity 47.6%, positive predictive value (PPV) 45%, and negative predictive value (NPV) 100%, (P value 0.011). TBNA acid-fast bacilli (AFB) smear was positive in 20/44 patients (45.45%) out of which 12 were culture positive, with sensitivity of 67%, specificity 80.95%, PPV 60%, NPV 85% (P value 0.011). TBNA Gene Xpert was positive in 30/44 patients (68.2%), out of which 6 (13.63%) showed RR-TB and two were cytology negative. Sixteen patients where culture positive with sensitivity of 88.89%, specificity 66.67%, PPV 53.33%, NPV 93.33% (P value of 0.005). TBNA AFB culture was positive in 18/44 patients (40.9%). Conclusion: EBUS-TBNA is an effective and safe diagnostic tool for intrathoracic TB, especially for mediastinal tuberculous lymphadenitis. The combination of various tests increases the diagnostic yield. Mediastinal nodal aspirates traditionally believed to be paucibacillary can still be captured by Gene Xpert.

Background: Tuberculous lymphadenopathy is an extremely common condition in developing countries; however, vocal cord paralysis secondary to compression by enlarged tuberculous lymph node is an extremely rare presentation. Case Presentation: In this paper, we present the case of a 72-year-old male patient who came to us with concerns of hoarseness of voice for the last eight months with fever and chills. He had been treated previously at ear, nose and throat (ENT) clinics and on evaluation, we discovered he had left vocal cord paralysis. Imaging showed multiple enlarged mediastinal and right hilar lymph nodes. Management & Results: Mediastinoscopy with biopsy was done and after histopathologic confirmation of tuberculosis, the patient was prescribed antituberculous treatment. Conclusion: Antituberculous treatment in such patients shows signs of clinical and radiologic improvement.

Background: Diagnosis of isolated mediastinal tuberculosis (TB) can be challenging. Endobronchial ultrasound (EBUS) increases the diagnostic yield by direct sonographic visualization of mediastinal and hilar lymph nodes. With the advent of molecular techniques such as Gene Xpert, their addition to the cytology and cultures increases the diagnostic yield and detection of rifampicin resistance (RR) which helps change the effective therapeutic regimen immediately. Materials and Methods: Prospective analysis of all patients undergoing EBUS-guided transbronchial needle aspiration (EBUS-TBNA) with a clinical possibility of TB in isolated mediastinal lymphadenopathy patients at a tertiary care referral center between June 2016 and January 2018. All patients had at least five passes from each node of which two passes from each lymph node sampled in 2 ml of saline for culture and Gene Xpert for microbiologic, pathologic, and molecular analysis as per hospital protocol. Results: Out of 60 patients, 44 were diagnosed to have mediastinal tuberculous lymphadenitis, 8 sarcoidosis, 2 malignancies, and 6 reactive lymphadenitis. TBNA cytology was positive in 40/44 patients (90.9%), out of which 18 patients were culture positive with the sensitivity of 100%, specificity 47.6%, positive predictive value (PPV) 45%, and negative predictive value (NPV) 100%, (P value 0.011). TBNA acid-fast bacilli (AFB) smear was positive in 20/44 patients (45.45%) out of which 12 were culture positive, with sensitivity of 67%, specificity 80.95%, PPV 60%, NPV 85% (P value 0.011). TBNA Gene Xpert was positive in 30/44 patients (68.2%), out of which 6 (13.63%) showed RR-TB and two were cytology negative. Sixteen patients where culture positive with sensitivity of 88.89%, specificity 66.67%, PPV 53.33%, NPV 93.33% (P value of 0.005). TBNA AFB culture was positive in 18/44 patients (40.9%). Conclusion: EBUS-TBNA is an effective and safe diagnostic tool for intrathoracic TB, especially for mediastinal tuberculous lymphadenitis. The combination of various tests increases the diagnostic yield. Mediastinal nodal aspirates traditionally believed to be paucibacillary can still be captured by Gene Xpert. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate effectiveness of the apparent diffusion coefficient (ADC) values of the peripancreatic lymphadenopathy to differentiate tuberculous lymphadenopathy from metastatic lymphadenopathy. Materials and methods: Twenty-nine patients with 65 peripancreatic necrotic tuberculous lymphadenopathy and 31 patients with 47 peripancreatic necrotic metastatic lymphadenopathy from pancreatic ductal adenocarcinoma, who underwent magnetic resonance imaging (MRI), were included in this study. MRI features in the T1-weighted image (WI), T2WI, and diffusion-weighted image were analyzed. The ADC values of necrotic and non-necrotic portions of the lymph nodes were measured and compared using t test. Receiver operating characteristic analysis was performed to obtain the optimal ADC threshold value and diagnostic accuracy for differentiating tuberculous lymphadenopathy from metastatic lymphadenopathy. Results: On T2WI, the signal intensity of necrotic portions was variable in tuberculous lymphadenopathy, but was mostly high in metastatic lymphadenopathy. The mean ADCs of necrotic portions of tuberculous lymphadenopathy were significantly lower than those of metastatic lymphadenopathy ([0.919 ± 0.272] × 10−3 mm2/s vs. [1.553 ± 0.406] × 10−3 mm2/s, p < 0.001). Receiver operating characteristic analysis for differentiating tuberculous from metastatic lymphadenopathy demonstrated an area under the curve for the ADC values of necrotic portions of 0.929 (95% CI, 0.865–0.969) with an ADC threshold of 1.022. The sensitivity and specificity for the differentiation of tuberculous from metastatic lymphadenopathy were 80.0% and 97.8%, respectively. Conclusion: The ADC values of necrotic portions of peripancreatic lymphadenopathy may be useful for differentiating tuberculous from metastatic lymphadenopathy. [ABSTRACT FROM AUTHOR]

Background: The incidence of tuberculosis (TB) is changing in India. The commonest extra pulmonary manifestation of TB is tuberculous lymphadenitis. Aims and objectives: To detect changes in occurrence of TB lymphadenitis by comparing current data with that from 10 years back. Methods: Fine Needle Aspiration Cytology (FNAC) findings of patients presenting with lymphadenopathy between January 2014 and December 2015 were included in the study as current data. Cases of TB lymphadenitis were analysed for cyto-morphological patterns and frequency of acid fast bacilli (AFB) positivity. Cytological data of patients with lymphadenopathy between January 2002 and December 2003, were collected from records. Subsequently, comparison was done between previous data and current observation. Results: Total 302 cases of lymphadenopathy were included in 2014 and 2015. Tuberculous lymphadenitis accounted for 96 (31.7%) cases, among which AFB was present in 47 (49%) cases. Data collected from registers of the years 2002 and 2003 included 318 cases where tuberculous lymphadenitis accounted for 161 (50.6%) cases and AFB was detected in 101 (63%) patients. Maximum AFB positivity was found in smears with caseous necrosis only. Conclusion: Presently occurrence of TB lymphadenopathy has reduced compared to the period of 2002–2003. Despite this declining trend, the disease continues to be one of the leading causes of lymphadenopathy in both periods.

Background. Diagnosis of pulmonary tuberculosis (PTB) in children remains difficult. Lateral chest radiographs are frequently used to facilitate diagnosis, but interpretation is variable. In this study, lateral chest radiographs (CXRs) are evaluated against sagittal CT reconstructions for the detection of mediastinal lymphadenopathy. Aim. To correlate suspected lymphadenopathy on lateral CXR with sagittal CT reconstructions and determine which anatomical group of lymph nodes contributes to each lateral CXR location. Methods and materials. Thirty TB-positive children’s lateral CXRs were retrospectively reviewed for presence of mediastinal lymphadenopathy in 3 pre-determined locations in relation to the carina: retrocarinal, subcarinal and precarinal. Findings of the CT sagittal reconstructions were then correlated with the CXRs for the presence of lymphadenopathy in the same 3 pre-determined areas across the width of the mediastinum. Axial and coronal CT crossreferencing confirmed the position of the lymphadenopathy. Results. The most frequent locations for lymphadenopathy were the subcarinal (28) and right hilar (25). Sensitivity and specificity values of the CXRs were moderate, with the precarinal region having the best sensitivity and specificity for presence of lymphadenopathy. Contribution to each zonal group on lateral CXR were from multiple anatomical lymph node sites. Conclusion. The precarinal zone on CXR had the best specificity and sensitivity, and represented mainly subcarinal and right hilar lymph node groups. Attention should be paid to this area on lateral CXRs for detecting lymphadenopathy in children with suspected PTB.

156 patients suffering from tuberculous lymphadenopathy (TL) were examined at the Republican AIDS Center and the Republican Specialized Applied Research Medical Center of Phthisiology and Pulmonology. based on the obtained results we suggest on the apparent exacerbation of TL in case of HIV infection. Thereat, symptoms changed along with the rapid development of HIV terminal stage. The clinical signs of TL in HIV-infected patients include a great variety of symptoms of local and general origin. TL course as compared with that in non-HIV patients especially in the progression stage is far severer and contributes to the mortality in patients reported with such comorbidity. The clinical pattern features of concurrent TL and HIV-infection have been associated with the progressive formation of infectious and toxic syndrome. [ABSTRACT FROM AUTHOR]

Background: FNAC is considered as a reliable and inexpensive test for diagnosing lymphadenopathy cases with a high degree of accuracy. The objective of this study was to determine the cytomorphological pattern of superficial lymph node aspirates. Material & Methods: This cross-sectional study was conducted in the Department of Pathology, Bannu Medical College, Bannu, Pakistan from October, 2012 to September, 2013. All patients with superficial lymphadenopathy were included in the study. Patients with a history of less than four weeks lymphadenopathy, having acute inflammatory process in the draining area or having lymphadenopathy due to known primary malignancy were excluded. The demographic variables were sex, age in years and age grouping. The research variables were site and cause of lymphadenopathy. Age grouping was; up to 15 years, 16-40 years and above 40 years. Results: Out of 235 cases, there were 110(46.80%) males and 125(53.20%) females. The mean age of the sample was 35.00±13.50 (05-70) years. The frequency of age group up to 15 years was 82(34.90%), of 16-40 years was 50(21.27%) and of above 40 years was 103(43.83%). Site of lymphadenopathy were; left cervical lymph nodes in 105 (44.68%), right cervical lymph nodes in 60(25.53%), bilateral cervical lymph nodes in 11(4.68%), axillary lymph nodes in 30(12.76%), and other sites were involved in 29(12.35%) cases. The most cause of lymphadenopathy was chronic granulomatous lymphadenitis in 110 (46.8%). Conclusion: Fine needle aspiration cytology is a good diagnostic tool in diagnosis of lymphadenopathy and will significantly enhance the institution of timely and appropriate treatment regimens.

Cystic pancreatic neoplasms are tumors with malignant potential treated surgically. Isolated tuberculosis of celiac lymph nodes is rare, treatment of this entity being non-surgical. Radiological appearances of cystic pancreatic neoplasm and tuberculous peripancreatic lymph nodal mass is similar and difficult to differentiate. Here we present a case of mass lesion in the region of pancreatic head mimicking cystic pancreatic neoplasm which was actually abdominal tuberculous lymphadenopathy proven by biopsy. [ABSTRACT FROM AUTHOR]

Background: FNAC is considered as a reliable and inexpensive test for diagnosing lymphadenopathy cases with a high degree of accuracy. The objective of this study was to determine the cytomorphological pattern of superficial lymph node aspirates. Material & Methods: This cross-sectional study was conducted in the Department of Pathology, Bannu Medical College, Bannu, Pakistan from October, 2012 to September, 2013. All patients with superficial lymphadenopathy were included in the study. Patients with a history of less than four weeks lymphadenopathy, having acute inflammatory process in the draining area or having lymphadenopathy due to known primary malignancy were excluded. The demographic variables were sex, age in years and age grouping. The research variables were site and cause of lymphadenopathy. Age grouping was; up to 15 years, 16-40 years and above 40 years. Results: Out of 235 cases, there were 110(46.80%) males and 125(53.20%) females. The mean age of the sample was 35.00±13.50 (05-70) years. The frequency of age group up to 15 years was 82(34.90%), of 16-40 years was 50(21.27%) and of above 40 years was 103(43.83%). Site of lymphadenopathy were; left cervical lymph nodes in 105 (44.68%), right cervical lymph nodes in 60(25.53%), bilateral cervical lymph nodes in 11(4.68%), axillary lymph nodes in 30(12.76%), and other sites were involved in 29(12.35%) cases. The most cause of lymphadenopathy was chronic granulomatous lymphadenitis in 110 (46.8%). Conclusion: Fine needle aspiration cytology is a good diagnostic tool in diagnosis of lymphadenopathy and will significantly enhance the institution of timely and appropriate treatment regimens. [ABSTRACT FROM AUTHOR]

Lymph node tuberculosis is the most frequent form of extrapulmonary tuberculosis, especially in immunocompromised patients. We have studied patients with proven lymph node tuberculosis in the Department of Infectious Diseases at Pitie´-Salpeˆtrie&grave;re Hospital, Paris, between January 1997 and January 2002. Clinical presentation, microbiological diagnosis and treatment were analyzed in 13 HIV infected and 19 non-HIV infected patients. A risk factor for tuberculosis was present in all cases (HIV infection, immigration, life in community, poverty, past history of tuberculosis and IVDU). The median duration between the onset of symptoms and diagnosis was longer for HIV infected (2 months) compared with non-HIV infected patients (1 month). At the time of the diagnosis, general symptoms were present in >50% of patients of both groups. In HIV infected patients, abdominal lymph node involvement was more frequent (P < 0.05). All the non-HIV infected and 85% of HIV infected patients had peripheral adenopathies. A pulmonary tuberculosis was noted in more than half of the cases (53% non-HIV and 69% HIV patients). Inflammatory parameters and liver function tests were frequently abnormal in both groups. Hyponatremia was more frequent in HIV patients (P < 0.05). TB skin testing was more frequently positive and phlyctenular in non-HIV infected patients (P < 0.05). In this study, direct examination of the needle aspirate from infected lymph nodes was rarely positive; cultures were more frequently positive after biopsy compared to needle-aspiration. The median duration of treatment was 9 months for the two groups (6–24 months). Three HIV infected patients were infected by mycobacteria resistant to at least one antibiotic (isoniazid, 1; rifampicin, 1; isoniazid, streptomycin, etambutool, 1). All the patients recovered. [Copyright &y& Elsevier]

Abstract: A previously healthy 33 year old lady presented with acute dysphagia with endoscopic and CT features of oesophageal carcinoma. Endoscopic ultrasound (EUS) revealed a large subcarinal lymph node compressing at the mid-oesophagus. Fine-needle aspiration (FNA) showed a single well-formed epithelioid granuloma with no evidence of malignancy. Molecular analysis showed the aspirate to be positive for Mycobacterium tuberculosis. She continues to improve with standard anti-TB medication without surgery. This is a rare case of acute dysphagia secondary to primary tuberculous mediastinal lymphadenopathy. EUS and FNA have completely altered the clinical management of this lady. [ABSTRACT FROM AUTHOR]