Diagnosing mycobacterial lymphadenitis in children using fine needle aspiration biopsy: Cytomorphology, ZN staining and autofluorescence-making more of less

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dc.contributor.authorWright C.A.
dc.contributor.authorVan Der Burg M.
dc.contributor.authorGeiger D.
dc.contributor.authorNoordzij J.G.
dc.contributor.authorBurgess S.M.
dc.contributor.authorMarais B.J.
dc.date.accessioned2011-05-15T16:16:15Z
dc.date.available2011-05-15T16:16:15Z
dc.date.issued2008
dc.description.abstractAlthough the incidence of TB has stabilized or declined in most world regions, it is increasing in Africa, Southeast Asia, and the Eastern Mediterranean, fuelled by the HIV pandemic. More than 4,000 people died daily from TB-related illnesses in 2005. TB is a major cause of childhood morbidity and mortality in these developing countries, and there is an urgent need for rapid and definitive modalities for mycobacterial diagnosis in children. This prospective study in Tygerberg Hospital, Cape Town, South Africa, evaluates the ability of fine needle aspiration biopsy (FNAB) to diagnose mycobacterial lymphadenitis in children, using cytomorphology, autofluorescence on Papanicolaou stained smears, Ziehl-Nielsen (ZN) staining and/or culture. FNABs were performed on 200 children, and 25 (12.5%) aspirates were inadequate. Cultures were positive in 79/175 (45%); Mycobacterium tuberculosis was identified in 61 and Mycobacterium bovis BCG in 18 cases. Using culture as the gold standard, the concordance of the different techniques was as follows: cytomorphology 70%, ZN staining 73%, and autofluorescence 68%. Using an alternative gold standard (culture positive and/or suggestive cytomorphology plus positive autofluorescence or ZN smear), the "true" diagnostic performance of the various techniques was as follows: cytomorphology - sensitivity 78%, specificity 91%, positive predictive value (PPV) 93%, ZN staining - sensitivity 62%%, specificity 97%, PPV 97%; autofluorescence - sensitivity 67%, specificity 97%, PPV 97%; and culture - sensitivity 75%, specificity 100%, and PPV 100%. FNAB was shown to provide a rapid and definitive diagnosis in the majority of cases of suspected tuberculous lymphadenitis in children, based on cytomorphology and identification of the organism. © 2008 Wiley-Liss, Inc.
dc.description.versionArticle
dc.identifier.citationDiagnostic Cytopathology
dc.identifier.citation36
dc.identifier.citation4
dc.identifier.issn87551039
dc.identifier.other10.1002/dc.20788
dc.identifier.urihttp://hdl.handle.net/10019.1/13696
dc.subjectantibiotic agent
dc.subjectarticle
dc.subjectaspiration biopsy
dc.subjectautofluorescence
dc.subjectbacterium culture
dc.subjectcell structure
dc.subjectchild
dc.subjectchild care
dc.subjectcontrolled study
dc.subjectdiagnostic procedure
dc.subjectfemale
dc.subjecthuman
dc.subjectlymphadenitis
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectMycobacterium bovis
dc.subjectMycobacterium tuberculosis
dc.subjectPapanicolaou test
dc.subjectpriority journal
dc.subjectsensitivity and specificity
dc.subjecttuberculosis
dc.subjectBiopsy, Fine-Needle
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectCulture Techniques
dc.subjectFemale
dc.subjectFluorescence
dc.subjectHumans
dc.subjectImmunocompromised Host
dc.subjectInfant
dc.subjectMale
dc.subjectMycobacterium bovis
dc.subjectMycobacterium tuberculosis
dc.subjectPredictive Value of Tests
dc.subjectProspective Studies
dc.subjectSouth Africa
dc.subjectStaining and Labeling
dc.subjectTuberculosis, Lymph Node
dc.titleDiagnosing mycobacterial lymphadenitis in children using fine needle aspiration biopsy: Cytomorphology, ZN staining and autofluorescence-making more of less
dc.typeArticle
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