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PubMed2004

Real-time PCR assay using fine-needle aspirates and tissue biopsy specimens for rapid diagnosis of mycobacterial lymphadenitis in children.

A real-time PCR assay was developed to diagnose and identify the causative agents of suspected mycobacterial lymphadenitis. Primers and probes for the real-time PCR were designed on the basis of the internal transcribed spacer sequence, enabling the recognition of the genus Mycobacterium and the species Mycobacterium avium and M. tuberculosis. The detection limit for the assay was established at 1,100 CFU/ml of pus, and the specificity tests showed no false-positive reaction with other mycobacterial species and other pathogens causing lymphadenitis. From 67 children with suspected mycobacterial lymphadenitis based on a positive mycobacterial skin test, 102 samples (58 fine-needle aspirates [FNA] and 44 tissue specimens) were obtained. The real-time PCR assay detected a mycobacterial infection in 48 patients (71.6%), whereas auramine staining and culturing were positive for 31 (46.3%) and 28 (41.8%) of the patients. The addition of the real-time PCR assay to conventional diagnostic tests resulted in the recognition of 13 more patients with mycobacterial disease. These results indicate that the real-time PCR is more sensitive than conventional staining and culturing techniques (P = 0.006). The M. avium-specific real-time PCR was positive for 38 patients, and the M. tuberculosis-specific real-time PCR was positive for 1 patient. Analysis of 27 patients from whom FNA and tissue biopsy specimens were collected revealed significantly more positive real-time PCR results for FNA than for tissue biopsy specimens (P = 0.003). Samples from an age-matched control group of 50 patients with PCR-proven cat scratch disease were all found to be negative by the real-time PCR. We conclude that this real-time PCR assay with a sensitivity of 72% for patients with lymphadenitis and a specificity of 100% for the detection of atypical mycobacteria can provide excellent support for clinical decision making in children with lymphadenitis.

Base Sequence↗

PubMedDate not supplied

Toxoplasma lymphadenitis. Analysis of cytologic and histopathologic criteria and correlation with serologic tests.

OBJECTIVE: To identify cases of Toxoplasma lymphadenitis by light microscopic examination of fine needle aspiration cytology (FNAC) smears and paraffin sections and to correlate the result with those of serologic tests. STUDY DESIGN: The study group consisted of 19 cases of Toxoplasma lymphadenitis, 7 of which were diagnosed by FNAC, 9 on excision biopsy and 3 on FNAC followed by biopsy. Nineteen cases of reactive lymphadenitis, tuberculosis and infectious mononucleosus composed the control group. Sera from all 38 patients were screened for antibodies to Toxoplasma. RESULTS: Eleven of 19 cases (58%) of Toxoplasma adenitis had very high titers of antibody (> 300 ELISA units/ml), and 6 cases (31%) had antibody titers in a range suggestive of active infection (210-300 ELISA units/mL) and required demonstration of rising titers. Overall, 89% of patients with Toxoplasma lymphadenitis showed significant levels of antibody. All patients from the control group showed consistently low levels of antibody to Toxoplasma. CONCLUSION: Though serologic tests are mandatory for the diagnosis of Toxoplasma lymphadenitis, a high index of suspicion can be obtained by means of light microscopy alone.

Adolescent↗

PubMed1997

Specific and nonspecific lymphadenitis in childhood: etiology, diagnosis, and therapy.

Over a period of 4 years, 39 children with lymphadenitis were treated surgically; in 31 cases cervical lymph nodes were the main location. In 9 cases the lymphadenitis was caused by mycobacterial infection. Staphylococcus aureus was the most frequent causative organism of unspecific lymphadenitis (11 cases). The therapy of choice appears to be surgical treatment and medical care after operation. Especially in mycobacterial lymphadenitis, complete surgical excision of the lymph node is decisive for definitive healing. There was only 1 case of therapy-resistant, relapsing cervical lymphadenitis that needed a second operation. Causative organisms in this case were Mycobacterium avium and Mycobacterium intracellulare. All other patients showed an uneventful postoperative clinical course. We believe that a consequent diagnostic process and cooperation between the pediatric surgeon and pediatrician are necessary for effective therapy.

Adolescent↗

PubMed2004

Fine-needle aspiration cytology in tuberculous lymphadenitis of patients with and without HIV infection.

A study of the cytologic features and role of fine-needle aspiration cytology (FNAC) in tuberculous lymphadenitis (TBL) of 21 patients with HIV (group 1) and 21 patients without HIV (group 2) infection was undertaken. Four cytologic patterns were observed, of which necrotizing lymphadenitis (42.9%) and necrotizing suppurative lymphadenitis (28.6%) were predominant in group 1 while necrotizing granulomatous lymphadenitis (47.7%) and granulomatous lymphadenitis (23.8%) were more common in group 2. No pattern was found specific for either group. Zeihl-Neelsen-stained cytology smears of group 1 showed a much higher percentage of positively (61.9%) and a higher density of acid-fast bacilli than group 2. Definitive diagnoses of TBL on FNAC could be provided in 61.9% of group 1 as against 9.5% of group 2. The need for culture or biopsy for definitive diagnosis was higher in group 2. In suspected TBL, diagnostic efficacy can be improved and the need for surgical biopsy reduced if material collected on FNA is also used for culture.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

Tuberculous lymphadenitis, a diagnostic problem in areas of high prevalence of HIV and tuberculosis.

The human immunodeficiency virus (HIV) epidemic is associated with a marked increase of tuberculosis cases. The influence of HIV on diagnostic methods for tuberculous lymphadenitis is less clear. In an environment of high HIV and tuberculosis prevalence in Blantyre, Malawi, a prospective study compared results of basic procedures diagnosing tuberculous lymphadenitis with the outcome of histology and/or culture. One hundred out-patients, aged 15-55 years, with extra-inguinal lymphadenopathy not responding to general antibiotics, entered the study. Among 52 cases, with whom all procedures were carried out in accordance with the protocol, 38 (73%) were diagnosed as tuberculous lymphadenitis; 84% of the latter (32/38) were seropositive for HIV. Needle aspirate and biopsy smears stained by the Ziehl-Neelsen technique contributed little to detecting tuberculosis, 8% and 11% respectively. In contrast, macroscopic caseation of excised lymph nodes showed a high yield of 82%, which was similar to histology, and higher than that of Löwenstein-Jensen culture (61%). The study suggested that HIV positivity of tuberculous lymphadenitis patients decreased the possibility of histology and culture both being indicative of tuberculosis (odds ratio 0.10; P = 0.06). Consequently histology results, often used as the single definitive method, failed to diagnose 18% (7/38) of tuberculosis cases. However, it was reassuring that 4 simple methods, which can safely be carried out at district level, could be expected to diagnose 80-95% of tuberculous lymphadenitis cases in a timely and cost-effective manner.

Adolescent↗

PubMed2000

Polymerase chain reaction detection of Mycobacterium tuberculosis from fine-needle aspirate for the diagnosis of cervical tuberculous lymphadenitis.

BACKGROUND: Despite its well-established usefulness in the diagnosis of cervical tuberculous lymphadenitis, fine-needle aspiration cytology (FNAC) has several limitations in its clinical applications, especially when the presence of acid-fast bacilli is not proven. Furthermore, fine-needle aspirate is sometimes inadequate for diagnosis, and the sensitivity and specificity of this technique for cervical tuberculous lymphadenitis has not been firmly established. OBJECTIVE: The authors performed Mycobacterium tuberculosis polymerase chain reaction (PCR) for mycobacterial DNA sequences from the remainder of fine-needle aspirate after cytological examination and evaluated its diagnostic efficacy in clinical situations. METHODS: Conventional diagnostic procedures including FNAC and M tuberculosis PCR were performed simultaneously in 29 cases that had been suspected to be cervical tuberculous lymphadenitis on patients' first visit. The results of FNAC and M tuberculosis PCR were compared with the clinical outcomes after several months of follow-up and pathological results from open biopsy of some cases. RESULTS: Among the 17 cases of cervical tuberculous lymphadenitis diagnosed in clinical situations, M tuberculosis DNA was found by PCR in 13 cases (76.4%). Negative findings on PCR were achieved in 12 cases, which revealed non-granulomatous lymphadenopathy. CONCLUSION: From these results, we conclude that M tuberculosis PCR using the remainder of aspirate for cytological examination is a very useful tool for the diagnosis of cervical tuberculous lymphadenitis, and its clinical application with FNAC could reduce the necessity for open biopsy.

Adolescent↗

PubMed2005

Antibiotic therapy for nontuberculous mycobacterial cervicofacial lymphadenitis.

OBJECTIVES/HYPOTHESIS: To evaluate the efficacy of antibiotic treatment of nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis, both as an alternative and as adjuvant to surgical excision. STUDY DESIGN: Retrospective chart review of pediatric patients with NTM cervicofacial lymphadenitis treated from January 1993 to November 2003 at an academic tertiary care children's hospital. METHODS: Fifty-five patients (age range, 15 mo-16 y) with the diagnosis of NTM cervicofacial lymphadenitis by fine-needle aspiration biopsy that had 1) lymph node culture positive for an atypical mycobacteria, 2) histological findings consistent with mycobacterial infection (granulomas) with negative bartonella serological titers, 3) histological stain positive for the presence of acid-fast bacillus in the absence of tuberculous infection, or 4) positive Mantoux tuberculin skin test result with a negative finding on polymerase chain reaction for tuberculous mycobacteria. Clinical response was defined as complete or partial resolution of skin changes and palpable lymphadenopathy in response to antibiotic therapy consisting of macrolide therapy alone or in combination with other anti-mycobacterial pharmaceuticals. RESULTS: Of the 55 children studied, 45 of 55 (82%) with both single and multiple lesions underwent a trial of medical therapy, and 30 of 45 lesions (67%) ranging in size from 1 x 1 to 6 x 5 cm achieved resolution without surgical excision. Of the other 15 patients treated initially with medical therapy, 6 of 15 (40%) responded well to a course of antibiotic therapy before undergoing surgical excision, and 7 of 15 (47%) patients were nonresponsive to antibiotic therapy and required surgical excision to resolve the neck mass. The remaining 2 of 15 patients (13%) proceeded to surgery only after a course of antibiotics of 3 weeks or less. Ten of the 55 patients (18%) underwent surgical excision initially, with 5 of 10 patients (50%) receiving postoperative antibiotics for treatment of residual disease or prevention of recurrence. CONCLUSION: Some NTM cervicofacial lymphadenitis infections appear to respond to medical therapy alone. A trial of antibiotic therapy might be considered in patients with NTM cervicofacial lymphadenitis before surgical excision or as an adjuvant to surgical excision.

Adolescent↗

PubMed2001

Ultrasonographic differentiation between tuberculous lymphadenitis and malignant lymph nodes.

OBJECTIVE: To assess the usefulness of ultrasonography in the differential diagnosis of cervical tuberculous lymphadenitis versus malignant lymph nodes. METHODS: Ultrasonography of cervical lymph nodes was performed with a real-time linear scanner using a 7.5- or 11-MHz probe or both. Ultrasonographic findings were retrospectively reviewed in 73 patients: 49 with malignant lymphoma, 15 with tuberculous lymphadenitis, and 9 with metastatic lymph nodes. RESULTS: Ultrasonographic features specific to cervical tuberculous lymphadenitis were strong echoes (33.3%) and an echogenic thin layer (86.7%). When the lymph nodes had at least 1 of these 2 features, tuberculous lymphadenitis was diagnosed with a sensitivity of 100% and a specificity of 100%. CONCLUSIONS: Ultrasonographic evaluation of cervical lymph nodes can be useful in the diagnosis of cervical tuberculous lymphadenitis.

Adolescent↗

PubMedDate not supplied

Correlative study of histopathology and bacteriology in patients of tubercular lymphadenitis.

Histopathology as well as bacteriology of lymph node specimen are useful diagnostic tools for tuberculous lymphadenitis. In the present study, a total of 71 cases of lymphadenitis were selected for histopathological and bacteriological studies. Only 46 patients had caseating type and 4 had non-caseating type of tuberculous lymphadenitis while 21 patients revealed non-specific chronic lymphadenitis on histopathological examination. Only 6 lymph node smears were positive for acid fast bacilli (AFB), 19 cases were positive for mycobacterial culture growth. Thus, it is not necessary that the cases which are histopathologically positive will be positive for culture as well. Therefore, both bacteriology and histopathology are complimentary diagnostic tools for tuberculous lymphadenitis.

Adult↗

PubMed1997

Specific and nonspecific lymphadenitis in childhood: etiology, diagnosis, and therapy

Journal Article↗

PubMed2003

Management of nontuberculous mycobacterial cervical lymphadenitis.

OBJECTIVE: To review the treatment and outcome of patients with nontuberculous mycobacterial (NTM) cervical lymphadenitis. DESIGN: Retrospective chart review. SETTING: Tertiary care children's hospital. PATIENTS: Thirty consecutive immunocompetent patients (median age, 32 months; age range, 11-147 months) diagnosed as having NTM cervical lymphadenitis over a 77-month period. INTERVENTIONS: Primary therapy for 34 foci of NTM cervical lymphadenitis in 30 children consisted of excisional biopsy (n = 8), incision and drainage procedures (n = 14), fine-needle aspiration biopsy (n = 7), observation only (n = 4), and antimycobacterial chemotherapy only (n = 1). MAIN OUTCOME MEASURES: (1) Time to cure, (2) recurrent adenitis, and (3) complications associated with therapy were determined for each therapeutic option. The average duration of follow-up was 32 months (range, 6-78 months). RESULTS: Nearly all patients (97%) were cured of their disease regardless of which therapeutic option was used. Excisional biopsy, while associated with transient marginal mandibular nerve injury in 1 patient, typically resulted in the most rapid resolution of disease. Observation alone did result in eventual cure, although the disease course was protracted. Simple incision and drainage without curettage was associated with prolonged postoperative wound discharge and hypertrophic scarring. CONCLUSIONS: A variety of therapeutic options were used in children with NTM cervical lymphadenitis. Resolution of infection was an eventual outcome regardless of treatment option, although duration of disease, potential for facial nerve injury, and incidence of hypertrophic scarring varied among the different treatments. An individualized management approach is recommended, with excisional biopsy as the preferred option when feasible.

Anti-Bacterial Agents↗

PubMed1982

Histiocytic necrotizing lymphadenitis without granulocytic infiltration.

Twenty-seven cases of an unusual necrotizing lymphadenitis previously described only in Japan are reported as occurring in West Germany (23 cases), Iran (1 case), Italy (1 case), Korea (1 case) and Spain (1 case). The lesion frequently develops in the cervical lymph nodes of young women. It is characterized by infiltration of the cortex and/or paracortex by large collections of proliferating histiocytes and is devoid of granulocytes. Complete or, more often, incomplete necrosis of lymphoid tissue is seen in all cases. In cases with incomplete necrosis, the histiocytes are interspersed with pyknotic cells and nuclear debris. Based on the histological findings, the term "histiocytic necrotizing lymphadenitis without granulocytic infiltration" is proposed. Lesions to be considered in a differential diagnosis are malignant histiocytic neoplasms and necrotizing lymphadenitis with granulocytic infiltration, which is seen in lupus erythematosus and bacterial infections. The aetiology of histiocytic necrotizing lymphadenitis without granulocytic infiltration is still unclear. Some clinical and histological features indicate the possibility of an underlying viral infection.

Adult↗

PubMed2006

The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children.

BACKGROUND: Nontuberculous mycobacteria (NTM) are a common cause of chronic cervicofacial lymphadenitis in young children. The differential diagnosis includes other infections, lymphoepithelial cysts and malignancies. OBJECTIVE: To assess the sonographic findings of NTM cervicofacial lymphadenitis in children. MATERIALS AND METHODS: We analysed the sonograms of cervicofacial lymph nodes of 145 children with microbiologically proven NTM lymphadenitis. RESULTS: The size of the involved lymph nodes ranged from 1.9 cm to 4.4 cm. Most of the NTM patients (85%) presented in a stage of lymph node fluctuation with violaceous skin discoloration. On sonography, marked decreased echogenicity was seen in all cases. In 133 of the patients (92%) liquefaction with intranodal cystic necrosis, nodal matting and adjacent soft-tissue oedema were present. 66 children received antibiotic treatment, and the other children underwent surgical excision of the involved lymph nodes. In 69% of the patients successfully treated with antibiotics, multiple intranodal calcifications were present on sonography after 1 year. CONCLUSIONS: Sonographic findings can provide additional diagnostic clues for NTM lymphadenitis in childhood. A marked decrease of echogenicity in the early stages, with intranodal liquefaction in the advanced stages, are universal features, albeit not entirely specific. Multiple intranodal calcifications are rather characteristic of end-stage mycobacterial infection.

Anti-Bacterial Agents↗

PubMed1989

Lupus lymphadenitis: report of a case with immunohistologic studies on frozen sections.

A case of lupus lymphadenitis with frozen section immunohistologic studies is presented. Clinically, the patient had well-documented systemic lupus erythematosus (SLE) when rapid development of generalized lymphadenopathy raised the possibility of a diagnosis of malignant lymphoma. Histologically, the findings of paracortical foci of necrosis and hematoxylin bodies were diagnostic of SLE. Granulocytes were absent. Monoclonal antibodies applied to frozen sections demonstrated two predominant cell populations within and surrounding the paracortical zones of necrosis: OKM1+, Leu-M1+ histiocytes and OKT8+, Leu-4+ T cytotoxic/suppressor cells. In the lymph node not involved by necrosis, lymphoid follicles were composed of polytypic B cells and the interfollicular regions of T cells. Leu-3a+, Leu-4+ T helper/inducer cells outnumbered T cytotoxic/suppressor cells in a 3:1 ratio. Since lupus lymphadenitis may closely resemble histiocytic necrotizing lymphadenitis of Kikuchi and Fujimoto, particularly if hematoxylin bodies are not found, we compared the findings in this case with findings of cases of histiocytic necrotizing lymphadenitis of Kikuchi and Fujimoto reported in the literature. The immunologic findings in both diseases are similar. We conclude that immunologic studies using frozen sections are probably of no help in differentiating between these two disorders when histologic findings are not conclusive.

Adult↗

PubMed2001

A description of parasite-harbouring cells in localized lymphadenitis in dry type cutaneous leishmaniasis.

Lymphadenitis with or without dry-type cutaneous leishmaniasis is rare. The lesion might self heal or show excellent response to antimonial therapy. Routine histopathological changes of localized leishmaniasis lymphadenitis are non-caseating to suppurative granulomata mostly in paracortical areas, some with extension to germinal centres, medullary cords and/or pericapsular spaces which have to be distinguished from other causes of lymphadenitis such as tuberculosis, cat-scratch disease and toxoplasmosis. Dense lymphoplasmocytic infiltrate was observed surrounding the necrotizing granuloma together with dense capsular fibrosis with multiple granulomata in subcapsular and pericapsular areas. Immunostaining of lymph nodes showed that a few macrophages were harbouring Leishman bodies. Dispersed Langerhans cells were also harbouring Leishman bodies in the parasitophorous vacuoles between their cytoplasmic pseudopods. In conclusion multiple noncaseating to suppurative granulomata with dense pericapsular and capsular granulomo-sclerotic changes should be considered in the differential diagnosis of leishmaniasis lymphadenitis.

Adolescent↗

PubMed1984

Management of lymphadenitis in childhood: the role of percutaneous needle aspiration.

Bacterial lymphadenitis occurs commonly during childhood, but the preferred initial therapy has not been clearly established. We studied lymphadenitis in children to determine the course of patients with fluctuant and nonfluctuant infections, and to assess the role of percutaneous needle aspiration as a form of therapy. Of 32 patients diagnosed as having lymphadenitis, 30 were followed successfully (26 with initially nonfluctuant and four with initially fluctuant infections). Fluctuance subsequently developed in four of 26 lymph nodes that were initially firm to palpation. In all eight children with fluctuant lesions the infections were resolved following percutaneous needle aspiration and antibiotic therapy, and 25 of 26 with initially nonfluctuant infections were cured with antibiotic therapy alone or with antibiotics accompanied by percutaneous aspiration when fluctuance developed (four cases). Thus we recommend initial percutaneous aspiration for the treatment of lymphadenitis whenever abscess formation is detected clinically.

Adolescent↗

PubMed2004

Human herpesvirus-6-associated acute lymphadenitis in immunocompetent adults.

In contrast to other causes of herpetic lymphadenitis, the histological features associated with human herpesvirus-6 (HHV-6) infection have remained elusive since its discovery in 1986. We describe the histologic and phenotypic changes associated with acute HHV-6 lymphadenitis in two immunocompetent adults who presented with fever, fatigue, generalized lymphadenopathy, and elevated liver enzymes. Serologic tests for human immunodeficiency virus, acute Epstein-Barr virus, and cytomegalovirus infection were negative. Lymph node biopsies were consistent with viral lymphadenitis. Intranuclear and cytoplasmic inclusions were identified in CD4-positive T lymphocytes in expanded paracortical areas. Immunohistochemical staining with monoclonal antibody to the HHV-6 gp60/110 kDa envelope glycoprotein showed that the inclusions were positive for viral antigen. Electron microscopy demonstrated numerous viral particles in the cytoplasm and nucleus, characteristic of Herpesviridae family. Clustering of viral particles was observed, which has previously been reported only in infected tissue culture cells. PCR followed by sequencing of DNA extracted from the lymph nodes identified the virus as HHV-6, type B. This is the first report that documents distinctive histologic features of HHV-6 lymphadenitis and demonstrates that the cells harboring the virus in vivo are CD4-positive T lymphocytes.

Adult↗

PubMed2003

Lack of human herpesvirus 8 and Epstein-Barr virus in Kikuchi's histiocytic necrotizing lymphadenitis.

Kikuchi's histiocytic necrotizing lymphadenitis is a self-limited disorder that typically involves the cervical lymph nodes of young women. Although a viral etiology has been postulated, a definitive viral agent has not been identified. Recent reports have suggested that human herpesvirus 8 (HHV 8) or Epstein-Barr virus (EBV) may play an etiologic role. We investigated the presence of HHV 8 and EBV in archival tissue from 34 cases of Kikuchi's histiocytic necrotizing lymphadenitis. We examined 29 cases for HHV 8 using a nested polymerase chain reaction (PCR) on paraffin-embedded or frozen tissue, and 24 cases for EBV RNA using in situ hybridization (ISH) for EBER1. Controls included reactive lymph nodes from 8 adult women presenting with cervical or axillary lymphadenopathy. The study patients included 7 men and 27 women with a mean age of 28 years. All patients were previously healthy without evidence of immunocompromise and presented with cervical, axillary, or inguinal lymphadenopathy. Two cases exhibited EBV RNA by ISH; this was confirmed by PCR for EBV DNA. HHV 8 DNA was not amplified by nested PCR in any of the cases of Kikuchi's histiocytic necrotizing lymphadenitis or reactive lymph nodes; control PCR demonstrated the presence of amplifiable DNA in all cases. These findings suggest that HHV 8 and EBV do not play causative roles in Kikuchi's histiocytic necrotizing lymphadenitis.

Adolescent↗