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 ORIGINAL ARTICLE
Year : 2011  |  Volume : 29  |  Issue : 4  |  Page : 389-394

A study of tubercular lymphadenitis: A comparison of various laboratory diagnostic modalities with a special reference to tubercular polymerase chain reaction


1 Consultant Microbiologist, Deenanath Mangeshkar Hospital and Research Centre, Erandawane, Pune, India
2 Infectious Diseases Consultant, Deenanath Mangeshkar Hospital and Research Centre, Erandawane, Pune, India
3 Consultant Pathologist, Deenanath Mangeshkar Hospital and Research Centre, Erandawane, Pune, India
4 Medical Director and Consultant Surgeon, Deenanath Mangeshkar Hospital and Research Centre, Erandawane, Pune, India

Correspondence Address:
S A Patwardhan
Consultant Microbiologist, Deenanath Mangeshkar Hospital and Research Centre, Erandawane, Pune
India
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DOI: 10.4103/0255-0857.90173

PMID: 22120800

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Objective: The purpose of our study was to compare various laboratory diagnostic methods, namely histopathological examination, Ziehl-Neelsen (ZN) stain, AFB culture by conventional Lowenstein-Jensen (LJ) method and fluorescence-based mycobacterial growth indicator tube (MGIT) technique and polymerase chain reaction (PCR) in clinically suspected cases of tubercular lymphadenitis. Materials and Methods: A total of 65 lymph nodes biopsied from patients clinically suspected of having tubercular lymph nodes were included. Specimens were processed for AFB culture after NaOH-NALC concentration and inoculation on LJ medium and using the MGIT system. PCR was performed on all specimens using a commercial nested PCR kit targeting IS6110 insertion element of Mycobacterium tuberculosis complex. All lymph node specimens were subjected to histopathological examination. Results: Of the 65 lymph nodes, 37 (56.9%) were positive on MGIT culture and 45 (69.2%) were positive by PCR. Histopathology showed maximum sensitivity (96%) but with compromised specificity (78.5%). PCR showed 90.1% sensitivity and 100% specificity. The mean turnaround time for mycobacterial growth in smear negative specimens was 30 days determined by LJ and 20 days by MGIT techniques. Conclusion: PCR is a rapid and useful method for diagnosis of TB lymphadenitis and definitely increases the positive predictive value of a positive histopathology report. MGIT is better than LJ culture as regards time to positivity and higher yield.






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