Diagnosis of Extra-Pulmonary Tuberculosis by MTB/RIF from a Fine Needle Aspirate Biopsy: Case Report

Year 2020, , 59 - 61, 15.03.2020

Abubakar Tukur Dawakin Kudu Sami Iliya Akinfenwa Taofeq Atanda Nasiru Abdullahi Ismail Abdurrahaman Abba Shehe

https://doi.org/10.5799/jmid.700523

Abstract

Tuberculosis lymphadenitis is the frequent form of extra pulmonary tuberculosis (EPTB). Fine needle technique is easy to be carried out by trained healthcare workers in resources limited setting in Nigeria. This case report was aimed to highlight use and challenges of fine-needle aspirate Biopsy (FNAB) for GeneXpert MTB/RIF assay in the diagnosis of EPTB. Fine needle aspirate was taken from left lymph node and processed for cytological staining with Diff Quik and Ziehl Neelsen stains (ZN) as well as GeneXpert molecular assay. The Diff Quik and ZN showed necrotic debris with epithelioid histiocytes and occasional giant cells while ZN was negative. GeneXpert result reveals Mycobacterium tuberculosis Complex and Rifampicin resistance not detected. These findings provided quick and effective means of diagnosis of EPTB especially from FNAB which has not been commonly undertaken in resource limited Nigeria. J Microbiol Infect Dis 2020; 10(1):59-61.

Keywords

Tuberculous lymphadenitis, Mycobacterium tuberculosis, Xpert MTB/RIF assay, Fine-needle aspirate biopsy

References

• 1. Mekonnen D, Defrbie A, Abeje A, et al. Epidemiology of tuberculous lymphadenitis in Africa: A systematic review and meta-analysis. PLoS ONE 2019; 14(4): e0215647. 2. Wright CA, Hesseling AC, Bamford C, Burgess SM, Warren R, Marais BJ. Fine-needle aspiration biopsy: a first-line diagnostic procedure in paediatric tuberculosis suspects with peripheral lymphadenopathy? Int J Tuberc Lung Dis 2009; 13(11): 1373–1379. 3. Tadesse M, Abebe G, Bekele A, et al. Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a diagnostic evaluation study. Clinical Microbiology and Infection.2019; 25(8); 1000–1005. 4. World Health Organization. (2014). Xpert MTB/RIF implementation manual. Technical and operational ‘how-to’: practical considerations. 2014. Geneva. https://www.who.int/tb/publications/xpert_implem_manual/en/ 5. National Tuberculosis and Leprosy Programme Control (NBTLC). Manual on Technical SOPs for Tuberculosis Laboratories in Nigeria. 2018 (Mention edition). 6. Gupta P.R Difficulties in managing Lymph node Tuberculosis Lung India; 2004; 21: 50-3 7. Prudent E, La Scola B, Drancort M, Angelakis E, Raoul D. Molecular Strategy for the diagnosis of infectious lymphadenitis. Europ J Clin Microbiol Infect Dis 2018; 37 (6): 1179-1186. 8. Fanny ML, Beyam N, Chrusostome JG, et al. Fine-needle aspiration for diagnosis of tuberculous lymphadenitis in children in Bangui, Central African Republic 2012. BMC Pediatr. 2012; 12:191. 9. Yu G, Zhong F, Ye B, Xu X, Chen D, Shen Y. Diagnostic Accuracy of the Xpert MTB/RIF Assay for Lymph Node Tuberculosis: A Systematic Review and Meta-Analysis. BioMed Research International 2019; 2019:4878240. 10. Habous ME, Elimam MA, Kumar RL, Deesi ZA. Evaluation of GeneXpert Mycobacterium tuberculosis/Rifampin for the detection of Mycobacterium tuberculosis complex and rifampicin resistance in nonrespiratory clinical specimens. Intern J Mycobacteriol 2019;8:132-137.