Immunocytochemical Expression of IFN-γ and IL-4 in Tuberculous Lymphadenitis with Dark Oval Bodies

BACKGROUND: We noticed some smears being cytologically diagnosed as common chronic lymphadenitis that cannot be treated with ordinary antibiotics, but succeeded with the anti-tuberculosis drug (ATD), even though it takes longer, up to a year or more. Re-examining the MGG smears, we got cases that show the structure, we call Dark Oval Bodies (DOB). Most of DOB smears express Interferon (IFN)-γ. IFN-γ _plays a role in the protection of infection while interleukin (IL)-4 in the opposite. AIM: The purpose of this study is to determine if there is a difference between an expression of IFN-γ _and IL-4 in DOB and whether IFN-γ _is associated with the protection of the disease. MATERIALS AND METHODS: Included in this study 41 cases of tuberculous lymphadenopathy with DOB that were not successfully treated with common antibiotics but succeeded with ATD. Antigen expression was determined using rabbit polyclonal to IFN-γ, (ab9657), and IL-4 (ab9622), Abcam. The expression was categorized as positive and negative. The details of the 41 cases were 37 cases (90%) with IFN-γ _(+), 4 (10%) with IFN-γ _(-), 10 (24%) with IL-4 (+), and 31 (76%) with IL-4 (-). Thirty cases expressed IFN-γ _(+) and IL-4 (-), 1: IFN-γ _(-) and IL-4 (+), 8: IFN-γ _(+) and IL-4 (+), and 2: IFN-γ _(-) and IL-4 (-). RESULTS: IFN-γ _is more frequently expressed in DOB compared to IL-4 (p<0.05, the Fisher’s exact tests). CONCLUSION: IFN-γ _can be benefited as the indicator of protection to the tuberculous process.

Contribution of fine needle aspiration and auramine tests in diagnosis of Tuberculosis lymphadenitis at Kigali University Teaching Hospital (CHUK), Rwanda

Background Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis. Tuberculosis affects mainly the lungs but other organs of the body are involved. TB lymphadenitis is most common in extrapulmonary TB. Lymphadenitis is the infection or inflammation of the lymph nodes which are essential in immune response of the body. Objective To evaluate the contribution of fine needle aspiration (FNA) and auramine tests in the diagnosis of TB lymphadenitis. Methods Smears from lymph node aspirates were prepared. Air-dried smears were stained by auramine staining for AFB examination and Diff-Quick staining cytological technique to detect malignant cells and other pathology. The slides were examined by laboratory technologists and the pathologist. Results Results are based on a total number of 137 samples; 58 (42.33%) cases were auramine positive for TB lymphadenitis while other 79 (57.67%) suspected cases were non TB lymphadenitis. Necrotizing lymphadenitis, granulomatous lymphadenitis, chronic lymphadenitis, acute lymphadenitis and reactive lymphadenitis represented 21.19%; 13.14%; 1.42%; 2.19%; and 19.71% respectively. Conclusion The use of auramine test and FNA cytology should be considered as useful in the diagnosis of tuberculosis lymphadenitis. These techniques are less expensive, quick, safe and show low complication rate. Keywords: TB lymphadenitis; fine needle aspiration; auramine test

Husband and wife with sarcoidosis: possible environmental factors involved

Sarcoidosis is a granulomatous multisystem disorder of unclear etiology that involves any organ, most commonly the lung and the lymph nodes. It is hypothesized that the disease derives from the interaction between single or multiple environmental factors and genetically determined host factors. Multiple potential etiologic agents for sarcoidosis have been proposed without any definitive demonstration of causality. We report the case of two patients, husband (57 years old) and wife (55 years old), both suffering from sarcoidosis. They underwent a lymph node biopsy by mediastinoscopy which showed a “granulomatous epithelioid giant cell non-necrotising chronic lymphadenitis”. They had lived up to 3 years ago in the country in a farm, in contact with organic dusts, animals such as dogs, chickens, rabbits, pigeons; now they have lived since about 3 years in an urban area where there are numerous chemical industries and stone quarries. The aim of this case report was to focus on environmental factors that might be related to the pathogenesis of the sarcoidosis.

HIV-associated tuberculous lymphadenitis: the importance of polymerase chain reaction (PCR) as a complementary tool for the diagnosis of tuberculosis - a study of 104 patients

BACKGROUND: Lymphadenitis is common in HIV-positive patients. Diagnosis of the infections associated with this condition is complex, particularly in the case of tuberculosis. Rapid and specific detection of Mycobacterium tuberculosis (M. tuberculosis) is fundamental in ensuring adequate treatment. In addition, frequent causes of lymphadenitis such as those associated with lymphoma and histoplasmosis, among others, must be eliminated as possible causes. OBJECTIVES: To evaluate the accuracy of polymerase chain reaction as a tool for the diagnosis of lymphadenitis resulting from M. tuberculosis. METHODS: In this study, a protocol was developed using the following procedures: direct microscopy using Ziehl-Neelsen staining, culture in Lowenstein-Jensen medium, histology and polymerase chain reaction. RESULTS: A total of 104 patients were included in the study. According to histopathology, 38 patients (36%) were found to have nonspecific chronic lymphadenitis, 27 (26%) had tuberculous lymphadenitis, 11 patients (10.5%) had lymphoma and 9 (8.7%) had histoplasmosis. When Lowenstein-Jensen culture was performed, positive tests for tuberculous lymphadenitis increased by 30%. With polymerase chain reaction, M. tuberculosis DNA was detected in 6 out of 38 samples of non-specific chronic lymphadenitis. Three of these patients were followed up, developed symptoms of tuberculosis and were cured following specific treatment. CONCLUSION: The data obtained in this study suggest that all cases of lymphadenopathies should be submitted to histopathology, Lowenstein-Jensen or Ogawa culture and polymerase chain reaction. Polymerase chain reaction may prove to be useful in providing an early and accurate detection of cases of extrapulmonary tuberculosis in HIV-positive patients with lymphadenopathies, avoiding empirical treatment and the possible development of resistant strains.