Fantahun, Mengistu (2016) Assessment of Possible Tuberculous Lymphadenopathy by Xpert MTB/RIF Assay Compared to Non-Molecular Methods at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Masters thesis, Addis Ababa University.
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Abstract
Background: There are nearly 9 million new cases and 2 million deaths from tuberculosis (TB) worldwide every year. The incidence of mycobacterial lymphadenitis has increased in parallel with the increase in the incidence of mycobacterial infection worldwide. TB lymphadenitis is seen in nearly 35 per cent of extra pulmonary TB which constituted about 15 to 20 % of all cases of TB. Extra pulmonary tuberculosis (EPTB) is a significant health problem worldwide because of difficulties in its diagnosis and in monitoring its treatment, in which Tuberculous lymphadenitis (TBLN) is high prevalent. . However, no adequate information had been made available on the tuberculous lymphadenitis in Addis Ababa. To this effect, adequate knowledge on the prevalence and better diagnosis method is required. Objective: This study was aimed to determine the prevalence of TBLN and assesse diagnostic performance of laboratory methods in diagnosis of TBLN among presumptive TBLN patients at St. Paul’s hospital millennium medical college (SPHMMC). Materials and Methods: A cross-sectional study was conducted on tuberculosis lymphadenitis presumptive patients at SPHMMC from December 2015 to May 2016. Fine needle aspiration samples were collected from all TB lymphadenitis presumptive patients. Structured questioners were used to collect socio-demographic and clinical related data. Samples were screened for TB lymphadenitis using TB culture, cytomorphology, Xpert MTB/RIF assay and other staining techniques. The data were analyzed using software packages SPSS version 20 (SPSS Inc, Chicago, Illinois, USA). Negative predictive value, positive predictive value, sensitivity and specificity were calculated. Kappa value was calculated to see the presence of agreement. Chisquare test was done along with P-value to see the presence of associations. P-value less than 0.05 were considered as statistically significant and logistic regression analyses were used to see the association of different variables. Odds ratios and 95% confidence interval were computed to determine the presence and strength of association Result: Of the 152 TBLN presumptive cases, 103(67.8%) were positive for TBLN by FNAC examinations. On the other hand, only 44.7% were positive by mycobacterial culture and 24.3% cases were detected by Fluorescent microscopy (FM). ziehl Neelsen (ZN) was detected in 14.5% cases while 49.3% cases were positive for mycobacteria by Xpert MTB/RIF assay. Pus (AOR0.082, 95% CI 0.030-0.228) and caseous (AOR 0.059, 95%CI 0.020-0.169) aspirates and Previous treatment was significantly associated with TBLN (AOR 0.113, 95% CI 0.031-0.407). The sensitivity of GenXpert compared to composite LJ culture was 78% (73.7-82.3) and specificity 74% (69.4-78.6). The sensitivity was 30.9% for ZN, 47% for FM and 94.1% for cytology compared to composite LJ culture. Cytology showed the lowest specificity (53.6%) but ZN revealed highest sensitivity 98.8% compared to composite culture. Cytology had 61.3% specificity and 87.8% sensitivity compared to against bacteriological methods. Among 49 cytological non-TBL cases, 10 were positive on GeneXpert. The highest agreement was observed between ZN and FM (k=0.69) and the lowest between FNAC and ZN (k=0.199). Conclusion: The results of this study revealed a high prevalence of TBLN in the study sites. TBLN is an important public health problem that needs to be addressed in the area. Types of aspirate and previous treatment were significantly associated with tuberculosis lymphadenitis. FNA cytology showed a relatively high sensitivity but a low specificity. Combining bacteriological methods with FNA cytology in an endemic region like Ethiopia improves the overall accuracy of the diagnosis of mycobacterial lymphadenitis, which in turn may lead to better patient management. Further prospective and advanced studies are recommended to determine the specific etiologic agents and contributing factors and Pathologists should be conscious of tuberculosis cases whenever they encounter enlarged lymph node with pus and/or causous aspirates to initiates immediate treatments.
| Item Type: | Thesis (Masters) |
|---|---|
| Subjects: | H Social Sciences > HV Social pathology. Social and public welfare R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
| Divisions: | Africana |
| Depositing User: | Emmanuel Ndorimana |
| Date Deposited: | 31 Oct 2018 09:54 |
| Last Modified: | 31 Oct 2018 09:54 |
| URI: | http://thesisbank.jhia.ac.ke/id/eprint/7213 |
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