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Rapid Diagnosis of Pediatric Mycobacterial Lymphadenitis Using Fine Needle Aspiration Biopsy

Coetzee, Liezel MB ChB*; Nicol, Mark P. PhD; Jacobson, Rachael Msc, Med; Schubert, Pawel T. FC (Path Anat)*; van Helden, Paul D. PhD§; Warren, Robin M. PhD§; Wright, Colleen A. FRC Path*

The Pediatric Infectious Disease Journal: September 2014 - Volume 33 - Issue 9 - p 893–896
doi: 10.1097/INF.0000000000000312
Original Studies

Background: Diagnosis of tuberculosis in children is challenging and fine needle aspiration biopsy (FNAB) is used worldwide in the diagnosis of palpable masses including peripheral lymphadenopathy. Recent studies of the use of nucleic acid amplification such as the Xpert MTB/RIF test on FNAB in adult patients have shown considerable promise. Xpert MTB/RIF allows for the rapid diagnosis of Mycobacterium tuberculosis and identification of rifampicin susceptibility. Studies to date have been predominantly performed in adults. This study aims to determine the accuracy of Xpert MTB/RIF for the detection of M. tuberculosis complex in FNAB from children with clinically suspected mycobacterial lymphadenitis.

Methods: Prospective hospital-based study of children <13 years referred for FNAB at Tygerberg hospital and Dora Nginza hospital, South Africa, for suspected mycobacterial lymphadenitis. Aspirates were performed and the results of the Xpert MTB/RIF test were compared with liquid (mycobacterial growth indicator tube) culture and cytology.

Results: FNABs were collected from 110 children and 38 (35%) cases were excluded. Of the 72 cases included in the study, 32 were positive for M. tuberculosis complex on Xpert MTB/RIF, 36 on cytology and 25 were culture positive for M. tuberculosis complex. Compared with the combined reference standard (cytomorphology suggestive of mycobacterial disease with direct visualization of the organism and/or bacteriological culture), Xpert MTB/RIF identified 32 of 40 cases as positive with a sensitivity and a specificity of 80% and 93.8%, respectively.

Conclusions: FNAB and Xpert MTB/RIF enable a rapid diagnosis in pediatric mycobacterial lymphadenitis, expediting appropriate treatment and potentially preventing morbidity and mortality.

From the *Division of Anatomical Pathology University Stellenbosch and National Health Laboratory Service (NHLS), Tygerberg Hospital, Port Elizabeth; Division of Medical Microbiology, University of Cape Town and NHLS Groote Schuur Hospital; Centre for Tropical Opportunistic and Hospital Infections, National Institute for Communicable Diseases and NHLS Groote Schuur Hospital; and §Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/MRC Centre for Molecular and Cellular Biology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa.

Accepted for publication February 11, 2014.

We report the following sources of funding: Current grant support from the Medical Research Council (MRC) and the National Research Foundation (NRF) of South Africa, which are 2 statutory science funding agencies of South Africa; Ongoing grant support from the Foundation for Innovative New Diagnostics for studies of Xpert MTB/RIF; Current employment by the Medical Research Council of South Africa and Current research funding from the National Institutes of Health.

The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Dr. Liezel Coetzee, Division of Anatomical Pathology, P.O. Box 1903, Tygerberg, Cape Town 7505, South Africa. E-mail: lc@sun.ac.za.

© 2014 by Lippincott Williams & Wilkins, Inc.