Is tuberculous lymphadenitis over-diagnosed in Ethiopia? Comparative performance of diagnostic tests for mycobacterial lymphadenitis in a high-burden country
Abstract
Ethiopia reports the third highest number of extrapulmonary TB cases globally, most of which are lymph node TB (TBLN). We investigated the performance of the available diagnostic tests for TBLN. Fine needle aspirate (FNA) and excision biopsy samples from affected lymph nodes were collected from 150 consenting patients with suspected TBLN visiting regional hospitals in Ethiopia. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of histopathology against culture as reference was 92%, 88%, 97% and 77% and of FNA cytology (FNAC) 76%, 88%, 100% and 55%, respectively. Naked eye examination of FNA had 67% sensitivity and 64% specificity. HIV coinfection did not diminish the performance of macroscopic examination, Ziehl-Neelsen stain, histology or cytology examinations. When any positive result in ZN, histopathology or culture was considered confirmatory, clinical diagnosis could be confirmed in 85% of the patients, suggesting that TBLN is over-diagnosed in up to 15% of cases. With combined criteria as reference standard, the sensitivity, specificity, PPV and NPV of FNAC was 72%, 100%, 100% and 55%, respectively. FNAC is a practical tool that can improve the diagnosis of TBLN in high-burden settings. Over-diagnosis alone cannot explain the high burden of LNTB in Ethiopia.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
ZN microscopy requires more than 5,000 organisms/ml of sample to detect bacilli.
“as investigating bacilli in a clinical specimen by ZN requires more than 5,000 organisms/ml of sample, but very low bacilli expected in FNA sample; another investigator also agrees with this explanation [40].”
From Diagnostic accuracy of Xpert MTB/RIF assay and non-molecular methods for the diagnosis of tuberculosis lymphadenitis (2019) · cites this paper as [40]
Cites
van Soolingen, D., Hermans, P. W. M., de Haas, P. E., Soll, D. R., & van Embden, J. D. (1991) · Journal of Clinical Microbiology · doi:10.1128/jcm.29.11.2578-2586.1991 · Cited by 987 · see citing works
Tsolaki, A. G., Hirsh, A. E., DeRiemer, K., Enciso, J. A., Wong, M. Z., Hannan, M. M., de la Salmonière, Y.-O. L. G., Aman, K., Kato‐Maeda, M., & Small, P. M. (2004) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0305634101 · Cited by 355 · see citing works
Mycobacterium bovis infection in human beings
Grange, J. M. (2001) · Tuberculosis · doi:10.1054/tube.2000.0263 · Cited by 289 · see citing works
HIV-associated tuberculosis in developing countries: clinical features, diagnosis, and treatment.
Raviglione, M. C., Narain, J. P., & Kochi, A. (1992) · PubMed · Cited by 260 · see citing works
Parsons, L. M., Brosch, R., Cole, S. T., Somoskövi, Á., Loder, A., Bretzel, G., van Soolingen, D., Hale, Y. M., & Salfinger, M. (2002) · Journal of Clinical Microbiology · doi:10.1128/jcm.40.7.2339-2345.2002 · Cited by 246 · see citing works
Identification of the Causative Organism of Tuberculous Lymphadenitis in Ethiopia by PCR
Kidane, D., Olobo, J. O., Habte, A., Negesse, Y., Aseffa, A., Abate, G., Yassin, M. A., Bereda, K., & Harboe, M. (2002) · Journal of Clinical Microbiology · doi:10.1128/jcm.40.11.4230-4234.2002 · Cited by 126 · see citing works
Self-citationMarais, B. J., Wright, C. A., Schaaf, H. S., Gie, R. P., Hesseling, A. C., Enarson, D. A., & Beyers, N. (2006) · The Pediatric Infectious Disease Journal · doi:10.1097/01.inf.0000199259.04970.d1 · Cited by 117 · see citing works
Blázquez, J., Monteros, L. E. E. D. L., Samper, S., et al. (1997) · Journal of Clinical Microbiology · doi:10.1128/jcm.35.6.1390-1393.1997 · Cited by 90 · see citing works
Wright, C. A., van der Burg, M., Geiger, D., Noordzij, J. G., Burgess, S. M., & Marais, B. J. (2008) · Diagnostic Cytopathology · doi:10.1002/dc.20788 · Cited by 84 · see citing works
Multiprimer PCR system for differential identification of mycobacteria in clinical samples
Portillo, P. D., Thomas, M. C., Martínez‐Romero, E., Marañón, C., Valladares, B., Patarroyo, M. E., & López, M. C. (1996) · Journal of Clinical Microbiology · doi:10.1128/jcm.34.2.324-328.1996 · Cited by 76 · see citing works
(2007) · PubMed · Cited by 63 · see citing works
Diagnosis of Tuberculous Lymphadenitis in Butajira, Rural Ethiopia
Yassin, M. A., Olobo, J. O., Kidane, D., Negesse, Y., Shimeles, E., Tadesse, A., Demissie, A., Britton, S., Harboe, M., Aseffa, A., et al. (2003) · Scandinavian Journal of Infectious Diseases · doi:10.1080/00365540310004027 · Cited by 45 · see citing works
Self-citationHodgkin's lymphoma and tuberculosis coexistence in cervical lymph nodes
Centkowski, P., Sawczuk-Chabin, J., Prochorec‐Sobieszek, M., & Warzocha, K. (2004) · Leukemia & lymphoma/Leukemia and lymphoma · doi:10.1080/10428190400019891 · Cited by 43 · see citing works
Bem, C., Patil, P. S., Bharucha, H., et al. (1996) · British journal of surgery · doi:10.1002/bjs.1800830124 · Cited by 40 · see citing works
Prevalence of tuberculous lymphadenitis in children in Wardha district, Maharashtra State, India.
Narang, P., Narang, R., Narang, R., et al. (2005) · PubMed · Cited by 32 · see citing works
(1997) · PubMed · Cited by 28 · see citing works
Tuberculous lymphadenitis, a diagnostic problem in areas of high prevalence of HIV and tuberculosis
Bekedam, H. J., Boeree, M., Kamenya, A., Liomba, G., Ngwira, B., Subramanyam, V. R., & Harries, A. D. (1997) · Transactions of the Royal Society of Tropical Medicine and Hygiene · doi:10.1016/s0035-9203(97)90081-x · Cited by 26 · see citing works
Osores-Plenge, F., Nolasco, O., Verdonck, K., Arévalo, J., Ferrufino, J. C., Agapito, J., Huayanay, L., Gotuzzo, E., & Vargas, C. P. M. (2006) · Clinical Infectious Diseases · doi:10.1086/507536 · Cited by 24 · see citing works
Beyene, D., Ashenafi, S., Yamuah, L. K., Aseffa, A., Wiker, H. G., Engers, H. D., Klatser, P. R., & Sviland, L. (2008) · PubMed · Cited by 18 · see citing works
Self-citationMycobacterial culture of fine needle aspirate-A useful tool in diagnosing tuberculous lymphadenitis
Aparna, S., Prasad, C., Srinivas, A., Triveni, B., Gokhale, S., Krishna Moorthy, K., & Kishore Reddy, V. (2008) · Indian Journal of Medical Microbiology · doi:10.4103/0255-0857.42040 · Cited by 17 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Derese, Y., Hailu, E., Assefa, T., Bekele, Y., Mihret, A., Aseffa, A., Hussien, J., Ali, I., & Abebe, M. (2011) · The Journal of Infection in Developing Countries · doi:10.3855/jidc.2050 · Cited by 61 · see citing works
Self-citationFantahun, M., Kebede, A., Yenew, B., Gemechu, T., Mamuye, Y., Tadesse, M., Brhane, B., Jibriel, A., Solomon, D., & Yaregal, Z. (2019) · PLoS ONE · doi:10.1371/journal.pone.0222402 · Cited by 38 · see citing works
Biadglegne, F., Mulu, A., Rodloff, A. C., & Sack, U. (2014) · Tuberculosis · doi:10.1016/j.tube.2014.05.002 · Cited by 35 · see citing works
Tuberculosis Lymphadenitis in Ethiopia
Biadglegne, F., Tesfaye, W., Anagaw, B., Tessema, B., Debebe, T., Anagaw, B., Mulu, A., Sack, U., & Rodloff, A. C. (2013) · Japanese Journal of Infectious Diseases · doi:10.7883/yoken.66.263 · Cited by 32 · see citing works
Combination method for the diagnosis of Tuberculous lymphadenitis in high burden settings
Shetty, D., & Vyas, D. (2022) · Surgical and Experimental Pathology · doi:10.1186/s42047-022-00111-z · Cited by 25 · see citing works
- Authors
- Iwnetu, R., van den Hombergh, J., Woldeamanuel, Y., Asfaw, M., Gebrekirstos, C., Negussie, Y., Bekele, T., Ashenafi, S., Seyoum, B., Melaku, K., Yamuah, L., Tilahun, H., Tadesse, Z., & Aseffa, A.
- Affiliations
- Armauer Hansen Research Institute (ET)
- Addis Ababa University (ET)
- Federal Ministry of Health (ET)
- Corresponding author
- Aseffa, Abraham
- Venue
- Scandinavian Journal of Infectious Diseases
- Publisher
- Informa UK Limited
- Published
- 2009-01
- Volume
- 41
- Issue
- 6-7
- Pages
- 462-468
- ISSN
- 0036-5548 (ISSN-L)
- 1651-1980
- OpenAlex
- W1965148277
- Cited by
- 53
- References
- 20
- Citations by year
- 2025: 1 · 2024: 6 · 2023: 4 · 2022: 2 · 2019: 4 · 2018: 4 · 2017: 2 · 2016: 3 · 2015: 4 · 2014: 8 · 2013: 9 · 2012: 2
- FWCI
- 1.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Scandinavian Journal of Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Global Fund to Fight AIDS, Tuberculosis and Malaria
- Bundesministerium für Gesundheit
- Addis Ababa University
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Surgery › Diagnosis and treatment of tuberculosis
- Health Sciences › Medicine › Surgery › Lymphadenopathy Diagnosis and Analysis
- Keywords
- tuberculous lymphadenitis, extrapulmonary tuberculosis, overdiagnosis, fine needle aspiration cytology, histopathology, Ziehl-Neelsen staining, diagnostic performance, HIV coinfection, Ethiopia
- MeSH terms
- Adolescent, Adult, Aged, Child, Child, Preschool, Ethiopia, Female, Histocytochemistry, Humans, Lymph Nodes, Male, Middle Aged, Mycobacterium tuberculosis, Predictive Value of Tests, Sensitivity and Specificity, Tuberculosis, Lymph Node, Chi-Square Distribution, Biopsy, Fine-Needle, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
