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DIAGNOSIS OF TUBERCULOSIS LYMPHADENITIS USING A POLYMERASE CHAIN REACTION ON PERIPHERAL BLOOD MONONUCLEAR CELLS

Providing prompt and precise laboratory confirmation of a clinical diagnosis of tuberculous lymphadenitis is difficult given the paucibacillary nature of lymph node specimens. In this study carried out in Karachi, Pakistan, a polymerase chain reaction (PCR) assay aimed at detecting Mycobacterium tuberculosis DNA in peripheral blood mononuclear cells (PBMC-PCR) was standardized and compared with standard M. tuberculosis diagnostic techniques or a lymph node PCR (LN-PCR) for the diagnosis of tuberculosis lymphadenitis. Thirty-seven (77%) specimens from 48 patients with clinical or diagnosis of tuberculosis lymphadenitis were positive by cytology [17/48 (35%) with no acid fast bacilli (AFB) (suggestive), and 20/48 (42%) with AFB (positive) in direct smears], 30 (63%) by PBMC-PCR, 16 (33%) by LN-PCR, and 13 (27%) by culture. All controls were negative, with the exception of one false-positive LN-PCR. These data suggest the PBMC-PCR may be helpful in the diagnosis of tuberculous lymphadenitis.

Received April 16, 2003. Accepted for publication July 14, 2003.

Acknowledgments: We thank the field staff of the Urban Health Program for their help during data collection, and the staff of the research laboratories of Aga Khan University for their participation in the study.

Financial support: This project was supported in part by the Aga Khan Health Services of Pakistan.

Authors’ addresses: Shaper Mirza, Department of Microbiology, University of Alabama, Birmingham, Bevill Building, 845 19th South Street, Birmingham, AL 35294, Telephone: 205-934-1923, Fax: 205-934-0605. Blanca I. Restrepo, Joseph B. McCormick, and Susan P. Fisher-Hoch, University of Texas Health Science Center Houston School of Public Health-Brownsville, The University of Texas at Brownsville, 80 Fort Brown SPH, 2nd Floor Room 2.202, Brownsville, TX 78520.

Reprint requests: Blanca I. Restrepo, University of Texas Health Science Center Houston School of Public Health, The University of Texas at Brownsville, 80 Fort Brown, SPH 2nd Floor, Room 2.202 Brownsville, TX 78520, Telephone: 956-279-3841, Fax: 956-554-5152, E-mail: birestrepo{at}utb.edu.