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Fine needle aspiration biopsy: an undervalued diagnostic modality in paediatric mycobacterial disease
C A Wright1, R M Warren, B J Marais
1Division of Anatomical Pathology, Department of Pathology, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Tygerberg, South Africa. cawr@sun.ac.za
Insights
Diagnosing pediatric tuberculosis (TB) in developing nations is challenging. Fine needle aspiration biopsy (FNAB) offers a practical solution for confirming mycobacterial disease in children with lymphadenopathy.
Area of Science:
- Global Health
- Infectious Diseases
- Pediatrics
Background:
- Tuberculosis (TB) and HIV co-infection pose significant challenges in developing countries.
- Diagnosing pediatric TB is difficult due to limitations in clinical, radiological, and laboratory methods.
- Pediatric TB lymphadenitis is a common extrapulmonary manifestation, often presenting as persistent cervical lymphadenopathy.
Purpose of the Study:
- To review diagnostic challenges of pediatric TB in resource-limited settings.
- To highlight the utility of Fine Needle Aspiration Biopsy (FNAB) for diagnosing pediatric TB.
- To provide guidance on performing and implementing FNAB in resource-limited settings.
Main Methods:
- Review of literature on pediatric TB diagnosis and FNAB.
- Analysis of FNAB as a specimen collection method for mycobacterial confirmation.
- Discussion of practical aspects and implementation strategies for FNAB in resource-limited settings.
Main Results:
- FNAB is an underutilized yet effective method for bacteriological confirmation of TB lymphadenitis in children.
- The procedure is simple, safe, and can be performed by nurses in outpatient settings.
- FNAB provides material for microscopy, culture, and susceptibility testing, aiding rapid diagnosis.
Conclusions:
- FNAB is a valuable tool for improving the diagnosis of pediatric TB, particularly in cases of peripheral lymphadenopathy.
- Increased utilization of FNAB can enhance mycobacterial disease confirmation in resource-limited settings.
- Implementing FNAB widely can address the significant burden of pediatric TB in endemic regions.
Abstract:
Mycobacterial disease, and particularly tuberculosis (TB), is an escalating problem in developing countries, fuelled by the parallel human immunodeficiency virus (HIV) pandemic. In TB endemic countries children carry a very high burden of disease, which may be unrecognised due to the difficulty in making a diagnosis based on clinical, radiological or laboratory methods. One of the main hurdles is the difficulty of obtaining adequate specimens for bacteriological confirmation of disease in children. TB lymphadenitis is the most common extra-pulmonary manifestation of TB, and up to 22% of children with persistent cervical lymphadenopathy and no local cause may have tuberculous adenitis. Fine needle aspiration biopsy (FNAB), a simple and safe out-patient procedure that can be performed by nurses in resource-limited settings, and that provides material for direct microscopy as well as culture and susceptibility testing, provides an excellent opportunity to obtain bacteriological confirmation. However, it remains a greatly underutilised specimen collection modality. This review provides a comprehensive overview of the difficulties faced in the diagnosis of paediatric TB in resource-limited settings, and suggests ways to utilise FNAB as a practical modality for the rapid and effective diagnosis of mycobacterial disease in the significant subset of patients who present with peripheral lymphadenopathy. It also provides detail on how best to perform the technique, and suggests ways of making it more widely available in resource-limited settings, which carry the brunt of the paediatric TB disease burden.
