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Tuberculosis or tularemia? A molecular study in cervical lymphadenitis
Sükrü Yıldırım1, Vedat Turhan2, Aynur Karadenizli3
1Pathology Laboratory, Bursa Military Hospital, Bursa, Turkey.
Summary
Tuberculous cervical lymphadenitis (TCL) is often misdiagnosed. Oropharyngeal tularemia can mimic TCL, highlighting the need for accurate differentiation in lymphadenitis diagnosis.
Area of Science:
- Infectious Diseases
- Pathology
- Microbiology
Background:
- Turkey has seen declining tuberculosis (TB) rates but increasing extrapulmonary TB (EPTB), particularly tuberculous cervical lymphadenitis (TCL).
- Concurrently, oropharyngeal tularemia cases have risen in Turkey over the last decade.
- The similar histopathological appearance of TCL and tularemia lymphadenitis presents a diagnostic challenge.
Purpose of the Study:
- To emphasize the critical need to differentiate between tuberculous cervical lymphadenitis (TCL) and oropharyngeal tularemia.
- To investigate the potential misdiagnosis of tularemia as TCL in cervical lymph node biopsies.
Main Methods:
- Review of 32 archival cases diagnosed as TCL from a pathology laboratory in Bursa, Turkey.
- PCR testing for Francisella tularensis and Mycobacterium tuberculosis on paraffin-embedded tissue blocks.
- Analysis of national statistics on pulmonary TB, EPTB, and tularemia in Turkey from 1996-2010.
Main Results:
- Six of 32 cases (19%) initially diagnosed with caseating granulomatous lymphadenitis consistent with tuberculosis tested positive for tularemia via PCR.
- This indicates a significant rate of misdiagnosis between TCL and tularemia.
Conclusions:
- Oropharyngeal tularemia must be considered in the differential diagnosis of cervical lymphadenitis, especially in the Northern Hemisphere.
- Histopathological findings of granulomatous inflammation with necrosis warrant exclusion of tularemia before diagnosing TCL.
Keywords:
Cervical lymphadenitisFrancisella tularensisMycobacterium tuberculosisOropharyngeal tularemiaPCRTuberculosisTularemiaMore Related Videos
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