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1 October 2006

Volume 43, Number 7
Clinical Infectious Diseases 2006;43:855–859
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4307-0009$15.00
DOI: 10.1086/507536
MAJOR ARTICLE

Clinical Evaluation of a 16S Ribosomal RNA Polymerase Chain Reaction Test for the Diagnosis of Lymph Node Tuberculosis

Fernando Osores,1

Oscar Nolasco,1,4

Kristien Verdonck,1,5

Jorge Arévalo,1,2

Juan Carlos Ferrufino,3

Juan Agapito,3

Leandro Huayanay,3

Eduardo Gotuzzo,1,3 and

Ciro Maguiña1,3

1Institute of Tropical Medicine Alexander von Humboldt and 2Department of Biochemistry, Molecular Biology, and Pharmacology, Universidad Peruana Cayetano Heredia, 3Hospital Nacional Cayetano Heredia, and 4Biolinks S.A., Lima, Peru; and 5Institute of Tropical Medicine, Antwerp, Belgium

Reports on the sensitivity of polymerase chain reaction (PCR) for the diagnosis of lymph node tuberculosis (TB) show divergent results. We evaluated the accuracy of the Roche Amplicor Mycobacterium tuberculosis PCR test with lymph node aspirate and biopsy samples.

Methods.The study was conducted at a public reference hospital in Lima, Peru. From the period of January 2003 to January 2004, we included patients who had lymphadenopathy and in whom the attending physician suspected TB. Aspirate and biopsy samples were submitted for culturing in Löwenstein‐Jensen medium, for histopathologic testing, and for PCR. The sensitivity and specificity of PCR were calculated against a reference standard based on histopathologic findings and culture.

Results.Our study included 154 patients. Median age was 29 years (interquartile range, 21–40 years); 97 patients (62.9%) were men. Twenty‐nine patients (18.8%) had acid fast bacilli–positive histopathologic findings, and 44 (28.6%) had a positive culture result. Using the combination of histopathologic findings and culture as reference standard, 55 patients (35.7%) had a diagnosis of tuberculous lymphadenitis. The sensitivity of the PCR test was 58.2%, and the specificity was 93.9%. For biopsy tissue only, the sensitivity of PCR was 52.7%, and the specificity was 97.0%. For aspirate samples only, the sensitivity of PCR was 47.3%, and the specificity was 96.0%.

Conclusion.The Amplicor PCR test revealed low sensitivity and high specificity for the diagnosis of lymph node TB. The sensitivity was higher in cases in which the bacillary load was high—in acid fast bacilli–positive samples and among HIV‐infected patients. Considering the results of microbiological and PCR tests together, there was still a patient group in whom no final diagnosis could be established.

Received 9 March 2006; accepted 13 June 2006; electronically published 22 August 2006.

Reprints or correspondence: Dr. Fernando Osores, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru ().

Cited by

R Khan, S H Harris, A K Verma, A Syed. (2009) Cervical lymphadenopathy: scrofula revisited. The Journal of Laryngology & Otology 123:07, 764
Online publication date: 1-Aug-2009.
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