|
Prepared by.... Thanyawee Puthanakit,
M.D
Virat Sirisanthana, M.D.
|
| Differential diagnosis
of cervical lymphadenitis |
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|
 |
| |
| What is a proper
management? |
1. The fine needle
aspiration (FNA) of the mass was performed.
> The FNA reveals several foamy histiocytes within reactive lymphoid
and necrotic background. Acid fast stain reveals acid
fast bacilli 3+ clustering within macrophages, few extracellular
acid fast bacilli are occasionally observed (Fig 4). Imp. Mycobacterium
lymphadenitis, most likely mycobacterium avium complex.
> Pus culture was also done and Mycobacterium spp
. was reported 2 months later. |
2. Hemoculture
for mycobacterium was performed.
> Four weeks later, hemoculture was reported as Mycobacterim avium.
|
About Mycobacterium
culture:
There are 2 methods: |
| 1. |
Standard culture methods: using
a combination of broth and solid media, such as Lowenstein-Jensen
or Middlebrook 7H10 or 7H11. Inoculated media are incubated
at 37 C for 6-8 weeks in 10% carbon dioxide and 90% air. Traditionally
it takes 2-4 weeks for the growth of mycobacteria. and
another 4-6 weeks for biochemical tests for species identification.
|
| 2. |
The BACTEC radiometric system:
specimen from the patient is inoculated into culture media containing
a radiolabled substrate that is metabolized in the presence
of mycobacteria to carbon dioxide and detected by radiorepirometirc
methods, a growth signal usually can be detected within average
of 2 weeks, however it may require up to 4 weeks for
specimen with low colony counts. |
| For the "species"
identification: |
| 1. |
Biochemical tests: 4-6 weeks |
| 2. |
Polymerase chain reaction method: 2
days (not always available) |
|
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| |
3. Chest X-ray
was performed.
The cardiac outline is normal and the lung fields are clear. There is prominent
right paratracheal soft tissue on right side compatible with enlarged nodes
(Fig 5).
4. Other Laboratory investigations:
CBC: Hb 9 gm/dl Hct 28% Wbc 5,800 cell/mm3
(PMN 67 %, Band 6% Lymp 22% Mono 5%), Plt 346,000 /mm3
LFT: TB/DB 0.49/0.25 mg/dl, AST/ALT 21/4 U/L, Alk 145 U/L, Alb/Glo
3.6/4.5 gm/dl |
| |
| Diagnosis:
HIV-infected child with Disseminated Mycobacterium avium complex
(DMAC) |
| Continue...........
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