|
Prepared
by....
Thanyawee
Puthanakit,
M.D
Virat
Sirisanthana,
M.D.
|
| Differential
diagnosis
of
cervical
lymphadenitis
|
|
|
 |
| |
| 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)
|
|
|
|
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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