Utility of modified bleach method technique for the demonstration of acid fast bacilli in the diagnosis of Tuberculous lymphadenopathy in comparison to routine Ziehl-neelsen staining
Keywords:
Acid Fast Bacilli, Ziehl–Neelsen stain, Modified Bleach Method, Fine Needle Aspiration
Abstract
Background: There is major role of fine needle aspiration in diagnosis of tubercular lymphadenitis as it is a less invasive procedure and Ziehl-Neelsen (ZN) method for acid-fast bacilli (AFB) plays a key role in diagnosis and also for the monitoring of treatment in tuberculosis. The bleach concentration method is a technique with many benefits over routine ZN staining as it improves the sensitivity of direct microscopy for the detection of AFB.Methods: A total of 129 cases of tuberculous lymphadenitis diagnosed by fine needle aspiration cytology (FNAC) were categorized into six cytomorphological patterns. The acid-fast bacilli positivity by routine staining was correlated with modified bleach methods of ZN staining. Sensitivity of routine ZN and modified bleach concentration was compared. Grading of acid fast bacilli and time taken to detect bacilli was also compared.Result: The classic cytomorphological pattern of tuberculosis of epithelioid granulomas and caseous necrosis was seen in 21.1% of cases. Routine ZN staining detected AFB in 58.9% of cases and the modified bleach method in 89.1%. The modified bleach method showed AFB positivity in all cases where routine ZN staining was positive. The mean time taken for detection of AFB by modified bleach method was 8.91 minutes and by routine ZN staining method was 23.36 minutes.Conclusion: The modified bleach method was more sensitive and safer than routine ZN staining. As the background was clear, the bacilli were easily visible and the screening time was shorter.References
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2. Bhatia AS, Kumar S, Harinath BC. Immunodiagnosis of tuberculosis: An update. Ind J Clin Biochem 2003;18(2): 1-5.
3. Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg 1990; 77: 911-2.
4. Lau SK, Kwan S, Lee J, Wei WI. Source of tubercle bacilli in cervical lymph nodes: A prospective study. J Laryngol Otol 1991;105:558-61.
5. Shahid M, Sirwar SM, Indupalli AS, Bhatt S . In Extrapulmonary Tuberculosis in sputum negative cases. International J of Bioassays; 2013. p. 971-74.
6. Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg1990;77 : 911-2.
7. Lau SK, Kwan S, Lee J, Wei WI. Source of tubercle bacilli in cervical lymph nodes: A prospective study. J Laryngol Otol 1991;105:558-61.
8. Chandrashekhar B, Prayaga AK. Utility of concentration method by modified bleach technique for the demonstration of acid-fast bacilli in the diagnosis of tuberculous lymphadenopathy. J Cytol 2012 July; 29:165-8
9. Khubnani H, Munjal K. Application of bleach method in diagnosis of extrapulmonary tuberculosis. Indian J Pathol Microbiol 2005; 49(4): 546-50.
10. Gangane N, Anshu, Singh R. Role of modified bleach method in staining of acid-fast bacilli in lymph node aspiration. Acta Cytol 2008;52:325-28.
11. Annam V, Mohan HK, Rekha BP. Improved microsopical detection of acid-fast bacilli by the modified bleach method in lymph node aspirates. Indian J Pathol Microbiol 2009;52:349-52
12. Patel MM, Patel KK, Italiya SL, Kaptan KR. Improved diagnosis of tuberculosis in lymph node cytology by bleach method for detection of acid fast bacilli in comparison to conventional Ziehl Neelsen staining method. Int J Med Sci Public Health. 2013; 2(4): 935-939.
Published
2016-10-25
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