African Journal of Clinical and Experimental Microbiology

Phenotypic characterization and antimicrobial susceptibility profiles of Vibrio cholerae isolates during the October 2022 and January 2023 outbreak in North-Kivu province, The Democratic Republic of Congo

R. K. S. Kabangwa, K. H. Mulasi, B. T. Moyengo, J. M. Byamungu, P. K. Mobile — Wed, 19 Jul 2023 00:00:00 +0000

Background: Cholera is an infectious disease characterized by severe watery diarrhea, frequently occurring in outbreaks which affects many communities in the Democratic Republic of the Congo (DRC). At the end of October 2022, a cholera outbreak was declared in the camp of internally displaced people (IDP) of Kanyaruchinya, 20 kilometers north of Goma, the provincial capital of the North-Kivu province in DRC, as well as in other IDP camps and settlements around the city of Goma. The aim of this study was to phenotypically characterize Vibrio cholerae isolates associated with this outbreak, and to determinate their antimicrobial susceptibility profiles.

Methodology: Between October 31, 2022 and January 31, 2023, faecal swab samples were collected into Cary-Blair medium from 1604 and 538 patients with clinical signs of cholera at the Kanyaruchinya IDP, and IDPs camps and settlements around the city of Goma, respectively. After enrichment in 1% alkaline peptone water, the samples were cultured on thiosulphate-citrate-bile salt-sucrose (TCBS) agar for isolation and phenotypic characterization of V. cholerae O1 using conventional biochemical tests and serotyping technique. Antimicrobial susceptibility of selected isolates was peformed to a panel of 8 antibiotics by the disk diffusion method in accordance with EUCAST and CLSI guidelines.

Results: Vibrio cholerae was cultured from 807 samples (50.3%) of 1604 patients from the Kanyaruchinya IDP, and from 206 samples (38.3%) of 538 patients around the city of Goma (p<0.01). All the V. cholerae isolates from the Kanyaruchinya IDP (807/807, 100.0%) were serotyped as V. cholerae O1 Inaba whereas 136 (66.0%), 67 (32.5%), and 3 (1.5%) V. cholerae O1 isolates from around Goma were serotyped as V. cholerae O1 Ogawa, V. cholerae O1 Inaba, and Hikojima respectively. Antimicrobial susceptibility test on 174 and 62 isolates selected randomly from the 807 and 206 V. cholerae isolates from the Kanyaruchinya IDP camp, and from around the city of Goma respectively, showed that all the tested V. cholerae O1 isolates were resistant to polymyxin and cotrimoxazole, while being susceptible to tetracycline and azithromycin. All tested V. cholerae O1 isolates from Kanyaruchinya IDP camp displayed a unique antimicrobial susceptibility profile characterized by resistance to ampicillin, cotrimoxazole and chloramphenicol, and susceptiblility to ciprofloxacin, norfloxacin, azithromycin, tetracycline and doxycycline. Their counterparts from settlements around the city of Goma displayed a more variable antimicrobial susceptibility profile.

Conclusion: Our results suggest that a single V. cholerae O1 Inaba clone probably caused the cholera outbreak in the Kanyaruchinya IDP camp, whereas during the same period, several V. cholerae clones (Ogawa, Inaba and Hikojima) were associated with the cholera outbreak around the city of Goma.

Emergence of clinical vanA-type vancomycin-resistant Staphylococcus aureus isolates in National Orthopaedic Hospital Dala, Kano, Nigeria

U. Abdulrahim, D. A. Oche, M. Kachallah, G. O. Adeshina, B. O. Olayinka — Wed, 19 Jul 2023 00:00:00 +0000

Background: The increasing prevalence of multi drug resistance (MDR) in strains of Staphylococcus aureus is a major challenge in the selection of an appropriate therapeutic agents, especially in persistent orthopaedic infections. This study investigated the patterns of antimicrobial resistance and identified the genetic determinants of resistance in S. aureus isolates from orthopaedic patients.

Methodology: This was a descriptive cross-sectional study of hospitalized patients at National Orthopaedic Hospital Dala (NOHD), Kano, Nigeria from whom urine samples, and nasal and wound swabs were collected for isolation of S. aureus. Samples were cultured on standard media and S. aureus isolated and identified using both conventional biochemical tests and a standard rapid diagnostic kit. The antibiotic susceptibility was determined to a panel of 15 antibiotics using the modified Kirby-Bauer disc diffusion method. Vancomycin minimum inhibitory concentration (MIC) of each isolate was determined using vancomycin Epsilon-test strip. mecA and vanA were detected by multiplex polymerase chain reaction (PCR) assay.

Results: From the total of 134 samples, S. aureus was isolated from 36 (26.8%); 10 (7.4%) from urine, 13 (9.7%) from nasal swab, and 13 (9.7%) from wound swab. Thirty-four (94.4%) isolates were phenotypically methicillin (cefoxitin) resistant (MRSA), while 2 (5.6%) isolates were methicillin sensitive (MSSA). Phenotypic resistance rate of the S. aureus isolates was highest to gentamicin (94.4%), followed by penicillin (88.8%), cephalosporins and fluoroquinolones (87.4%), while rate was lowest to vancomycin (11.1%, 4/36). Seventeen (47.2%) were MDR, 16 (44.4%) were extensively drug resistant (XDR), and 2 (5.6%) were pan-drug resistant (PDR) S. aureus isolates. The mecA gene was detected in 4 (11.8%) of the 34 phenotypic MRSA isolates and vanA genes in 2 (50.0%) of the 4 phenotypic VRSA isolates.

Conclusion: The detection of vanA and mecA in clinical S. aureus isolates in this study is an indication that clinical VRSA has emerged in MRSA population in Nigeria. This emergence can pose a major threat to primary care-givers and a public health challenge among the daily inhabitants of National Orthopaedic Hospital Dala (NOHD), Kano and the community at large.

Emergence of New Delhi metallo-β-lactamase-1 (NDM-1) producing Enterobacterales from water sources: An impending public health challenge in Adamawa-north senatorial zone, Nigeria

M. Y. Tula, O. I. Enabulele, E. A. Ophori, R. O. Okojie, F. Joel — Wed, 19 Jul 2023 00:00:00 +0000

Background: The emergence of New Delhi metallo-beta-lactamase-1 (NDM-1) among Enterobacterales in water sources has raised a major public health concern and constitute critical threat to human health as these organisms exhibits high level of resistance to available potent antibiotics. The aim of this study is to detect the presence of NDM-1 gene among carbapenem resistant Enterobacterales (CRE) isolates from water sources.

Methodology: A total of 256 water samples were collected from randomly selected hand-dug wells (128 samples) and river/stream (128 samples) for each of dry and rainy seasons in four out of the five local government areas (LGAs) of Adamawa-north senatorial zone, Nigeria. The water samples were filtered using membrane filtration technique and the filters introduced into appropriate bacteriologic media for bacterial growth. The bacterial isolates recovered were identified by both phenotypic and molecular protocols. Phenotypic carbapenem (imipenem) resistance was determined by disc diffusion test, blaNDM-1 gene was detected by specific polymerase chain reaction (PCR) test, and plasmid DNA was extracted and electrophoresed by standard procedure.

Results: Of the 256 water samples analyzed for bacteria growth, 300 bacterial isolates of the order Enterobacterales were recovered. Of these, only 45 (12.6%) isolates were phenotypically resistant to carbapenem (imipenem) antibiotic and blaNDM-1 gene was detected in 30 (66.7%) of these. While blaNDM-1 gene was detected in all the isolates of Klebsiella oxytoca, Klebsiella variicola, Enterobacter aerogenes, Enterobacter hormaechei, Enterobacter asburiae, Citrobacter freundii, and Morganella morganii that were resistant to imipenem, other isolates harbored blaNDM-1 gene in varying proportion. Most of the isolates positive for blaNDM-1 also harbored R-plasmids.

Conclusion: Emergence of carbapenem resistance mediated by NDM-1 gene in Enterobacterales isolated from water sources constitutes an emerging public health challenge with potential transmission to humans, thereby complicating the treatment of infections caused by these resistant pathogens in man. As such, the urgent need for antimicrobial surveillance and stewardship is of utmost importance.

The influence of exposure to various concentrations of five antimicrobial agents on intracellular cytotoxin B production in Clostridioides difficile

W. Jamal, B. I. Duerden, V. O. Rotimi — Wed, 19 Jul 2023 00:00:00 +0000

Background: Clostridioides difficile is an important cause of healthcare-associated diarrhea. Several anti- microbial agents are known to promote C. difficile infection (CDI). The impact of various concentrations of ampicillin (AMP), cefotaxime (CTX), clindamycin (CC), metronidazole (MTZ) and vancomycin (VAN) on intra-cellular cytotoxin B production was investigated in this study.

Methodology: Six clinical strains of C. difficile were grown at minimum inhibitory concentration (MIC) and sub-MIC concentrations of these antibiotics. Inoculum standardization was performed by Miles and Misra method. Intracellular toxin B production was detected using Vero cell cytotoxicity assay in sonicated cultures on days 1, 2, 3, 4, 5 and 7 days of incubation.

Results: There was a heterogeneous relationship between antibiotic exposure and the intra-cellular toxin production by the toxigenic strains. Clinical strains of C. difficile when exposed to MIC and sub-inhibitory concentrations of certain antibiotics produced high cytotoxin levels. All toxigenic isolates produced increased levels of cell-bound cytotoxin after exposure to antibiotics but there was no consistent pattern and the response to different doses varied considerably. Metronidazole was the most potent inducer of cell-bound cytotoxin followed by cefotaxime and clindamycin. Vancomycin induced the least amount of cytotoxin activity.

Conclusion: The effects of sub-inhibitory concentration of antibiotic that predispose to C. difficile infection may partially suppress the normal gut flora, allowing colonization and growth of C. difficile, and may affect the level of toxin produced.

Prevalence and risk factors for hepatitis C virus infection among HIV positive patients at the Lagos University Teaching Hospital, Nigeria

P. O. Oshun, O. B. Salu, S. A. Omilabu — Wed, 19 Jul 2023 00:00:00 +0000

Background: Worldwide, an estimated 58 million people have chronic hepatitis C virus (HCV) infection, with about 1.5 million new infections occurring per year. About 2.3 million people living with HIV globally have serological evidence of past or present HCV infection. The aim of this study was to determine the prevalence of active HCV infection and associated risk factors among HIV positive patients attending the HIV clinic, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria.

Methodology: A cross sectional study was conducted to determine the prevalence of and risk factors for HCV infection among randomly selected HIV positive patients at the LUTH HIV clinic. Socio-demographic, clinical and laboratory data were collected from the participants using a structured questionnaire. Blood samples were collected and tested for HCV antibodies with an enzyme linked immunosorbent assay (CTK Biotech USA) and HCV RNA was detected using reverse transcriptase polymerase chain reaction assay.

Results: One hundred and ninety-five HIV infected participants were recruited into the study of which 134 (68.7%) were females and 61 (31.3%) were males. The mean age of participants was 40.1±7.8 years. Of the 195 participants, 5 tested positive for antibody to HCV, giving a seroprevalence rate of 2.6% (95% CI = 0.8-5.9%). Of the 5 seropositive participants, HCV RNA was detected in 1 (20.0%), giving a prevalence of 0.5% (1/195) for active HCV infection. The seroprevalence of HCV in males of 4.9% (3/61) and females of 1.5% (2/134) was not significantly different (OR=3.41, 95% CI=0.56-20.98%, p=0.18). The mean log₁₀ HIV viral load was significantly higher among participants seropositive for HCV (5.1±0.9 log copies/ml) than those seronegative (2.7±1.2 log copies/ml) (p < 0.001). The mean duration of antiretroviral therapy was significantly lower among participants seropositive for HCV (2.6±1.3 years) than those seronegative (5.6±3.1 years) (p=0.004). The seroprevalence of HCV was significantly higher in those with CD4 count <350 cells/mm³ (8.5%) than those with CD4 count >350cells/mm³(p=0.02). The seroprevalence of HCV in the HIV-positive participants was significantly associated with sexual partners (p=0.0473), with highest seroprevalence in those with ≥ 3 sexual partners (OR=11.625, 95% CI=1.049-128.83). Other risk factors were not significantly associated with seroprevalence of HCV (p>0.05), while risk factors associated with active HCV infection could not be evaluated with the only one HCV RNA positive participant

Conclusion: Although the prevalence of active HCV infection in HIV infected individuals in this study was apparently low (0.5%), screening with HCV antibody test and confirmation with HCV RNA PCR assay are recommended.

Seroprevalence of transfusion transmissible infections by ELISA in donors testing negative with rapid ICT in Asokoro District Hospital, Abuja, Nigeria

C. G. Nwankwo, Y. D. Obazee, E. O. Sanni, N. K. Ezike, B. Adegboro, A. F. Asalu — Wed, 19 Jul 2023 00:00:00 +0000

Background: Blood transfusion saves lives, but it is associated with many complications which include transfusion transmissible infections (TTIs). The major objectives of this study were to determine; the prevalence of TTIs in the blood donated at Asokoro District Hospital, Abuja, Nigeria from 01 January to 31 December 2019; investigate the accuracy of rapid immunochromatographic (ICT) tests for preliminary TTIs screening of blood donors’ samples and confirmed by ELISA test; and establish baseline data that will provide the impetus for improvement in equipment, infrastructure, and health system management, with the ultimate goal of ensuring safer blood transfusion practice.

Methodology: This was a retrospective cross-sectional study of records of blood donors at the Blood Bank of Asokoro District Hospital, a quasi-tertiary centre situated at Abuja, Federal Capital Territory (FCT), northcentral Nigeria, between 01 January to 31 December 2019. The socio-demographic biodata (age and gender), blood parameters (PCV and blood groups), and TTIs test results (by rapid ICT kit and ELISA) of donors were manually extracted from the record books of the hospital’s blood bank. Only donor blood samples that initially tested negative for TTIs met the inclusion criteria. The data were entered into the spreadsheet of Microsoft Excel, and analysed with the Statistical Package for the Social Sciences (SPSS) for Windows version 23.0. Chi square test was used to determine association between variables and p value less than 0.05 was considered statistical significance.

Results: A total of 1400 blood samples of donors, received within the study period, met the inclusion criteria of testing negative for TTIs on rapid ICT kit test. The mean age (± SD) of the donors was 35.6±6.7 years with age range of 18-67 years. The median age was 35 years, and the predominant age group was 30-39 years, accounting for 55.4% (775/1400). Majority of the donors (97.1%, 1359/1400) were males. In terms of ABO blood group distribution, group O Rh D positive was the commonest, followed by group A Rh D positive, while the least is group AB Rh D positive. The overall prevalence of TTIs by ELISA test was 4.9% (68/1400). This prevalence was highest for HCV (1.9%, 26/1400), followed by HIV (1.2%, 17/1400), HBV (0.9%, 13/1400) and syphilis (0.9%, 12/1400).

Conclusion: The detection of TTIs by ELISA test from false negative donor samples preliminarily screened with rapid ICT kit highlighted by our study speaks to the unreliability of rapid ICT kits in screening of blood donors for TTIs. There is need therefore for health authorities in Nigeria and other LMICs to ensure widespread availability of highly sensitive blood screening methods such as ELISA to the point where it will be possible to enforce legislation against the use of the less accurate rapid ICT screening kits.

Prevalence and antifungal susceptibility pattern of oral candidiasis among HIV-infected patients in a Mission Hospital, southeast Nigeria

Wed, 19 Jul 2023 00:00:00 +0000

Background: Oral candidiasis is an infection that follows colonization of oral cavity by Candida species mostly Candida albicans. About 90% of HIV-infected persons develop this disease during the course of HIV infection and could serve as early sign of HIV-related immunodeficiency. Treatment involves the use of antifungal drugs. The objectives of this study are to determine the prevalence of oral candidiasis and the susceptibility of isolated Candida species to available antifungal agents among selected HIV-infected patients in a mission hospital, southeast Nigeria.

Methodology: This was a descriptive cross-sectional study of 150 consecutively selected HIV-infected patients attending the Heart-to-Heart clinic of Iyi-Enu mission hospital Ogidi, Anambra State, Nigeria, between December 2022 and February 2023. Demographic information of each participant was obtained using structured questionnaire. Five milliliters of whole blood were drawn from the antecubital vein of each participant for CD4⁺ estimation. Mouth specimens were collected using two sterile cotton swabs for microscopy and culture on Sabouraud Dextrose Agar, and Candida species were identified after subculture on CHROMAgar. Antifungal susceptibility testing was performed by Kirby-Bauer disk diffusion method using fluconazole, clotrimazole, ketoconazole, and nystatin disks, and results interpreted according to the guidelines of the Clinical and Laboratory Standards Institute.

Results: A total of 98 (65.3%) HIV-infected participants were positive for oral candidiasis, with 4 species of Candida isolated; Candida albicans (62.2%), Candida glabrata (18.4%), Candida tropicalis (12.2%) and Candida krusei (7.1%). Fifty-nine (60.2%) of the 98 participants had CD4⁺ cell count ˂ 200, 33 (33.7%) had counts in the range of 200-399, and 6 (6.1%) had counts in the range of 400-499 cells/μL (p=0.001). The prevalence of candi- diasis was not significantly different between the female (67.0%, 65/97) and male (62.3%, 33/53) participants (p=0.6598), but the prevalence was significantly higher (p<0.05) in participants age group 21-30 years (80.7%, 42/52), divorced (100%, 1/1) and married (75%, 45/60), those with primary school level education (73.7%, 42/57), civil servants (85.7%, 18/21), and those who performed mouth hygiene once daily (71.9%, 69/96). Nystatin (77.6%, 76/98) showed the highest while fluconazole and ketoconazole (68.4%, 62/98) showed the lowest in vitro antifungal activity

Conclusion: Oral candidiasis is prevalent among HIV-infected patients in the study population, with evidence of in vitro resistance of the Candida isolates to available antifungal drugs. Proper diagnosis, susceptibility testing and treatment of infection will be helpful in managing oral candidiasis infection among HIV infected patients.

Potentials and limitations of cold-adapted hydrogen producing bacteria: A mini review

Wed, 19 Jul 2023 00:00:00 +0000

Low-temperature bacteria have potential to produce biohydrogen and are often considered a potential renewable energy generator for the future. However, the bacteria have presented poor hydrogen yield due to slow metabolic rate and prolonged lag phase often caused by their restricted growth temperature limit. The ineffective search for new biocatalysts from cold environments and the application of modification techniques almost jeopardize the economic viability of these strains in the biohydrogen production research. This article examined cold genetic and enzymatic adaptation potentials that led to the continuous expression of novel biocatalysts of biotechnological importance under the following headings; cold-adapted bacteria, biohydrogen-producing bacteria, strategies for adapting to stress in low temperatures, performance of cold-adapted bacteria in biohydrogen production, challenges of cold-adapted bacteria in biohydrogen production and future prospect. Finding new strains and studying their unique properties can improve the efficiency of hydrogen production by cold-adapted bacteria, as this new area has not yet been extensively studied.

A review of staphylococcal scalded skin syndrome

N. Medugu, J. Imran, T. O. Musa-Booth, B. Makun, B. Adegboro — Wed, 19 Jul 2023 00:00:00 +0000

Staphylococcal scalded skin syndrome (SSSS) is characterized by widespread epithelial necrosis and/or superficial blistering of the skin following infection by some toxigenic strains of Staphylococcus aureus. The disease primarily affects children under the age of 5 years, but it can also occur in adults. Due to the recent increase in reported cases of SSSS, we have reviewed the epidemiology, pathogenesis, clinical features, diagnosis, treatment, and prevention, including the development of vaccines for S. aureus infections. Electronic databases including PubMed, Google Scholar and websites of the Center for Disease Prevention and Control (CDC), and the World Health Organization (WHO), were searched for publications on SSSS written in English language. Our review showed that SSSS is more common in children, amongst whom it carries a mortality rate of <5%, as opposed to mortality rate of >50% in affected adults. Penicillinase-resistant penicillins are recommended for the treatment of SSSS, and administration of fresh frozen plasma (FFP) may aid early recovery. Important staphylococcal vaccine candidates are also highlighted in the review.

Antibiotic susceptibility profiles of Gram-negative bacterial uropathogens in a tertiary hospital, southwest Nigeria

I. I. Otaigbe, E. Ebeigbe, H. N. Okunbor, T. O. Oluwole, C. J. Elikwu — Wed, 19 Jul 2023 00:00:00 +0000

Background: Increasing rates of antibiotic resistance have made it necessary to regularly monitor antibiotic susceptibility patterns of gram negative bacterial uropathogens in order to optimize antibiotic therapy for urinary tract infections. The aim of this study was to analyze the antibiotic susceptibility patterns of Gram-negative bacterial uropathogens in Babcock University Teaching Hospital, Ilishan-Remo, southwest Nigeria.

Methodology: This study was a retrospective review of the Medical Microbiology Laboratory records of the hospital to analyze the in vitro antibiotic susceptibility patterns of Gram-negative urinary bacterial isolates between May 2016 and April 2022. The bacteria were isolated and identified from routine urine samples using standard bacteriological methods. In vitro antibiotic susceptibility test (AST) to amoxicillin-clavulanate, piperacillin-tazobactam, ceftriaxone, ceftazidime, nitrofurantoin, ciprofloxacin and meropenem was routinely performed by the modified Kirby-Bauer disk diffusion test and susceptibility break points determined using the Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: A total number of 3,549 urine samples were processed during the period of review, and 808 (22.8%) samples yielded positive bacterial cultures. Of the 808 isolates, 604 (74.8%) were Gram-negative bacteria. The most frequently isolated Gram-negative bacteria were Escherichia coli (41.9 %) and Klebsiella spp (27.5%) while Pseudomonas spp and Proteus spp accounted for 4.3% and 1.0% of all isolates respectively. Meropenem had the highest in vitro antibacterial activity (74.3% to 90.3% of isolates were sensitive) for all isolates. Overall, E. coli, Klebsiella spp., and Proteus spp. showed high resistance rates to amoxicillin-clavulanate (65.3% to 97.1%).

Conclusion: Effective antimicrobial stewardship programs must be in place in order to ensure the appropriate use of antibiotics for treating urinary tract infections.

Isolation of Globicatella sanguinis from a neonate with sepsis using BacT/Alert and VITEK-2 compact system at Federal Teaching Hospital, Katsina, northwest Nigeria: A case report

H. K. Obaro, M. B. Suleiman, S. A. Yekinni, A. Sanda, B. T. Aminu — Wed, 19 Jul 2023 00:00:00 +0000

Neonatal sepsis is a significant cause of neonatal morbidity and mortality, predominantly in developing countries. The bacterial causes of neonatal sepsis and their antimicrobial susceptibility patterns are however dynamic. Globicatella sanguinis is a streptococcus-like bacterial agent capable of causing serious infection in humans that has been rarely isolated from clinical samples, and is an uncommon pathogen that is difficult to identify. Identification based on phenotypic methods alone can misidentify many bacteria, and this may affect precise antibiotic treatment. We report the isolation of a rare bacterial pathogen, G. sanguinis from a three-hour-old preterm female neonate (28 weeker, extremely low birth weight) with sepsis and respiratory distress syndrome (RDS) at Federal Teaching Hospital Katsina, Nigeria, and to the best of our knowledge, one of the very few reported cases all over the world. Blood sample was aseptically collected from the neonate and cultured on BacT/Alert automated system (BioMérieux, Mercy-Etoile, France). A rare bacterium was identified from a positive culture, and in vitro susceptibility test using VITEK-2 compact system showed the isolate to be sensitive to gentamicin, cefuroxime, ceftriaxone, and ceftazidime. Despite antibiotic treatment and other standards of care, on day 9 of admission, the baby developed apnea and all resuscitative measures proved abortive. In a developing country like Nigeria where child mortality due to infection is high, the inclusion of advanced technologies such as improved VITEK-2 compact system, PCR, MALDI-TOF MS, and next-generation sequencing, could play a significant role in its reduction.

Isolated axillary tuberculous lymphadenitis in a Nigerian female: A case report with review of the literature

J. O. Uchendu, D. G. Yovwin, O. Esemuede — Wed, 19 Jul 2023 00:00:00 +0000

Tuberculosis (TB) is a chronic granulomatous infectious pulmonary and systemic disease caused mostly by members of the Mycobacterium tuberculosis complex (MTBC). It has variable clinical presentation and is a major cause of morbidity and mortality in the middle-and-low-income-countries (LMICs). Isolated axillary tuberculous lymphadenitis (ATL) is rare and is defined as the presence of axillary tuberculous lymphadenitis in the absence of previous or active pulmonary TB or evidence of extrapulmonary TB elsewhere. We present a case of isolated ATL in a 54-year-old HIV-negative Nigerian woman, whose diagnosis was made using histological evaluation that demonstrated typical Langhan’s giant cells and caseous necrosis, with the detection of mycobacterial DNA by GeneXpert TB test. Isolated ATL is a diagnostic enigma but should be considered in young and middle-aged women in TB endemic regions presenting with enlarged axillary lymph nodes in the absence of foci of infections or malignancy. Sex difference in immunological response to infection may account for this unique presentation among the female gender.