Keywords: Lymphadenitis tuberculosis, histopathological features, well organized granuloma, poorly organized granuloma, leukocyte count, immune response


Background: Indonesia is the 3rd country with the highest incidence of tuberculosis (TB) in the world. 15% of TB cases are EPTB with 50% of them being lymphadenitis TB (LNTB). The histopathological features of the biopsy samples play an important role in the diagnosis of this disease by producing the images of WOG or POG. The number of leukocytes can describe the immune response in people with LNTB.

Methods: This study is an observational analytic study with a cross-sectional approach. The data were obtained by documenting the medical records of LNTB patients who were treated at the RSUD Provinsi NTB and  RSUD Kota Mataram in the January 2019 - February 2020 period.

Results: The total number of research subjects is 51 people. In the histopathological features, 37 samples included WOG, and 14 samples included POG. On the leukocyte count, none of the patients had leukopenia, 39 patients had normal leukocyte counts and 12 patients had leukocytosis. The results of the Spearman correlation test obtained p = 0.005 and r = 0.384

Conclusion: There is a significant correlation between the histopathological features and the number of leukocytes in patients with LNTB in NTB in January 2019 - February 2020. The correlation is weak.


1. WHO. Global tuberculosis report 2019. Geneva; 2019.
2. Kartasasmita CB. Epidemiologi Tuberkulosis. Sari Pediatr [Internet]. 2009;11(2). Available from:
3. Wahid F, Rehman H, Ahmad I. Extrapulmonary tuberculosis in patients with cervical lymphadenopathy. J Pak Med Assoc [Internet]. 2013;63(9):1094–7. Available from:
4. Ahmed HGE, Nassar AS, Ginawi I. Screening for Tuberculosis and Its Histological Pattern in Patients with Enlarged Lymph Node. Patholog Res Int. 2011;2011:417635.
5. Goldszmid RS, Dzutsev A, Trinchieri G. Host immune response to infection and cancer: unexpected commonalities. Cell Host Microbe. 2015;15(3):295–305.
6. Chaplin DD. Overview of the Immune Response. J Allergy Clin Immunol. 2010;125(2):S3-23.
7. Kumar V, Abbas AK, Aster JC. Robbins Basic Pathology. 9th ed. Philadelphia: Elsevier Inc.; 2013.
8. Hong LF, Li XL, Luo SH, Guo YL, Liu J, Zhu CG, et al. Relation of leukocytes and its subsets counts with the severity of stable coronary artery disease in patients with diabetic mellitus. PLoS One. 2014;9(3):1–7.
9. Chmielewski PP, Strzelec B. Elevated leukocyte count as a harbinger of systemic inflammation, disease progression, and poor prognosis: A review. Folia Morphol. 2018;77(2):171–8.
10. Dragu R, Huri S, Zuckerman R, Suleiman M, Mutlak D, Agmon Y, et al. Predictive value of white blood cell subtypes for long-term outcome following myocardial infarction. Atherosclerosis. 2008;196(1):405–12.
11. Ramakrishnan L. Revisiting the role of the granuloma in tuberculosis. Nat Rev Immunol [Internet]. 2012;12(5):352–66. Available from:
12. Ehlers S, Schaible UE. The granuloma in tuberculosis: Dynamics of a host-pathogen collusion. Front Immunol. 2012;3:1–9.
13. Pagán AJ, Ramakrishnan L. The Formation and Function of Granulomas. Annu Rev Immunol. 2018;36(13:7):639–65.
14. Petersen HJ, Smith AM. The Role of the Innate Immune System in Granulomatous Disorders. Front Immunol. 2013;4(May):1–11.
15. Hines ME, Kreeger JM, Herron AJ. Mycobacterial Infecions of Animals?: Pathology and Pathogenesis. Lab Anim Sci. 1995;45(4):334–51.
16. Martinot AJ. Microbial Offense vs Host Defense: Who Controls the TB Granuloma? Vet Pathol. 2018;55(1):14–26.
17. Flynn JL, Chan J, Lin PL. Macrophages and control of granulomatous inflammation in tuberculosis. Mucosal Immunol [Internet]. 2011;4(3):271–8. Available from:
18. Miranda MS, Breiman A, Allain S, Deknuydt F, Altare F. The tuberculous granuloma: An unsuccessful host defence mechanism providing a safety shelter for the bacteria? Clin Dev Immunol. 2012;2012.
19. Prezzemolo T, Guggino G, La Manna MP, Di Liberto D Di, Dieli F, Caccamo N. Functional signatures of human CD4 and CD8 T cell responses to Mycobacterium tuberculosis. Front Immunol. 2014;5(180):1–13.
20. Volkman HE, Clay H, Beery D, Chang JCW, Sherman DR, Ramakrishnan L. Tuberculous granuloma formation is enhanced by a Mycobacterium virulence determinant. PLoS Biol. 2004;2(11).
21. Patterson KC, Queval CJ, Gutierrez MG. Granulomatous Inflammation in Tuberculosis and Sarcoidosis: Does the Lymphatic System Contribute to Disease? BioEssays. 2019;41(11):1–8.
22. Wang J, Yin Y, Wang X, Pei H, Kuai S, Gu L, et al. Ratio of monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis. Brazilian J Infect Dis [Internet]. 2015;19(2):125–31. Available from:
23. Rees CA, Pineros DB, Amour M, Munseri P, Said J, Magohe A, et al. The potential of CBC-derived ratios (monocyte-to-lymphocyte, neutrophil-to-lymphocyte, and platelet-to-lymphocyte) to predict or diagnose incident TB infection in Tanzanian adolescents. BMC Infect Dis. 2020;20(1):1–10.
24. Iliaz S, Iliaz R, Ortakoylu G, Bahadir A, Bagci BA, Caglar E. Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis. Ann Thorac Med. 2014;9(4):232–5.
25. Özdemir C, Sökücü SN, Önür ST. Can neutrophil/lymphocyte ratio and platelet/lymphocyte ratio be used in differential diagnosis of Stage I sarcoidosis from tuberculosis lymphadenopathy? Eurasian J Pulmonol. 2018;20(1).
26. Ayed H Ben, Koubaa M, Marrakchi C, Rekik K, Jemaa T Ben, Jemaa M Ben, et al. Could neutrophil to lymphocyte ratio be a prognostic predictor of relapse in patients with extra-pulmonary tuberculosis? Electron J Gen Med. 2018;15(4).
27. Rahman EY, Tjokrosonto S. Hubungan antara ekspresi CD4+ dan CD8+ dengan gambaran histopatologis dan gambaran klinis pada pasien limfadenitis tuberkulosis [Internet]. Universitas Gajah Mada; 2004. Available from:
28. Silva AA, Mauad T, Saldiva PHN, Pires-Neto RC, Coletta RD, Graner E, et al. Immunophenotype of lung granulomas in HIV and non-HIV associated tuberculosis. Med Express. 2014;1(4).
29. Eliandy S, Lubis MND. Hubungan Gambaran Bercak-Bercak Gelap ( Dark Specks ) pada Latar Belakang Material Nekrotik Granular Eosinofilik dengan Kadar CD4 Penderita Limfadenitis Tuberkulosis Servikalis yang Disertai HIV / AIDS. Maj Patol. 20(3):8–14.
30. Rao JS, Kumari J, Kini U. Correlation of CD4 Counts with the FNAC Patterns of Tubercular Lymphadenitis in Patients with HIV: A Cross Sectional Pilot Study. Diagn Cytopathol. 2014;43(1):16–20.