Tuberculous lymphadenitis, a diagnostic problem in areas of high prevalence of HIV and tuberculosis.
The human immunodeficiency virus (HIV) epidemic is associated with a marked increase of tuberculosis cases. The influence of HIV on diagnostic methods for tuberculous lymphadenitis is less clear. In an environment of high HIV and tuberculosis prevalence in Blantyre, Malawi, a prospective study compared results of basic procedures diagnosing tuberculous lymphadenitis with the outcome of histology and/or culture. One hundred out-patients, aged 15-55 years, with extra-inguinal lymphadenopathy not responding to general antibiotics, entered the study. Among 52 cases, with whom all procedures were carried out in accordance with the protocol, 38 (73%) were diagnosed as tuberculous lymphadenitis; 84% of the latter (32/38) were seropositive for HIV. Needle aspirate and biopsy smears stained by the Ziehl-Neelsen technique contributed little to detecting tuberculosis, 8% and 11% respectively. In contrast, macroscopic caseation of excised lymph nodes showed a high yield of 82%, which was similar to histology, and higher than that of Löwenstein-Jensen culture (61%). The study suggested that HIV positivity of tuberculous lymphadenitis patients decreased the possibility of histology and culture both being indicative of tuberculosis (odds ratio 0.10; P = 0.06). Consequently histology results, often used as the single definitive method, failed to diagnose 18% (7/38) of tuberculosis cases. However, it was reassuring that 4 simple methods, which can safely be carried out at district level, could be expected to diagnose 80-95% of tuberculous lymphadenitis cases in a timely and cost-effective manner.
Bekedam
H J
HJ
Regional Health Office, Blantyre, Malawi.
Boeree
M
M
Kamenya
A
A
Liomba
G
G
Ngwira
B
B
Subramanyam
V R
VR
Harries
A D
AD
D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008295:Malawi / Q000453:epidemiology; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis* / Q000473:pathology