title: HIV-associated tuberculous lymphadenitis: the importance of polymerase chain reaction (PCR) as a complementary tool for the diagnosis of tuberculosis - a study of 104 patients.
abstract: BACKGROUND
  Lymphadenitis is common in HIV-positive patients. Diagnosis of the infections associated with this condition is complex, particularly in the case of tuberculosis. Rapid and specific detection of Mycobacterium tuberculosis (M. tuberculosis) is fundamental in ensuring adequate treatment. In addition, frequent causes of lymphadenitis such as those associated with lymphoma and histoplasmosis, among others, must be eliminated as possible causes.
  
  
  OBJECTIVE
  To evaluate the accuracy of polymerase chain reaction as a tool for the diagnosis of lymphadenitis resulting from M. tuberculosis.
  
  
  METHODS
  In this study, a protocol was developed using the following procedures: direct microscopy using Ziehl-Neelsen staining, culture in Lowenstein-Jensen medium, histology and polymerase chain reaction.
  
  
  RESULTS
  A total of 104 patients were included in the study. According to histopathology, 38 patients (36%) were found to have nonspecific chronic lymphadenitis, 27 (26%) had tuberculous lymphadenitis, 11 patients (10.5%) had lymphoma and 9 (8.7%) had histoplasmosis. When Lowenstein-Jensen culture was performed, positive tests for tuberculous lymphadenitis increased by 30%. With polymerase chain reaction, M. tuberculosis DNA was detected in 6 out of 38 samples of non-specific chronic lymphadenitis. Three of these patients were followed up, developed symptoms of tuberculosis and were cured following specific treatment.
  
  
  CONCLUSIONS
  The data obtained in this study suggest that all cases of lymphadenopathies should be submitted to histopathology, Lowenstein-Jensen or Ogawa culture and polymerase chain reaction. Polymerase chain reaction may prove to be useful in providing an early and accurate detection of cases of extrapulmonary tuberculosis in HIV-positive patients with lymphadenopathies, avoiding empirical treatment and the possible development of resistant strains.
authors.affiliation: Nilton Lins University Center, Manaus, Amazonas, Brazil.
authors.forename: Marcio Valle
authors.initials: MV
authors.lastname: Cortez
authors.forename: Cintia Mara Costa de
authors.initials: CM
authors.lastname: Oliveira
authors.forename: Rossicléia Lins
authors.initials: RL
authors.lastname: Monte
authors.forename: José Ribamar de
authors.initials: JR
authors.lastname: Araújo
authors.forename: Bruna Backsmann
authors.initials: BB
authors.lastname: Braga
authors.forename: Débora Zotteli dos
authors.initials: DZ
authors.lastname: Reis
authors.forename: Luis Carlos de Lima
authors.initials: LC
authors.lastname: Ferreira
authors.forename: Milton Ozório
authors.initials: MO
authors.lastname: Moraes
authors.forename: Sinésio
authors.initials: S
authors.lastname: Talhari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002908:Chronic Disease; D004269:DNA, Bacterial / Q000032:analysis*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006660:Histoplasmosis / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics* / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial