title: Polymerase chain reaction amplifying mycobacterial DNA from aspirates obtained by endoscopic ultrasound allows accurate diagnosis of mycobacterial disease in HIV-positive patients with abdominal lymphadenopathy.
abstract: Abdominal lymphadenopathy in human immunodeficiency virus (HIV) infection remains a diagnostic challenge. We performed a prospective cohort study by recruiting 31 symptomatic HIV + patients with abdominal lymphadenopathy and assessing the diagnostic yield of endoscopic ultrasound fine-needle aspiration (EUS-FNA). Mean age was 38 years; 52% were female; and mean CD4 count and viral load were 124 cells/μL and 4 log, respectively. EUS confirmed additional mediastinal nodes in 26%. The porta hepatis was the most common abdominal site. Aspirates obtained by EUS-FNA were subjected to cytology, culture and polymerase chain reaction (PCR) analysis. Mycobacterial infections were confirmed in 67.7%, and 31% had reactive lymphadenopathy. Cytology and culture had low sensitivity, whereas PCR identified 90% of mycobacterial infections. By combining the appearance of aspirates obtained by EUS-FNA and cytologic specimens, we developed a diagnostic algorithm to indicate when analysis with PCR would be useful. PCR performed on material obtained by EUS-FNA was highly accurate in confirming mycobacterial disease and determining genotypic drug resistance.
authors.affiliation: Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa; DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Martin
authors.initials: M
authors.lastname: Nieuwoudt
authors.affiliation: Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa.
authors.forename: Roeland
authors.initials: R
authors.lastname: Lameris
authors.affiliation: Department of Molecular Pathology, Ampath Laboratories, Pretoria, South Africa.
authors.forename: Craig
authors.initials: C
authors.lastname: Corcoran
authors.affiliation: Department of Family Medicine, University of Pretoria, Pretoria, South Africa.
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Rossouw
authors.affiliation: Department of Pathology, Ampath laboratories, Pretoria, South Africa; Department of Anatomical Pathology, University of Pretoria, Pretoria, South Africa.
authors.forename: Tomas
authors.initials: T
authors.lastname: Slavik
authors.affiliation: Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa.
authors.forename: Johannie
authors.initials: J
authors.lastname: Du Plessis
authors.affiliation: Department of Surgery, Chris Hani-Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Jones A O
authors.initials: JA
authors.lastname: Omoshoro-Jones
authors.affiliation: MRC Unit of Inflammation and Immunity, Department of Immunology, University of Pretoria, Pretoria, South Africa; Tshwane Academic Division of the National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Stivaktas
authors.affiliation: Interventional GI Unit, Pretoria East Hospital, Pretoria, South Africa.
authors.forename: Fritz
authors.initials: F
authors.lastname: Potgieter
authors.affiliation: Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa. Electronic address: Schalk.vandermerwe@uzleuven.be.
authors.forename: Schalk W
authors.initials: SW
authors.lastname: Van der Merwe
mesh_terms: D000005:Abdomen; D000328:Adult; D044963:Biopsy, Fine-Needle; D015331:Cohort Studies; D004247:DNA; D019160:Endosonography / Q000379:methods*; D005260:Female; D005434:Flow Cytometry / Q000379:methods; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008206:Lymphatic Diseases / Q000150:complications*; D008297:Male; D009164:Mycobacterium Infections / Q000150:complications* / Q000175:diagnosis*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D004247:DNA
keywords: Abdominal lymphadenopathy; Endoscopic ultrasound; HIV; Human immunodeficiency virus; Tuberculosis