Etiological study of lymphadenopathy in HIV-infected patients in a tertiary care hospital.
BACKGROUND
Human immunodeficiency virus (HIV) infection has become a global pandemic. Persistent generalized lymphadenopathy (PGL) is very common manifestation of HIV infection. Moreover, different opportunistic infections such as tuberculosis (TB) and malignancies may present with lymphadenopathy. Mycobacterium avium complex (MAC) infection is most common with cluster of differentiation (CD)4+ count ≤50 cells/μL. Fine-needle aspiration cytology (FNAC) offers a simple and effective modality for obtaining a representative sample of the material from lymph nodes, permitting cytological evaluation and other investigations.


OBJECTIVE
The aim of this study is to find out the different etiologies of lymphadenopathy in HIV-infected patients and to establish a possible correlation with CD4+ count.


METHODS
A total of 100 HIV-infected patients having significant (>1 cm) extrainguinal lymphadenopathy were studied in 1 year at the Department of Pathology by FNAC and the stains used were Leishman-Giemsa, Ziehl-Neelsen (ZN), Papanicoloau, and Gram stains. For tubercular culture, Löwenstein-Jensen (LJ) medium was used. CD4+count was done by flow cytometer.


RESULTS
The present study revealed four types of cytomorphological variants in lymphadenopathy cases by FNAC, which include: Reactive hyperplasia and caseation necrosis; caseation necrosis and ill-formed granuloma; well-formed granuloma without any necrosis; and non-Hodgkin lymphoma (NHL). The highest acid-fast bacilli (AFB) positivity was among the patients showing caseation necrosis. Tubercular culture in LJ media turned out as a more sensitive method for diagnosis than routine ZN staining. The 2 cases that showed well-formed epithelioid granuloma without any necrosis turned out to be histoplasmosis and cryptococcosis, respectively. In this study, we found 2 cases of NHL. The study also revealed that caseation necrosis and AFB positivity along with opportunistic infections increases with decreased CD4+ count.
Department of Pathology, Medical College, Kolkata, West Bengal, India.
Dipanwita
D
Nag
Department of Pathology, Medical College, Kolkata, West Bengal, India.
Sumedha
S
Dey
Department of Pathology, Medical College, Kolkata, West Bengal, India.
Ayandip
A
Nandi
Department of Pathology, Malda Medical College, Malda, West Bengal, India.
Ranjana
R
Bandyopadhyay
Department of General Medicine, Medical College, Kolkata, West Bengal, India.
Debjani
D
Roychowdhury
Department of Microbiology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India.
Raja
R
Roy
Cluster of differentiation (CD)4+ count; human immunodeficiency virus (HIV); lymphadenopathy; tuberculosis (TB)