title: Patterns of granulomatous responses in TB lymphadenitis and their correlation with treatment outcomes.
abstract: BACKGROUND
  Four patterns are noted in aspirates of TB lymphadenitis with or without concomitant HIV. They are granulomatous, necrotizing granulomatous, predominantly necrotizing and necrotizing suppurative designated pattern 1, 2, 3 and 4, respectively. The present study attempted to correlate granulomatous patterns, Acid Fast Bacilli (AFB) density with treatment outcomes.
  
  
  METHODS
  The MGG and Papanicolaou stained slides of 56 lymphadenitis patients, 38 TB and 18 TB with seropositive HIV were studied for two years. The AFB were stratified into: 0 - nil (1 - ≤1 AFB, 2 - >1 but <10 AFB, 3 - ≥10 AFB)/10 fields.
  
  
  RESULTS
  There were 35 males and 21 females. Eleven aspirates demonstrated AFB. TB+HIV lymphadenitis displayed a higher AFB score. TB+HIV lymphadenitis aspirates significantly showed higher grade granulomas and AFB. TB+HIV lymphadenitis required ≥8-month treatment. Granulomas (pattern 3 or 4) but not high AFB scores required longer treatment (>6 months). Treatment of AFB (≥1) often extended to >6 months.
  
  
  CONCLUSIONS
  TB with seropositive HIV, possibly due to defective immune regulation exhibited granulomas (pattern 3 or 4) necessitating treatment for ≥8 months. Pattern 3 or 4 granulomas irrespective of HIV status demanded >6-month treatment.
authors.affiliation: Kasturba Medical College, Mangalore, Manipal University, India. Electronic address: devrishi2006@gmail.com.
authors.forename: Debarshi
authors.initials: D
authors.lastname: Saha
authors.affiliation: Kasturba Medical College, Mangalore, Manipal University, India.
authors.forename: Komal
authors.initials: K
authors.lastname: Rautela
authors.affiliation: Kasturba Medical College, Mangalore, Manipal University, India.
authors.forename: Ashwani
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Kasturba Medical College, Mangalore, Manipal University, India.
authors.forename: Pooja K
authors.initials: PK
authors.lastname: Suresh
mesh_terms: D005260:Female; D006099:Granuloma; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D008199:Lymphadenitis / Q000150:complications / Q000473:pathology*; D008297:Male; D016896:Treatment Outcome; D014388:Tuberculosis, Lymph Node / Q000150:complications / Q000473:pathology*
keywords: Granuloma; HIV; Lymphadenitis; Treatment response; Tuberculosis