Histological Features of Tubercular Lymphadenitis in HIV Positive Patients

Abstract

ResultsIn the current study, 33 cases (44%) were diagnosed as tubercular lymphadenitis and were the second most common causes of lymphadenopathy after reactive hyperplasia. The presenting complaints in this group were fever (100%) followed by cough (84%) and weight loss (75%). Generalized lymphadenopathy was seen in 25 cases (75.6%) where as cervical lymphadenopathy was found in 7 cases (21.2%). One case presented with axillary lymphadenopathy. All the patients (33) were clinically diagnosed as AIDS. A raised ESR was seen in all cases ranging from 40 to 140mm/hr. The CD4 counts of all these patients ranged from 10-258/µl with the CD4 count being<200 in 84.8% of cases (Table 1) AbstractTuberculosis is one of the most common causes of lymphadenopathy in HIV positive patients. Though the presenting complaint is same as non HIV patient, the histologic features of lymph node biopsy varies depending on the immune status. The present study is conducted to find out these differences and its relevance in diagnosis. Material and methods:The histological features seen on lymph node biopsies, done on HIV positive patients who presented with lymphadenopathy, with or without other systemic manifestations over a period of three years were analysed. Seventy four lymph node biopsies were found adequate and provided the material for the present study. The lymph nodes biopsies were fixed in 10% formalin and were stained using Haematoxylin and eosin (H&E) stain. Sections were stained for AFB by using ZiehlNeelson method if H & E stained slides showed features suggestive of tuberculosis on light microscopy.Results: In the current study, 33 cases (44%) were diagnosed as tuberculous lymphadenitis and was the second most common cause of lymphadenopathy. The CD4 counts of all these patients ranged from 10-258/µl with the CD4 count being<200 in 84.8% of cases. In the present study, granulomas were detected in 90.9% of the cases and were the most common and conspicuous feature. Confluent granulomas were more commonly seen than discrete ones. Most of the cases of caseating (75%) had more than 1 AFB/hpf whereas in the remaining cases (25%), number was less than 1/100hpf. Granulomatous lymphadenitis without caseous necrosis was seen in 2 cases (6.7%). Microabscess with granular debris without coexisting granuloma was found in 11 cases (33.3%) and all showed acid fast bacilli on Ziehl-Neelsen stain. Other features noted in present study were plasmacytosis (57.6%), paracortical expansion (12.1%) and periadenitis(30.3%). In the present study, AFB was positive in all the 33 cases. Two cases were diagnosed as tuberculosis on biopsies and confirmed as atypical mycobacterium. Conclusion:Lymph node biopsy is a valuable tool in the evaluation of HIV positive patient to identify the causes of lymphadenopathy. AFB were performed in 22 cases and was strongly positive in all of them. Granulomas were detected in 90.9% of the cases and were the most common and conspicuous feature. Micro abscess with granular debris without coexisting granuloma was found i...

Histopathological Cellular and Diagnostic Features of Tuberculous Lymphadenitis

“…Jayalakshmi et al [8] reported epithelioid cell granulomas in 100% of cases with central caseation necrosis in 96.6% of cases. Agarwal et al [9] reported caseous necrosis as the most prominent feature in lymph node biopsies even in the absence of granulomas or in the presence of poorly formed ones in LNTB patients present with human immunodeficiency virus (HIV) infection. We also reported caseation necrosis as a primary finding in our study.…”

Prevalence and Risk Factors of Infection with High Risk Human Papilloma Viruses among HIV-Positive Women with Clinical Manifestations of Tuberculosis in a Middle-Income Country

“…Lymph node TB is the most common extrapulmonary TB form in the immunosuppressed individuals including PLWH. It represents 16–30% of extrapulmonary tuberculosis cases [ 55 , 56 , 57 ], and >40% TB cases in PLWH [ 58 ]. In our study, the number of cases of lymph node TB was significantly lower (8,6% of the cases; p < 0.05).…”

“…GU TB commonly affects kidneys as well as the genital tract [ 63 ]. HIV/AIDS increases the risk to develop GU TB [ 58 ]. In our study, we found GU TB in only one patient.…”