FINE NEEDLE ASPIRATION CYTOLOGY OF LYMPH NODES IN HIV INFECTED PATIENTS

HIV Lymphadenopathy: Differential Diagnosis and Important Imaging Features

OBJECTIVE. The purpose of this article is to review important imaging and clinical features to help elucidate causes of lymphadenopathy in patients with HIV infection. CONCLUSION. HIV lymphadenopathy has various causes generally categorized as inflammatory or reactive, such as immune reconstitution syndrome; infectious, such as tuberculous and nontuberculous mycobacterial infections and HIV infection itself; and neoplastic, such as lymphoma, Kaposi sarcoma, and Castleman disease. It is important to consider patients' demographic characteristics, clinical presentations, CD4 lymphocyte counts, and radiologic features to identify likely causes of lymphadenopathy.

FNAC of lymph nodes in HIV positive patients-a diagnostic boon

OBJECTIVES

The goal of this study is to examine the fine-needle aspiration cytology (FNAC) features of lymph node lesions in human immunodeficiency virus (HIV)-positive patients and to evaluate the role of FNAC in diagnosis. This study also aims to analyze the cytological patterns and available clinicopathological parameters of FNAC.

MATERIALS AND METHODS

This study was carried out in the Department of Pathology at Government Medical College Miraj and P.V.P.G.H. Sangli from August 2012 to July 2014. FNAC was conducted for all HIV-positive patients with lymphadenopathy referred into this department. A total 70 lymph nodes were aspirated from different sites in 60 HIV-positive cases.

RESULTS

The mean age of presentation was 32.4 years with a male predominance (66.7%). The cervical lymph node was the most commonly involved site (70%). The most common lesion was tuberculous lymphadenitis (66.66%) followed by reactive lymphadenitis (13.33%). The most common staining pattern in acid fast bacilli (AFB)-positive tuberculous lymphadenitis was grade 1 (87.88%). The overall AFB positivity in tuberculous lymphadenitis in the present study was 82.5%. The most common cytological pattern was caseous necrosis with epithelioid cell granulomas (60%). The mean CD4 count showed an inverse relationship with increasing grade of AFB positivity. The mean CD4 count was lowest in caseous necrosis-only pattern (330.2 cells/μL). All the cases were consistent with HIV type A lymphadenopathy. Two cases of malignancy was also seen.

CONCLUSIONS

FNAC is a rapid and cheap procedure that can help in establishing the diagnosis in a large number of cases. It also helps in segregating the lesions that need further evaluation. Comparison of lymph node lesions with CD4 counts, AFB grading, and hematological alterations reflects immunity, stage of disease, and disease activity, thus aiding in better treatment.

A clinicopathological study of peripheral lymph nodes in HIV-infected patients with special reference to CD4+ T-cell counts: Experience from a tertiary care institution in Darjeeling (India)

BACKGROUND

HIV/AIDS is a major health burden worldwide. India bears the third highest HIV-patients load globally. In the Darjeeling district, HIV-prevalence is >1% with very little known about the profile of HIV-lymphadenopathy. The aim of this study was to identify the different causes of peripheral lymphadenopathy among HIV-infected patients in this region, correlate them with CD4+ T-cell counts and formulate some common clinico-haematological parameters as potential predictors of CD4+ T-cell count.

METHODS

In the present study, 76 cases were evaluated. Fine Needle Aspiration Cytology (FNAC) was performed as an out-patient procedure in the Department of Pathology. Smears were stained routinely with Haematoxylin-Eosin and Leishman stains. ZN stains were done when indicated by the cytological findings. Immediate CD4+ T-cell count was obtained by referring the patients to the Anti-retroviral therapy centre.

RESULTS

Cytological diagnoses included tuberculosis (82.9%), reactive hyperplasia (6.6%), nonspecific granulomatous lesions (3.9%), non-Hodgkin lymphoma (2.6%), histoplasmosis (2.6%) and simultaneous filariasis with toxoplasmosis (1.3%). Statistically, the opportunistic infections and lymphomas significantly concurred with a CD4+ T-cell count <350/μl. Likewise, the number of enlarged lymph nodes and absolute lymphocyte count (ALC) were found to be useful predictors of CD4+ T-cell counts.

CONCLUSIONS

Lymph node cytology in HIV-infected patients is essential to identify opportunistic infections from neoplastic lesions and; to enable therapeutic strategies. Correlation of lesions with mean CD4+ T-cell count predicts personal immunity, stage of disease and disease activity. Furthermore, enlarged lymph node numbers and ALC can be surrogate markers of CD4+ T-cell count for monitoring the severity of the immune suppression in under-resourced countries like India.

Frequncy and etiology of lymphadenopathy in Iranian HIV/AIDS patients

OBJECTIVE

To estimate and outline the frequency and etiology of lymphadenopathy in HIV/AIDS patients.

METHODS

This study was conducted on 178 consecutive HIV/AIDS patient files for etiologies (categorized into three sub-groups: definite, probable and possible) and associated factors of local and generalized lymphadenopathy.

RESULTS

Seventy-two (40.45%) patients including 63 male patients (87.5%) developed lymphadenopathy. HIV in lymphadenopathy(+) patients was most commonly transmitted intravenously (n=49). Generalized and localized lymphadenopathy respectively occurred in 27 (37.50%) and 45 (62.50%) patients, mainly in the cervical region (28.9% for local and 63% for generalized lymphadenopathy). The most common causes of lymphadenopathy were tuberculosis (n=24, 33.3%) and lymphoma (n=12, 16.6%). The frequency of lymphadenopathy was non-significantly higher in patients with AIDS (CD4 count <200 cell/µL) vs. HIV(+) patients (CD4 count >200 cell/µL).

CONCLUSIONS

Lymphadenopathy in HIV/AIDS patients may reflect a serious condition, most likely tuberculosis and lymphoma. Since patients might underestimate lymphadenopathy, physicians would rather list these entities for diagnosis.

Head and neck tuberculosis in KwaZulu-Natal, South Africa

OBJECTIVE

To describe the clinical features of head and neck tuberculosis in KwaZulu-Natal, South Africa.

STUDY DESIGN

Retrospective, observational study.

METHOD

The study included 358 patients who received a histopathologically and/or microbiologically confirmed diagnosis of tuberculosis in the head and neck region between 1 January 2007 and 31 December 2011.

RESULTS

A total of 358 new cases of head and neck tuberculosis were identified during the study period, involving 196 males (54.7 per cent) and 162 females (45.3 per cent). These patients had a median age of 31 years (range, 3 months to 83 years). Testing for human immunodeficiency virus was positive in 233 (65.1 per cent) and negative in 125 (34.9 per cent). Right-sided cervical lymphadenitis was the commonest form of presentation of head and neck tuberculosis.

CONCLUSION

In this study, right-sided cervical lymphadenopathy was the commonest presentation of head and neck tuberculosis in both human immunodeficiency virus infected and non-infected individuals. Head and neck tuberculosis should not be excluded solely based on a normal chest X-ray, nor on the absence of constitutional symptoms.

Lymphoreticular Involvement in Human Immunodeficiency Virus Infection

BACKGROUND

Although lymphadenopathy, hepatomegaly and splenomegaly are commonly seen in human immunodeficiency virus (HIV) infection, little is known about the prognostic significance of these findings.

METHOD

A retrospective study of lymphoreticular involvement in 612 HIV-positive patients was done.

RESULT

Lymphadenopathy was found in 301 (49.18%), hepatomegaly in 102 (16.66%) and splenomegaly in 58 (9.47%) patients. Sixty eight (32.54%) of the 209 patients with only lymphadenopathy had acquired immunodeficiency syndrome (AIDS), as compared to 70 (23.97%) of the 292 patients without lymphadenopathy or hepatosplenomegaly (χ(2) 4.49, df-1, p<0.05). There was a higher chance of having AIDS if hepatomegaly was present with lymphadenopathy. Eight (72.73%) of 11 patients with hepatomegaly alone, had AIDS. Thirty (68.18%) of 44 cases with splenomegaly, with lymphadenopathy and hepatomegaly, three (50%) of six cases having splenomegaly with lymphadenopathy and one (33.33%) of three cases with splenomegaly had AIDS. Majority of lymphoreticular involvement cases were due to Mycobacterium tuberculosis infection. All 29 cases with abdominal lymphadenopathy and one with hilar lymphadenopathy had AIDS. Bilateral discrete cervical, axillary and inguinal lymphadenopathy was the most common presentation. CD4 counts were significantly (p<0.05) lower in those with lymphadenopathy and hepatosplenomegaly.

CONCLUSION

HIV cases with lymphadenopathy and hepatomegaly should be investigated for the presence of opportunistic infection.