Human immunodeficiency virus associated tuberculous lymphadenitis: a clinical study of 50 cases of Saurastra region of Gujarat, India
Keywords:
HIV-TB, Tuberculous lymphadenopathy, ART, FNAC, Extra-pulmonary TB, TuberculosisAbstract
Background: Tuberculosis continues to be one of the most important public health problems worldwide. HIV-TB co-infection contributes greatly to morbidity & mortality in patients. The objective of the study was to study clinical profile of tuberculous lymphadenitis in HIV positive patients.
Methods: The present study was conducted in the Department of Tuberculosis and Chest Diseases, P.D.U. Medical College and Hospital, Rajkot during June 2011 to August 2012. Total 50 indoor HIV positive patients clinically suspected of having tuberculous lymphadenitis were included by purposive sampling method. Information regarding past and family history were collected after taking written consent using pre designed, pretested semi structured Performa. Patient were examined and evaluated by necessary investigation. Data was statistically analysed using SPSS software (trial version).
Results: Out of total 50 patients, 42 (84%) patients were male. Age range of patients was 11 to 70 years with mean age was 34.8 ±10.3 years. All 50 patients presented with painless swelling. 11 (22%) patients had past history and 3 (6%) had family history of tuberculosis. 47 (94%) patients had cervical lymphadenopathy. 5 (10%) had sputum positive pulmonary tuberculosis. 21 (42%) patients were already on anti-retro viral therapy (ART). 23 (46%) patients had epithelioid granuloma with necrosis followed by 18 (36%) patients had epithelioid granuloma without necrosis revealed by FNAC. Half of the patients had abnormal chest radiograph with infiltration and pleural effusion in 14% and 10% respectively.
Conclusions: Cervical and axillary lymphadenopathy was most common involved site in tuberculous lymphadenitis in HIV positive patients. FNAC is a relatively inexpensive initial investigative technique in the diagnosis and management of HIV-positive patients.References
Park K. Park’s Textbook of Preventive and Social Medicine.21st edition. Bhanot Publishers. 2010;163.
Kishore J. School Health Services. National Health Programme of India. 9th edition. Century Publications. 2011;228.
Kulkarni AP, Baride JP. Tuberculosis. In, Textbook of Community Medicine.1st edition. Vora Medical Publications. 1998;168.
Khan AH, Sulaiman SA, Muttalif AR, Hassali MA, Khan TM. Tuberculous lymphadenitis at Penang General Hospital, Malaysia. Med Princ Pract. 2011;20(1):80-4.
Shobhana A, Guha SK, Mitra K, Dasgupta A, Neogi DK, Hazra SC. People living with HIV/AIDS-a study on lymph node FNAC & CD4 count. Indian J Med Microbiol. 2002;20(2):99-101.
Perenboom RM, Richter C, Swai AB, Kitinya J, Mtoni I, Chande H et al. Diagnosis of tuberculous lymphadenitis in area of HIV infection & limited facitity. Trop Geogr Med.1994;46(5):288-92.
Rajasekaran S, Gunasekaran M,. Jayakumar D.D, Jeyaganesh D Bhanumath V .Tuberculous cervical lymphadenitis in HIV positive & negative patients. Ind J Tub. 2001;48:201-4.
Ben C. Human immunodeficiency virus-positive tuberculous lymphadenitis in Central Africa: clinical presentation of 157 cases. Int J Tuberc Lung Dis. 1997;1(3):215-9.
Sharma SK, Mohan A, Raviglione MC. Tuberculosis. Jp Medical Pub;2009.
Kamana NK, Wanchu A, Sachdeva RK, Kalra N, Rajawanshi A. Tuberculosis is the leading cause of lymphadenopathy in HIV-infected persons in India: results of a fine-needle aspiration analysis. Scandinavian journal of infectious diseases. 2010; 42(11-12):827-30.
Vinishri HR, Nandini NM, Sunila R. Fine-needle aspiration cytology findings in human immunodeficiency virus lymphadenopathy. Indian J Pathol Microbiol. 2008;51(4):481-4.
Kumarguru BN, Kulkarni MH, Kamakeri NS. FNAC of peripheral lymph nodes in HIV positive patients. Sci Med. 2009;1(2):4-12.
