Document 0507
 DOCN  M9550507
 TI    Diagnosis of tuberculous lymphadenitis in an area of HIV infection and
       limited diagnostic facilities.
 DT    9505
 AU    Perenboom RM; Richter C; Swai AB; Kitinya J; Mtoni I; Chande H; Kazema
       RR; Mwakyusa DH; Maselle SY; Department of Medicine, Muhimbili Medical
       Centre, Dar es Salaam,; Tanzania.
 SO    Trop Geogr Med. 1994;46(5):288-92. Unique Identifier : AIDSLINE
       MED/95159217
 AB    In order to evaluate procedures leading to the diagnosis of tuberculous
       lymphadenitis, a prospective clinical study was carried out of patients
       with lymphadenopathy admitted to the medical wards of a referral
       hospital in Tanzania. The yield of diagnostic procedures (direct
       auramine/Ziehl-Neelsen (ZN) stained smears, Lowenstein-Jensen (LJ)
       cultures, cytology and histological examinations of fine needle
       aspirations (FNA) and biopsy material of lymph nodes, respectively, was
       compared. We also tried to identify clinical diagnostic markers. One
       hundred and twenty-eight (99 HIV-seropositive) patients were included.
       In 89 (67 HIV-positive) patients TB lymphadenitis could be proven.
       Histology and LJ culture of a lymph node biopsy had the highest
       diagnostic yield, 85% and 88% respectively, followed by detection of
       acid-fast bacilli (AFB) in biopsy smear (53%) and in fine-needle
       aspirations (35%). The diagnostic yield of the several procedures was
       not affected by associated HIV infection. Macroscopic caseation was 100%
       predictive for TB with a sensitivity of 69%. Firm and matted lymph
       nodes, ESR > 100 mm/hr, a positive PPD skin test and pleural opacity on
       a chest x-ray proved to be independent predictors for TB. Retrospective
       testing of a stepwise diagnostic approach based on direct smears of FNA,
       macroscopic visible caseation and direct smear of biopsy tissue,
       suggests that in 93% of the patients a definite diagnosis of TB
       lymphadenitis could have been made. Our data suggest that in HIV/TB
       epidemic areas most of the cases of TB lymphadenitis can be diagnosed
       correctly by simple and cheap methods which are generally available at
       district hospitals. Our findings need further prospective validation,
       however.
 DE    Adolescence  Adult  Child  Female  Human  HIV
       Seropositivity/COMPLICATIONS  Male  Medically Underserved Area  Middle
       Age  Prospective Studies  Support, Non-U.S. Gov't  Tanzania
       Tuberculosis, Lymph Node/COMPLICATIONS/*DIAGNOSIS  CLINICAL TRIAL
       JOURNAL ARTICLE

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