Title: The Study Proportion of HIV Seropositive Prevalence among Patients with Extra Pulmonary Tubercular Lymphadenitis in Western Rajasthan Indian Population

Authors: Dr Mangilal Choudhary, Dr Rekha Sirvi

 DOI: https://dx.doi.org/10.18535/jmscr/v8i4.68

Abstract

   

Objectives: The rising trend of extra-pulmonary tuberculosis among HIV positive patients, study of the proportion of HIV seropositive among patients with tubercular cervical lymphadenitis, variations in clinical presentation, diagnostic yield of FNAC, microbiological findings and cytomorphological pattern of cervical lymph nodes in HIV positives and negatives gains importance.

Methodology: In all, 110 patients, considered as tubercular cervical lymphadenitis cases, were screened by chest radiography, tuberculin test (MT), fine needle aspiration cytology (FNAC) and smear microscopy for AFB of aspirate lymph nodes. All these patients were also tested for HIV sero positivity by two different ETLISA tests, repeated at least twice.

Results: 85 confirmed tuberculosis patients, 16 (18.8%) had HIV seropositive, in which  9 of (56.2%) had demonstrable AFB in FNAC cervical node aspirate; only one HIV negative patient (1.4%) had positive smear microscopy for AFB. Among the 16 HIV positive patients, typical granuloma and/or caseative necrosis were found in 10 patients (62.5%) and atypical granuloma with numerous macrophages features were found in the remaining 6 patients (37.5%).

Conclusion: The high prevalence of HIV seropositivity (18.8%) among the 85 tubercular cervical lymphadenitis patients suggests a rising trend of HIV infection in pockets of rural western Rajasthan Indian population. Disseminated tuberculosis and atypical cytomorphological features were found in tubercular lymph nodes in our study suggest an advanced stage of HIV disease in our population group.

References

  1. Jones BE, Young SM, Antoniskis D, Davidson PT, Kramer F and Barnes PF; Relationship of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection; Am Rev Respir D«:1993, 148, 1292
  2. Rajasekaran S, Uma A, Kamakshi S, Jeyaganesh D, Senthamizhchelvan A, Savithri S and Gopinathan; Trend of HIV infection in patients with Tuberculosis in rural south India; Ind J Tub ;2000,47,223
  3. Bern C, Patil PS, Luo N; The increased burden of tuberculous lymphadenitis in central Africa : Lymph node biopsies in Lusaka, Zambia, 1981 and 1990; Trap Doct; 1996,26,58
  4. Malakar D, Jajoo UN, Kiran Swarup, Gupta OP, Jain AP, Poflee VW;A clinical evaluation of Fine Needle Aspiration Cytology in the diagnosis of lymphadenopathy; Ind. J Tub ;1991,38,17
  5. Deepjyoti V. Gadre, Usha R. Singh, Kamalcsh Saxena, Arati Bhatia, Vibha Talwar; Diagnosis of tubercular cervical lymphadenitis by FNAC, microscopy and culture; Ind. J. Tub;1991,38,25
  6. Narang P, Rahul Narang, Mendiratta DK, Sharma SM, Narang R, Nayar S; Field study to evaluate the bacteriological parameters in the diagnosis of lymphnode tuberculosis in children; Ind J Tub; 1998,45,211
  7. Rajeev Sen, Nisha Marwah, Gupta KB, Sanjay Marwah, Ritu Arora, Jain K; Cytomorphologic patterns in tuberculous lymphadenitis; Ind J Tub; 1999,46,125
  8. Finfer M, Perchick A, Burstein DE; Fine Needle Aspiration Biopsy diagnosis of tuberculosis lymphadenitis in patients with and without the acquired immunedefic-iency syndrome; Acta Cytol; 1991,31,325
  9. Bekedam HJ, Boeree M, Kamenya A, Liomba G, Ngwira B, Subramanyam VR, Harries AD; Tuberculous lymphadenitis, a diagnostic problem in areas of high prevalence of 111V and tuberculosis; Trans RSoc Trap Med Hyg; 1997,91,294
  10. Muller H, Takeshita M.; In situ immunophenotype of macrophages and lymphocytes in granuloma formation of tuberculous lymphadenitis in HIV-infccted and immuno- compctent patients; Res Virol;1991,142,159
  11. Parenboom RM, Richter C, Swai AB, Kitinya J, Mtoni I, Chande H, Kazema RR; Clinical features of HIV seropositive and HIV seronegative patients with tuberculous lymphadenitis in Dar es Salaam; Tuber Lung DIS,1995,76,401
  12. Lanjewar DN, Profile of AIDS pathology in India : an autopsy study; Nat Med J Ind; 1996,3,119.

Corresponding Author

Dr Mangilal Choudhary

Assistant Professor, Central lab Pathology

Govt. Medical College & Bangur Hospital Pali (Rajasthan), India