Human immunodeficiency virus-positive tuberculous lymphadenitis in Central Africa: clinical presentation of 157 cases.

SETTING

University Teaching Hospital, Lusaka, Zambia.

OBJECTIVE

To compare the clinical presentation of human immunodeficiency virus (HIV)-positive tuberculous lymphadenitis with primary HIV lymphadenopathy and HIV-negative tuberculous lymphadenitis.

DESIGN

Prospective study of patients undergoing diagnostic lymph node biopsy, with details of lymph node distribution, character and size assessed immediately before biopsy.

RESULTS

In total, 157 patients with HIV-positive tuberculous lymphadenitis, 71 with primary HIV lymphadenopathy and 28 with HIV-negative tuberculous lymphadenitis were examined. Amongst patients with HIV-positive tuberculous lymphadenitis, lymph node enlargement was symmetrical in 29% (45/157); cervical nodes were enlarged in 99% (155/157), axillary nodes in 82% (128/ 157), epitrochlear nodes in 36% (57/157) and ilioinguinal nodes in 54% (84/157). The size of the largest nodes was 3 cm in 36% (57/157), 2 cm in 24% (37/157) and 1 cm in 6% (10/157). This presentation overlapped with that of primary HIV lymphadenopathy, which was usually a symmetrical polylymphadenopathy with nodes < or = 3 cm in size, and contrasted with that of HIV-negative tuberculous lymphadenitis, which mostly presented with focal, asymmetrical cervical lymphadenopathy.

CONCLUSION

Tuberculous lymphadenitis may be more common in HIV-positive African patients with superficial lymphadenopathy than is generally believed. Greater use of lymph node aspiration or biopsy may improve the diagnosis of suspected tuberculosis in Africa.