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Histological Examination in Obtaining a Diagnosis in Patients with Lymphadenopathy in Lima, Peru.

Kirwan, DE; Ugarte-Gil, C; Gilman, RH; Hasan Rizvi, SM; Cerrillo, G; Cok, J; Ticona, E; Cabrera, JL; Matos, ED; Evans, CA; et al. Kirwan, DE; Ugarte-Gil, C; Gilman, RH; Hasan Rizvi, SM; Cerrillo, G; Cok, J; Ticona, E; Cabrera, JL; Matos, ED; Evans, CA; Moore, DAJ; Friedland, JS; The Lymph Node Tuberculosis Lntb Working Group, (2017) Histological Examination in Obtaining a Diagnosis in Patients with Lymphadenopathy in Lima, Peru. Am J Trop Med Hyg, 97 (4). pp. 1271-1276. ISSN 1476-1645 https://doi.org/10.4269/ajtmh.16-0961
SGUL Authors: Friedland, Jonathan Samuel

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Abstract

The differential diagnosis for lymphadenopathy is wide and clinical presentations overlap, making obtaining an accurate diagnosis challenging. We sought to characterize the clinical and radiological characteristics, histological findings, and diagnoses for a cohort of patients with lymphadenopathy of unknown etiology. 121 Peruvian adults with lymphadenopathy underwent lymph node biopsy for microbiological and histopathological evaluation. Mean patient age was 41 years (Interquartile Range 26-52), 56% were males, and 39% were HIV positive. Patients reported fever (31%), weight loss (23%), and headache (22%); HIV infection was associated with fever (P < 0.05) and gastrointestinal symptoms (P < 0.05). Abnormalities were reported in 40% of chest X-rays (N = 101). Physicians suspected TB in 92 patients (76%), lymphoma in 19 patients (16%), and other malignancy in seven patients (5.8%). Histological diagnoses (N = 117) included tuberculosis (34%), hyperplasia (27%), lymphoma (13%), and nonlymphoma malignancy (14%). Hyperplasia was more common (P < 0.001) and lymphoma less common (P = 0.005) among HIV-positive than HIV-negative patients. There was a trend toward reduced frequency of caseous necrosis in samples from HIV-positive than HIV-negative TB patients (67 versus 93%, P = 0.055). The spectrum of diagnoses was broad, and clinical and radiological features correlated poorly with diagnosis. On the basis of clinical features, physicians over-diagnosed TB, and under-diagnosed malignancy. Although this may not be inappropriate in resource-limited settings where TB is the most frequent easily treatable cause of lymphadenopathy, diagnostic delays can be detrimental to patients with malignancy. It is important that patients with lymphadenopathy undergo a full diagnostic work-up including sampling for histological evaluation to obtain an accurate diagnosis.

Item Type: Article
Additional Information: © The American Society of Tropical Medicine and Hygiene [open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: Adult, Biopsy, Female, Humans, Lymphadenopathy, Male, Middle Aged, Peru, The Lymph Node Tuberculosis Lntb Working Group, Humans, Biopsy, Adult, Middle Aged, Peru, Female, Male, Lymphadenopathy, Science & Technology, Life Sciences & Biomedicine, Public, Environmental & Occupational Health, Tropical Medicine, POLYMERASE-CHAIN-REACTION, LYMPH-NODE TUBERCULOSIS, CERVICAL LYMPHADENOPATHY, ANTIRETROVIRAL THERAPY, IMMUNE RECONSTITUTION, SPECIMENS, ADULTS, 11 Medical And Health Sciences, Tropical Medicine
Journal or Publication Title: Am J Trop Med Hyg
ISSN: 1476-1645
Language: eng
Dates:
DateEvent
October 2017Published
30 May 2017Accepted
Projects:
Project IDFunderFunder ID
MR/K007467/1Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
057434/Z/99/ZWellcome Trusthttp://dx.doi.org/10.13039/100004440
070005/Z/02/ZWellcome Trusthttp://dx.doi.org/10.13039/100004440
078340/Z/05/ZWellcome Trusthttp://dx.doi.org/10.13039/100004440
105788/Z/ 14/ZWellcome Trusthttp://dx.doi.org/10.13039/100004440
201251/Z/16/ZWellcome Trusthttp://dx.doi.org/10.13039/100004440
OPP1118545Bill and Melinda Gates Foundationhttp://dx.doi.org/10.13039/100000865
PubMed ID: 29031289
Web of Science ID: WOS:000423208300047
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/110600
Publisher's version: https://doi.org/10.4269/ajtmh.16-0961

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