Tuberculosis Lymphadenitis Among HIV-Positive Individuals and its Correlation to CD4 Count, Cytomorphological Pattern and Clinical Diagnosis in Mekell University Ayder Comprehensive Specialized Referral Hospital
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Date
2020-05
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Addis Ababa University
Abstract
Background: Tuberculosis is the second leading cause of death from infectious disease globally with its impact more dramatic in resource limited settings. Individuals with human immunodeficiency virus infection who also develop tuberculosis represent a significant challenge to TB control. HIV not only increases the number of TB cases, but also alters the clinical course of TB disease. As HIV related immunosuppression increases, the clinical pattern of TB changes, with increasing numbers of smear-negative and extrapulmonary cases. Lymphadenopathy is one of the most common manifestations at any stage of HIV/AIDS with different underlying pathogenesis. Tuberculous Lymphadenitis is the most common form of extrapulmonary TB and typically presents with asymmetric involvement of multiple nodes 1 cm or larger in size. Cervical and axillary nodes are most frequently affected.CD4 T cells play central roles in the function of the immune system and are important mediators of immunologic memory,
Objective: the objective of this study is to determine the prevalence of tuberculosis lymphadenitis infection among HIV/AIDS positive patients and its correlation to CD4-count, morphological patterns and clinical Diagnosis.
Method: A cross sectional study design was conducted from January 10/2019 to July 10/2019. A total of 90 HIV positive patients who develop lymph node were enrolled into the study by contacting the patients during their visit to the ART clinic. Socio -demographic characteristics and other variables were collected using a pretested semi-structured questionnaire. Detailed clinical history and laboratory investigations were considered in all patients. The statistical software and methods including the level of statistical significance were explained and employed for data analysis and interpretation. The results were then analyzed statistically using the statistical package for social sciences (SPSS) version 23 for Windows.
Result: Maximum number of tuberculosis lymphadenitis is seen in the age group of 21-30 years followed by age group of 31-42 and with a decreasing trend in elderly. There was a female preponderance of cases. Most cases of Tuberculosis lymphadenitis emerged as the 2nd most frequent Cytomorphological pattern of diagnosis next to reactive lymphoid hyperplasia to be associated with HIV infection With the typical caseous necrosis and Epitheloid granuloma.CD4 count <200/mm3 and WHO Severe clinical stage of the disease were found to be predictors of tuberculosis lymphadenitis and cervical and axillary group of lymph node were found to be the most involved site. Finally Tuberculosis lymphadenitis is over diagnosed clinically compared to Cyto-morphological Diagnosis.
Conclusion; Caseous necrosis and Epitheloid granuloma were leading causes of Tuberculosis lymphadenitis .CD4 count <200/mm3 and Sever clinical stage (stage IV) of the disease were found to be predictors of tuberculosis lymphadenitis. So initiation of Anti-retroviral treatment before the CD4 count drops below 350 /mm3 should be encouraged and intervention aimed at
preventing and treating HIV Associated tuberculosis lymphadenitis is crucial.
The cervical and auxiliary region was found to be the most involved site respectively and Tuberculosis lymphadenitis is over diagnosed in clinical Diagnosis compare to Cytomorphological Diagnosis suggesting the need of diagnostic test(s) like cytomorphological examination to supplement the clinical examinations.
Recommendation: cytologic examination of fine needle aspirates should be included in the diagnostic work-up of any patient suspected for TBLN in health institutions with limited laboratory capacity like regional or district Hospitals. Intervention aimed at preventing and treating HIV associated Tuberculosis lymphadenitis are crucial. High quality services should
provide by incorporating an efficient quality control system and a molecular technique that detects DNA sequences specific for Mycobacterium tuberculosis by polymerase chain reaction can be used as screening test. In addition since culture is considered as golden standard emphasis should be given in detection of mycobacterium tuberculosis from lymph node aspiration.
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Tuberculosis ,HIV-positive individuals , CD4 count, cytomorphological pattern ,clinical Diagnosis