Lymphadenopathy in an Inner-City Population Consisting Principally of Intravenous Drug Abusers with Suspected Acquired Immunodeficiency Syndrome

Abstract

Generalized lymphadenopathy in intravenous drug abusers (IVDAs) at risk for AIDS has not been well studied. We have retrospectively analyzed the results of lymph node biopsies obtained from 27 patients referred to the Infectious Diseases Service for evaluation of generalized lymphadenopathy and suspected AIDS during a recent 18-month period. Fourteen of the patients were heterosexual IVDAs, 7 were male homosexual IVDAs, and 6 were male homosexual non-IVDAs. All of the patients were residents of the Bronx, New York. Mycobacterium tuberculosis (TB) was the most frequent diagnosis established on lymph node biopsies from IVDAs, in 12 out of 21 (57%). Tuberculous adenitis was not diagnosed in the 6 non-IVDAs. All TB patients were febrile, 11 (91%) had lost weight, and 10 (84%) had an abnormal chest roentgenogram. The 5TU PPD skin test, however, was reactive in only 2 (16%) of 12 patients. Tuberculosis is important to consider in patient populations with exposure histories to both AIDS and TB. The alarmingly high prevalence of TB in this drug addict population emphasizes the importance of lymph node biopsies with acid-fast smears and mycobacterial cultures in symptomatic IVDAs. Preventive antituberculosis therapy for HIV-positive persons, especially IVDAs, with a history of positive tuberculin reactions or of recent household contact should be seriously considered.

Diagnostic utility of fine needle aspiration (FNA) cytology in HIV‐infected patients with lymphadenopathy

“…Different populations have differing prevalences of mycobacterial disease 30–32 . A population with a significant proportion of intravenous drug users 33 has a high prevalence of tuberculosis. African 6 , 8 , 34 and Asian 35–37 populations have a high prevalence of tuberculosis and studies to date have shown that M. avium‐intracellulare is rare in Africa 18 .…”

Tuberculosis in the AIDS era

“…Because of this, many cases are diagnosed late or not at all (195), resulting in persons remaining infectious longer and thereby potentially spreading tuberculosis to hospital staff and other patients. Numerous articles and reviews examining different aspects of the interrelationship between AIDS and tuberculosis have been published (13,20,48,64,65,67,116,145,155,203,219,238,254,256,291,306,328).…”

Cursed Duet: HIV Infection and Tuberculosis

“…•fj H IV -related the community to M. tuberculosis is infrequent, most of today's cases of tuberculosis occur in patients with a high background prevalence of tuberculous infec tion and thus represent reactivation of remotely acquired tubercle bacilli [12][13][14], Thus, the risk of de veloping HIV-related tuberculosis is considerably in creased among black and Hispanic intravenous drug users, and among immigrants from Haiti and other countries in which the prevalence of tuberculosis is extremely high [12][13][14][15][16].…”