The cytology of HIV‐induced immunosuppression. Changing pattern of disease in the era of highly active antiretroviral therapy

Kocjan, Gabrijela; Miller, R F

doi:10.1046/j.1365-2303.2001.00331.x

Cited by 14 publications

(14 citation statements)

References 84 publications

(78 reference statements)

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“…Recent literature has shown that FNAs, particularly from large nodes with necrotic centers, may contain no cellular response at all, i.e., no epithelioid or multinucleated histiocytes, and may even lack lymphocytes if the entire node has undergone necrosis. 11,12 Aspirates may then be entirely necrotic or may contain debris together with a secondary influx of neutrophils. The cytology then resembles an abscess more than it does classic tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

Mycobacterial autofluorescence in Papanicolaou‐stained lymph node aspirates: A glimmer in the dark?

Wright

Zyl

Burgess

et al. 2004

Diagnostic Cytopathology

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This study was undertaken to determine the value of incorporating fluorescence into cytopathological evaluation of lymph node fine-needle aspiration (FNA) specimens suspected of harboring mycobacterial species. The study population consisted of 1,044 HIV-positive and -negative patients referred for FNA to the cytopathology unit of a South African medical school located in a very high HIV prevalence region. Each aspirate was assessed on routine Papanicolaou-stained slides for morphologic characteristics of mycobacterial infection. The same glass slides were then viewed under fluorescent microscopy to determine the presence or absence of mycobacterial autofluorescence. Using multivariate analysis, results of both cytology and fluorescence were compared with mycobacterial culture as the final arbiter of the presence of organisms. In this large clinical study, compared with culture, cytomorphology showed sensitivity of 84.9%, but low specificity of only 50.9%. Fluorescence demonstrated lower sensitivity of 65.9%, but improved specificity of 73.0%. Taken together, positivity of both cytology and fluorescence improved specificity to 81.8%. Fluorescent microscopy is rapid, inexpensive, and cost-effective; neither radioactive materials nor further staining are required. It is felt that this methodology would be of diagnostic benefit if used on morphologically suspicious samples in areas with a high prevalence of HIV and mycobacterial infections. Appropriate therapy could be commenced within hours of FNA, with reduction in the current number of patients lost to follow-up while awaiting results of culture. The technique is readily extended to other FNA types such as deep organ aspirates. Autofluorescence of organisms specifically requires usage of Papanicolaou staining; the technique cannot be used in histopathologic specimens stained with hematoxylin-eosin.

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Section: Discussionmentioning

confidence: 99%

Mycobacterial autofluorescence in Papanicolaou‐stained lymph node aspirates: A glimmer in the dark?

Wright

Zyl

Burgess

et al. 2004

Diagnostic Cytopathology

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“…Other rarer etiologies include volume overload, “crack cocaine abuse” which results in anthracotic pigmentation within effusion macrophages [92] and an idiopathic etiology. Bilateral pleural effusions appear to be more common in KS and lymphoma than in parapneumonic effusion [93]. KS may result in either a chylous effusion due to lymphatic obstruction or a bloody effusion with direct pleural disease.…”

Section: Pulmonary Diseasementioning

confidence: 99%

Review of HIV-Related Cytopathology

Lang

Khalbuss

Michelow

et al. 2011

Pathology Research International

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Exfoliative and aspiration cytologies play a major role in the management of patients with human immunodeficiency virus infection. Common cytology samples include cervicovaginal and anal Papanicolaou tests, fine needle aspirations, respiratory specimens, body fluids, Tzanck preparations, and touch preparations from brain specimens. While the cytopathologists need to be aware of specific infections and neoplasms likely to be encountered in this setting, they should be aware of the current shift in the pattern of human immunodeficiency virus-related diseases, as human immunodeficiency virus patients are living longer with highly active antiretroviral therapy and suffering fewer opportunistic infections with better antimicrobial prophylaxis. There is a rise in nonhuman immunodeficiency virus-defining cancers (e.g., anal cancer, Hodgkin's lymphoma) and entities (e.g., gynecomastia) from drug-related side effects. Given that fine needle aspiration is a valuable, noninvasive, and cost-effective tool, it is frequently employed in the evaluation and diagnosis of human immunodeficiency virus-related diseases. Anal Papanicolaou tests are also increasing as a result of enhanced screening of human immunodeficiency virus-positive patients for cancer. This paper covers the broad spectrum of disease entities likely to be encountered with human immunodeficiency virus-related cytopathology.

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“…Incision or excision biopsy for histological evaluation is reliable for diagnostic purposes but is time consuming, expensive and many patients may be too ill to undergo this procedure. Several articles have determined the usefulness of FNA in HIV positive adults, concluding that FNA is inexpensive, provides a rapid diagnosis, and obviates the need for surgery 6–8,18–22 . Grossl et al.…”

Section: Discussionmentioning

confidence: 99%

“…Several articles have determined the usefulness of FNA in HIV positive adults, concluding that FNA is inexpensive, provides a rapid diagnosis, and obviates the need for surgery. [6][7][8][18][19][20][21][22] Grossl et al 9 state that the cytopathology laboratory plays a Ôkey role in the clinical management teamÕ in this clinical setting. In FNAs from HIV infected adults presenting with mass lesions, the most common diagnoses are reactive lymphadenopathy and mycobacterial infections especially TB.…”

Section: Discussionmentioning

confidence: 99%