Tuberculous lymphadenitis in South-Eastern Nigeria; A 15 years histopathologic review (2000-2014)

Abstract

Background:The human immunodeficiency virus (HIV) pandemic has brought about a resurgence in tuberculosis (TB), especially in developing countries. Previous studies on TB lymphadenitis (TBLN) in South-Eastern Nigeria were done before the advent of the HIV pandemic making a review pertinent.Aim:To evaluate the role of TBLN as a cause of superficial lymphadenopathy in the post-HIV/acquired immune deficiency syndrome (AIDS) era of South-Eastern Nigeria.Materials and Methods:This is a 15 years (2000-2014) retrospective review of all superficial lymph node biopsies (SLNBs) received at the Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Nigeria.Results:One hundred and seventy-two cases of TBLN were identified in this study constituting 14.6% (172/1,180) of SLNBs received at our Hospital's Morbid Anatomy Department during the 15 years period under review. Twenty-eight cases of TBLN were clinically screened for HIV, 23 of which tested positive, representing 82.1% (23/28) of clinically screened cases. Acid fast bacilli demonstration was positive in 15.1% (26/172) of cases using Ziehl-Neelsen stain. 48.8% (84/172) of TBLN cases were males, and 51.2% (88/172) were females with most (22) cases received in 2012 and least (5) cases in 2000. Most TBLN occurred in the 21-25 years age group with a total of 21.5% (37/172) of cases and a male to female ratio of 1:1.5 The most common biopsy site for TBLN was the cervical group followed by the axillary and inguinal groups with 73.8% (127/172), 14% (24/172), and 4.7% (8/172) of cases, respectively.Conclusions:There is a remarkable decline in the prevalence of TB lymphadenitis in South-Eastern Nigeria indicating a change in trend from the pre- to the post-HIV/AIDS era with slightly more females now presenting with TBLN and most TB lymphadenitis patients now presenting with associated HIV/AIDS disease. There is an urgent need to provide modern diagnostic facilities in our medical laboratories.

Histological Features of Tubercular Lymphadenitis in HIV Positive Patients

“…The most frequent forms are lymphadenitis and miliary disease. 1,7,8 Lymph nodes are commonly infected by mycobacterium in patients with AIDS.…”

“…The most frequent forms are lymphadenitis and miliary disease. 1,7,8 Lymph nodes are commonly infected by mycobacterium in patients with AIDS. 9 In such patients, abscesses and purulent inflammation comprise a significant component of the histologic features of tuberculous lymphadenitis.…”

“…These findings are similar to those of other workers. 8,9,10 Caseation alone was the most common specific and sensitive findings in most studies. Wannakrairot et al 13 not only found this to be the predominant feature in 74.5% of their cases but also found granulomas to be less numerous in AIDS than in non-AIDS patients.…”

“…In the current study, tuberculosis was diagnosed in these 11 patients on the basis of AFB positivity. Ukekwe et al 8 also opined that histological demonstration of AFB by Ziehl-Neelsen stain in TB is the goal standard for a diagnosis of TB. 8 …”

“…The most frequent forms are lymphadenitis and miliary disease. 1,7,8 Lymph nodes are commonly infected by mycobacterium in patients with AIDS.9 In such patients, abscesses and purulent inflammation comprise a significant component of the histologic features of tuberculous lymphadenitis. Morphologically, in addition to the presence of polymorphs, the other criteria for the diagnosis are caseous necrosis and granulomas, of which the former is the most specific and sensitive as shown by Arora et al Table 2).…”