Human immunodeficiency virus-positive tuberculous lymphadenitis in Central Africa: clinical presentation of 157 cases.

Methods: University Teaching Hospital, Lusaka, Zambia.

Objective: To compare the clinical presentation of human immunodeficiency virus (HIV)-positive tuberculous lymphadenitis with primary HIV lymphadenopathy and HIV-negative tuberculous lymphadenitis.

Methods: Prospective study of patients undergoing diagnostic lymph node biopsy, with details of lymph node distribution, character and size assessed immediately before biopsy.

Results: In total, 157 patients with HIV-positive tuberculous lymphadenitis, 71 with primary HIV lymphadenopathy and 28 with HIV-negative tuberculous lymphadenitis were examined. Amongst patients with HIV-positive tuberculous lymphadenitis, lymph node enlargement was symmetrical in 29% (45/157); cervical nodes were enlarged in 99% (155/157), axillary nodes in 82% (128/ 157), epitrochlear nodes in 36% (57/157) and ilioinguinal nodes in 54% (84/157). The size of the largest nodes was 3 cm in 36% (57/157), 2 cm in 24% (37/157) and 1 cm in 6% (10/157). This presentation overlapped with that of primary HIV lymphadenopathy, which was usually a symmetrical polylymphadenopathy with nodes < or = 3 cm in size, and contrasted with that of HIV-negative tuberculous lymphadenitis, which mostly presented with focal, asymmetrical cervical lymphadenopathy.

Conclusions: Tuberculous lymphadenitis may be more common in HIV-positive African patients with superficial lymphadenopathy than is generally believed. Greater use of lymph node aspiration or biopsy may improve the diagnosis of suspected tuberculosis in Africa.