Abstract:
Abdominal lymphadopathy in Human Immunodeficiency Virus (HIV) infection
remains a diagnostic challenge. We performed a prospective cohort study
recruiting thirty-one symptomatic HIV+ patients with abdominal
lymphadenopathy assessing diagnostic yield of endoscopic ultrasound (EUS)
fine needle aspiration (FNA). Mean age was 38 years, 52% were female, mean
CD4 count and viral load were 124 cells/pl, and 4 log respectively. EUS
confirmed additional mediastinal nodes in 26 %. Porta- hepatis was the most
common abdominal site. EUS FNA was subjected to cytology, culture and
polymerase chain reaction (PCR) analysis. Mycobacterial infections were
confirmed in 67.7% and 31% had reactive lymphadenopathy. Cytology and
culture had low sensitivity whereas PCR identified 90% of mycobacterial
infections. Combining appearance of EUS FNA and cytology a diagnostic
algorithm was developed to indicate when analysis with PCR would be useful.
PCR performed on an EUS guided aspirate was highly accurate in confirming
mycobacterial disease and determining genotypic drug resistance.
