Nieuwoudt, M.Lameris, R.Corcoran, CraigRossouw, Theresa M.Slavik, TomasDu Plessis J.Omoshoro-Jones, Jones A.O.Stivaktas, Paraskevi IreneVan der Merwe, S.W.2014-10-082014-10-082014Nieuwoudt, M, Lameris, R, Corcoran, C, Rossouw, TM, Slavik, T, Du Plessis, J, Omoshoro-Jones, JA, Stivaktas, P & Van der Merwe, SW 2014, 'Endoscopic ultrasound guided fine needle aspiration allows accurate diagnosis of mycobacterial disease in HIV-positive patients with abdominal lymphadenopathy', Ultrasound in Medicine and Biology, NYP.0301-5629 (print)1879-291X (online)http://hdl.handle.net/2263/42298BACKGROUND : Abdominal lymphadenopathy in HIV remains a challenge due to inaccessibility of lymph nodes and multitude of causes. The diagnostic yield of EUS FNA in HIV-infected patients with abdominal lymphadenopathy in the setting of high tuberculosis (TB) prevalence was assessed. METHODS : Prospective cohort study was conducted in tertiary referral centres recruiting symptomatic HIV+ patients (N=31, mean age 38.5 years, mean CD4 count 124 cells/μl, WHO stage 3-4 with abdominal lymphadenopathy. EUS was performed to assess lymph node characteristics and FNA aspirate subjected to cytological analysis, microbial culture and PCR. RESULTS : EUS appearance of lymph nodes was highly variable. Mycobacterial infections were the most common cause of lymphadenopathy in this cohort. Of the 31 patients 21/31 67.7 % had mycobacterial infections; 17 (80.9 %) of these were tuberculosis. Cytology failed to identify 23.8% and culture 38.1% of cases. PCR identified 16/17 (94.1%) of these cases. EUS-FNA altered the management of more than half of the patients. CONCLUSIONS : Mycobacterial disease was the commonest cause of lymphadenopathy in HIV but a third of patients had reactive lymphadenopathy. By combining the appearance of EUS FNA and cytological aspirate we could develop a diagnostic algorithm with a high PPV and NPV to identify patients in whom further analysis with PCR would be useful. PCR was highly accurate in confirming mycobacterial disease and determining genotypic drug resistance.en© 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved. Notice : this is the author’s version of a work that was accepted for publication in Ultrasound in Medicine and Biology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Ultrasound in Medicine and Biology, vol. x, no. y, pp. z-zz, date. doi : NYPAbdominal lymphadenopathyEndoscopic ultrasoundBackgroundHuman immunodeficiency virus (HIV)Tuberculosis (TB)Postprint Article