Histological Examination in Obtaining a Diagnosis in Patients with Lymphadenopathy in Lima, Peru

Cabrera, José Luis; Gilman, Robert Hugh; Kirwan, Daniela E.; Friedland, Jon S.; Moore, David Alexander James; Cok, Jaime; Matos, Eduardo D.; Ugarte Gil, Cesar Augusto; Cerrillo, Gustavo; Hasan Rizvi, Syed M.; Evans, Carlton Anthony William; Ticona, Eduardo; Lymph Node Tuberculosis Working Group

dc.contributor.author	Kirwan, Daniela E.
dc.contributor.author	Ugarte Gil, Cesar Augusto
dc.contributor.author	Gilman, Robert Hugh
dc.contributor.author	Hasan Rizvi, Syed M.
dc.contributor.author	Cerrillo, Gustavo
dc.contributor.author	Cok, Jaime
dc.contributor.author	Ticona, Eduardo
dc.contributor.author	Cabrera, José Luis
dc.contributor.author	Matos, Eduardo D.
dc.contributor.author	Evans, Carlton Anthony William
dc.contributor.author	Moore, David Alexander James
dc.contributor.author	Friedland, Jon S.
dc.contributor.author	Lymph Node Tuberculosis Working Group
dc.date.accessioned	2019-01-25T15:18:36Z
dc.date.available	2019-01-25T15:18:36Z
dc.date.issued	2017
dc.identifier.uri	https://hdl.handle.net/20.500.12866/4671
dc.description.abstract	The differential diagnosis for lymphadenopathy is wide and clinical presentations overlap, making obtaining an accurate diagnosis challenging. We sought to characterize the clinical and radiological characteristics, histological findings, and diagnoses for a cohort of patients with lymphadenopathy of unknown etiology. 121 Peruvian adults with lymphadenopathy underwent lymph node biopsy for microbiological and histopathological evaluation. Mean patient age was 41 years (Interquartile Range 26-52), 56% were males, and 39% were HIV positive. Patients reported fever (31%), weight loss (23%), and headache (22%); HIV infection was associated with fever (P < 0.05) and gastrointestinal symptoms (P < 0.05). Abnormalities were reported in 40% of chest X-rays (N = 101). Physicians suspected TB in 92 patients (76%), lymphoma in 19 patients (16%), and other malignancy in seven patients (5.8%). Histological diagnoses (N = 117) included tuberculosis (34%), hyperplasia (27%), lymphoma (13%), and nonlymphoma malignancy (14%). Hyperplasia was more common (P < 0.001) and lymphoma less common (P = 0.005) among HIV-positive than HIV-negative patients. There was a trend toward reduced frequency of caseous necrosis in samples from HIV-positive than HIV-negative TB patients (67 versus 93%, P = 0.055). The spectrum of diagnoses was broad, and clinical and radiological features correlated poorly with diagnosis. On the basis of clinical features, physicians over-diagnosed TB, and under-diagnosed malignancy. Although this may not be inappropriate in resource-limited settings where TB is the most frequent easily treatable cause of lymphadenopathy, diagnostic delays can be detrimental to patients with malignancy. It is important that patients with lymphadenopathy undergo a full diagnostic work-up including sampling for histological evaluation to obtain an accurate diagnosis.	en_US
dc.language.iso	eng
dc.publisher	American Society of Tropical Medicine and Hygiene
dc.relation.ispartofseries	American Journal of Tropical Medicine and Hygiene (ASTMH Journal)
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	Adult	en_US
dc.subject	Biopsy	en_US
dc.subject	Female	en_US
dc.subject	Humans	en_US
dc.subject	Lymphadenopathy/diagnosis/pathology	en_US
dc.subject	Male	en_US
dc.subject	Middle Aged	en_US
dc.subject	Peru	en_US
dc.title	Histological Examination in Obtaining a Diagnosis in Patients with Lymphadenopathy in Lima, Peru	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.4269/ajtmh.16-0961
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.03.06
dc.relation.issn	1476-1645