Tuberculous lymphadenitis, a diagnostic problem in areas of high prevalence of HIV and tuberculosis

H. J. Bekedam*, M. Boeree, A. Kamenya, G. Liomba, B. Ngwira, V. R. Subramanyam, A. D. Harries

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


The human immunodeficiency virus (HIV) epidemic is associated with a marked increase of tuberculosis cases. The influence of HIV on diagnostic methods for tuberculous lymphadenitis is less clear. In an environment of high HIV and tuberculosis prevalence in Blantyre, Malawi, a prospective study compared results of basic procedures diagnosing tuberculous lymphadenitis with the outcome of histology and/or culture. One hundred out-patients, aged 15-55 years, with extra-inguinal lymphadenopathy not responding to general antibiotics, entered the study. Among 52 cases, with whom all procedures were carried out in accordance with the protocol, 38 (73%) were diagnosed as tuberculous lymphadenitis; 84% of the latter (32/38) were seropositive for HIV. Needle aspirate and biopsy smears stained by the Ziehl-Neelsen technique contributed little to detecting tuberculosis, 8% and 11% respectively. In contrast, macroscopic caseation of excised lymph nodes showed a high yield of 82%, which was similar to histology, and higher than that of Lowenstein-Jensen culture (61%). The study suggested that HIV positivity of tuberculous lymphadenitis patients decreased the possibility of histology and culture both being indicative of tuberculosis (odds ratio 0.10; P = 0.06). Consequently histology results, often used as the single definitive method, failed to diagnose 18% (7/38) of tuberculosis cases. However, it was reassuring that 4 simple methods, which can safely be carried out at district level, could be expected to diagnose 80-95% of tuberculous lymphadenitis cases in a timely and cost-effective manner.

Original languageEnglish
Pages (from-to)294-297
Number of pages4
JournalTransactions of the Royal Society of Tropical Medicine and Hygiene
Issue number3
Publication statusPublished - 1997
Externally publishedYes


  • Diagnosis
  • Human immunodeficiency virus
  • Malawi
  • Mycobacterium tuberculosis
  • Tuberculosis
  • Tuberculous lymphadenitis


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