Polymerase chain reaction amplifying mycobacterial DNA from aspirates obtained by endoscopic ultrasound allows accurate diagnosis of mycobacterial disease in HIV-positive patients with abdominal lymphadenopathy

Martin Nieuwoudt; Roeland Lameris; Craig Corcoran; Theresa M Rossouw; Tomas Slavik; Johannie Du Plessis; Jones A O Omoshoro-Jones; Paraskevi Stivaktas; Fritz Potgieter; Schalk W Van der Merwe

doi:10.1016/j.ultrasmedbio.2014.04.006

Polymerase chain reaction amplifying mycobacterial DNA from aspirates obtained by endoscopic ultrasound allows accurate diagnosis of mycobacterial disease in HIV-positive patients with abdominal lymphadenopathy

Ultrasound Med Biol. 2014 Sep;40(9):2031-8. doi: 10.1016/j.ultrasmedbio.2014.04.006. Epub 2014 Jul 9.

Affiliations

¹ Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa; DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
² Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa.
³ Department of Molecular Pathology, Ampath Laboratories, Pretoria, South Africa.
⁴ Department of Family Medicine, University of Pretoria, Pretoria, South Africa.
⁵ Department of Pathology, Ampath laboratories, Pretoria, South Africa; Department of Anatomical Pathology, University of Pretoria, Pretoria, South Africa.
⁶ Department of Surgery, Chris Hani-Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
⁷ MRC Unit of Inflammation and Immunity, Department of Immunology, University of Pretoria, Pretoria, South Africa; Tshwane Academic Division of the National Health Laboratory Service, Johannesburg, South Africa.
⁸ Interventional GI Unit, Pretoria East Hospital, Pretoria, South Africa.
⁹ Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa. Electronic address: Schalk.vandermerwe@uzleuven.be.

PMID: 25023118
DOI: 10.1016/j.ultrasmedbio.2014.04.006

Abstract

Abdominal lymphadenopathy in human immunodeficiency virus (HIV) infection remains a diagnostic challenge. We performed a prospective cohort study by recruiting 31 symptomatic HIV + patients with abdominal lymphadenopathy and assessing the diagnostic yield of endoscopic ultrasound fine-needle aspiration (EUS-FNA). Mean age was 38 years; 52% were female; and mean CD4 count and viral load were 124 cells/μL and 4 log, respectively. EUS confirmed additional mediastinal nodes in 26%. The porta hepatis was the most common abdominal site. Aspirates obtained by EUS-FNA were 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. By combining the appearance of aspirates obtained by EUS-FNA and cytologic specimens, we developed a diagnostic algorithm to indicate when analysis with PCR would be useful. PCR performed on material obtained by EUS-FNA was highly accurate in confirming mycobacterial disease and determining genotypic drug resistance.

Keywords: Abdominal lymphadenopathy; Endoscopic ultrasound; HIV; Human immunodeficiency virus; Tuberculosis.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Abdomen
Adult
Biopsy, Fine-Needle
Cohort Studies
DNA
Endosonography / methods*
Female
Flow Cytometry / methods
HIV Infections / complications*
Humans
Lymphatic Diseases / complications*
Male
Mycobacterium Infections / complications*
Mycobacterium Infections / diagnosis*
Polymerase Chain Reaction / methods*
Prospective Studies
Sensitivity and Specificity

Substances

DNA