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

摘要

Abdominal lymphadopathy in Human Immunodeficiency Virus (HIV) infectionremains a diagnostic challenge. We performed a prospective cohort studyrecruiting thirty-one symptomatic HIV+ patients with abdominallymphadenopathy assessing diagnostic yield of endoscopic ultrasound (EUS)fine needle aspiration (FNA). Mean age was 38 years, 52% were female, meanCD4 count and viral load were 124 cells/pl, and 4 log respectively. EUSconfirmed additional mediastinal nodes in 26 %. Porta- hepatis was the mostcommon abdominal site. EUS FNA was subjected to cytology, culture andpolymerase chain reaction (PCR) analysis. Mycobacterial infections wereconfirmed in 67.7% and 31% had reactive lymphadenopathy. Cytology andculture had low sensitivity whereas PCR identified 90% of mycobacterialinfections. Combining appearance of EUS FNA and cytology a diagnosticalgorithm was developed to indicate when analysis with PCR would be useful.PCR performed on an EUS guided aspirate was highly accurate in confirmingmycobacterial disease and determining genotypic drug resistance.