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

• Published in: Ultrasound in medicine & biology Vol. 40; no. 9; pp. 2031 - 2038
• Main Authors: Nieuwoudt, Martin, Lameris, Roeland, Corcoran, Craig, Rossouw, Theresa M, Slavik, Tomas, Du Plessis, Johannie, Omoshoro-Jones, Jones A.O, Stivaktas, Paraskevi, Potgieter, Fritz, Van der Merwe, Schalk W
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-09-2014
• Subjects: Abdomen; Abdominal lymphadenopathy; Adult; Biopsy, Fine-Needle; Cohort Studies; DNA; Endoscopic ultrasound; Endosonography - methods; Female; Flow Cytometry - methods; HIV; HIV Infections - complications; Human immunodeficiency virus; Humans; Lymphatic Diseases - complications; Male; Mycobacterium; Mycobacterium Infections - complications; Mycobacterium Infections - diagnosis; Polymerase Chain Reaction - methods; Prospective Studies; Radiology; Sensitivity and Specificity; Tuberculosis; Abdominal lymphadenopathy; Tuberculosis; Human immunodeficiency virus; HIV; Endoscopic ultrasound
• ISSN: 0301-5629; 1879-291X
• 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.