Lymph node biopsies in HIV-infected and non-infected children with persistent lung disease

OBJECTIVE: The diagnosis of opportunistic infections in children with persi stent lung disease (PLD) who are infected with the human immunodeficiency v irus (HIV) is difficult to establish, especially in resource-poor countries . Lymphadenopathy is a frequent associated clinical finding among these chi ldren. We evaluated the usefulness of excision lymph node biopsies in deter mining an aetiological diagnosis in HIV-infected and non-infected children with PLD. METHOD: Forty-five children with PLD and significant lymphadenopathy were s ubjected to lymph node biopsy. Of these, 27 were HIV-infected. All subjects had excision biopsies; 39 (86.7%) of these cases also underwent fine needl e aspiration cytodiagnosis (FNAC) and trucut needle biopsies. RESULTS: Tuberculosis was identified as the final diagnosis in 11 (40.7%) a nd 12 (66.7%) HIV-infected and noninfected children, respectively. Ancillar y investigations (Mantoux, gastric washings) suggested a diagnosis of tuber culosis in eight (72.7%) and eight (66.7%) of the final diagnoses of tuberc ulosis among HIV-infected and non-infected children, respectively. Lymph no de biopsies identified a further three (27.3%) and four (33.3%) more cases of tuberculosis as compared to ancillary investigations among HIV-infected and non-infected groups, respectively. Results of FNAC and trucut biopsy sh owed good correlation with excision biopsy: 96.4% and 97.4%, respectively. However, adequate samples were obtained in only 23 of 39 FNAC and 33 of 33 trucut biopsies. CONCLUSION: Excision lymph node biopsies form a useful adjunct investigatio n in children with PLD and generalised lymphadenopathy. The most common dis ease identified among HIV-infected and non-infected children in Durban, Sou th Africa. is tuberculosis. FNAC and trucut biopsies may also be useful in the evaluation of lymphadenopathy when appropriate specimens are obtained.