Objectives: The present study was performed to evaluate various cytological patterns and acid fast bacillus (AFB) grades in HIV-infected patients with tuberculous lymphadenitis and to correlate these with each other as well as with peripheral CD4+ T-cell counts. Study Design: Ninety-two HIV-seropositive patients, cytologically diagnosed with tuberculous lymphadenitis, were evaluated. Fine needle aspiration cytology was performed as an outpatient procedure. Sonographic guidance was sought for internally sited lymph nodes. Cytopathological details were assessed on routinely stained and Ziehl-Neelsen-stained smears. Appropriate AFB grades were assigned. CD4+ T-cell counts were obtained immediately. Finally, the cytopathological findings, AFB grades and CD4+ T-cell counts were corroborated with each other. Results: Epithelioid cell granuloma in the presence of caseation appeared to be the most frequent (66.3%) cytomorphology on aspirated smears. AFB grades 3+ (37%) and 4+ (35.9%) were the commonest patterns of bacillary involvement. The mycobacterial density and cytological features significantly correlated with CD4+ T-cell counts. Conclusions: In HIV-associated tuberculous lymphadenitis, AFB grade and CD4+ T-cell counts worsen with the appearance of necrosis. Here, the peripheral CD4+ T-cell counts inversely correlated with bacillary load. Collectively, peripheral CD4+ T-cell counts, cytological findings and AFB grade exemplify the immune status in these patients.

Keywords:
Acid fast bacillus grade, CD4+ T-cell count, Epithelioid cell granuloma, HIV, Necrosis, Tuberculous lymphadenitis, Ziehl-Neelsen stain
1.
WHO: Global Health Observatory Data Repository: Data on the size of the HIV/AIDS epidemic: data by WHO region. http://apps.who.int/gho/data/node.main.619?lang=en (accessed August 12, 2013).
2.
Fauci AS, Lane HC: Human immunodeficiency virus disease: AIDS and related disorders; in Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL, Loscalzo J (eds): Harrison's Principles of Internal Medicine, ed 18. New York, McGraw-Hill, 2011, p 1146.
3.
UNAIDS: HIV in Asia and the Pacific, 1990-2009: getting to zero. http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/20110826_APGettingToZero_en.pdf (accessed August 12, 2013).
4.
Jayaram G, Chew MT: Fine needle aspiration cytology of lymph nodes in HIV-infected individuals. Acta Cytol 2000;44:960-966.
5.
Vanisri HR, Nandini NM, Sunila R: Fine-needle aspiration cytology findings in human immunodeficiency virus lymphadenopathy. Indian J Pathol Microbiol 2008;51:481-484.
6.
Woods GL: Mycobacteria; in McPherson RA, Pincus MR (eds): Henry's Clinical Diagnosis and Management by Laboratory Methods, ed 22. Philadelphia, Elsevier Saunders, 2011, pp 1145-1150.
7.
Tirumalasetti N, Latha PP: Lymph nodes cytology in HIV seropositive cases with haematological alterations. Indian J Med Res 2014;139:301-307.
8.
WHO: TB publications: global tuberculosis report 2013. http://www.who.int/tb/publications/global_report/en/ (accessed August 12, 2013).
9.
Kent PT, Kubica GP: Public health mycobacteriology: a guide for the level III laboratory. Atlanta, Department of Health and Human Services, 1985.
10.
WHO: HIV/AIDS Programme: 2010 ART guidelines for adults and adolescents - evidence map. http://www.who.int/hiv/topics/treatment/evidence/en/ (accessed August 12, 2013).
11.
Bottles K, McPhaul LW, Volberding P: Fine-needle aspiration biopsy of patients with acquired immunodeficiency syndrome (AIDS): experience in an outpatient clinic. Ann Intern Med 1988;108:42-45.
12.
Martin-Bates E, Tanner A, Suvarna SK, Glazer G, Coleman DV: Use of fine needle aspiration cytology for investigating lymphadenopathy in HIV positive patients. J Clin Pathol 1993;46:564-566.
13.
Reid AJ, Miller RF, Kocjan GI: Diagnostic utility of fine needle aspiration (FNA) cytology in HIV-infected patients with lymphadenopathy. Cytopathology 1998;9:230-239.
14.
Saikia UN, Dey P, Jindal B, Saikia B: Fine needle aspiration cytology in lymphadenopathy of HIV-positive cases. Acta Cytol 2001;45:589-592.
15.
Shenoy R, Kapadi SN, Pai KP, Kini H, Mallya S, Khadilkar UN, Prabha A: Fine needle aspiration diagnosis in HIV-related lymphadenopathy in Mangalore, India. Acta Cytol 2002;46:35-39.
16.
Kumar N, Gupta BB, Sharma B, Kaushal M, Rewari BB, Sundriyal D: Role of fine-needle aspiration cytology in human immunodeficiency virus-associated lymphadenopathy: a cross-sectional study from northern India. Hong Kong Med J 2015;21:38-44.
17.
Zafar N: Histoplasmosis in fine-needle aspiration cytology of axillary lymph node in an HIV-positive woman with clinical suspicion of lymphoma. Diagn Cytopathol 2009;37:584-585.
18.
Cozzolino I, Nappa S, Picardi M, De Renzo A, Troncone G, Palombini L, Zeppa P: Clonal B-cell population in a reactive lymph node in acquired immunodeficiency syndrome. Diagn Cytopathol 2009;37:910-914.
19.
Kumarguru BN, Kulkarni MH, Kamakeri NS: FNAC of peripheral lymph nodes in HIV-positive patients. Sci Med 2009;1:1-8.
20.
Das DK, Pant JN, Chachra KL, Murthy NS, Satyanarayan L, Thankamma TC, Kakkar PK: Tuberculous lymphadenitis: correlation of cellular components and necrosis in lymph node aspirate with AFB positivity and bacillary count. Indian J Pathol Microbiol 1990;33:1-10.
21.
Singh UR, Bhatia A, Gadre DV, Talwar V: Cytologic diagnosis of tuberculous lymphadenitis in children by fine needle aspiration. Indian J Pediatr 1992;59:115-118.
22.
Gupta SK, Chugh TD, Sheik ZA, AL-Rubah NA: Cytodiagnosis of tuberculous lymphadenitis: a correlative study with microbiologic examination. Acta Cytol 1993;37:329-332.
23.
Kumar S, Ferns S, Sujatha S, Jatiya L: Acid-fast staining patterns and their correlation with HIV positivity. Acta Cytol 2005;49:111-112.
24.
Phillips AN, Lee CA, Elford I, Janossy G, Timms A, Bofill M, Kernoff PB: Serial CD4 lymphocyte counts and development of AIDS. Lancet 1991;337:389-392.
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2015
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