Imperial College London
Alternate

ProfessorJonFriedland

Faculty of Medicine, Department of Infectious Disease

Visiting Professor
 
 
 
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Contact

 

+44 (0)20 3313 8521j.friedland Website

 
 
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Assistant

 

Ms Teyanna Gaeta +44 (0)20 3313 1943

 
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Location

 

8N21ACommonwealth BuildingHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Kirwan:2017:10.4269/ajtmh.16-0961,
author = {Kirwan, D and Ugarte-Gil, C and Gilman, RH and Hasan, Rizvi SM and Cerrillo, G and Cok, J and Ticona, E and Cabrera, JL and Matos, ED and Evans, CA and Moore, DAJ and Friedland, JS and The, Lymph Node Tuberculosis LNTB Working Group},
doi = {10.4269/ajtmh.16-0961},
journal = {American Journal of Tropical Medicine and Hygiene},
pages = {1271--1276},
title = {Histological examination in obtaining a diagnosis in patients with lymphadenopathy in Lima, Peru},
url = {http://dx.doi.org/10.4269/ajtmh.16-0961},
volume = {97},
year = {2017}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - The differential diagnosis for lymphadenopathy is wide and clinical presentations overlap, making obtaining an accurate diagnosis challenging. We sought to characterize the clinical and radiological characteristics, histological findings, and diagnoses for a cohort of patients with lymphadenopathy of unknown etiology. 121 Peruvian adults with lymphadenopathy underwent lymph node biopsy for microbiological and histopathological evaluation. Mean patient age was 41 years (Interquartile Range 26–52), 56% were males, and 39% were HIV positive. Patients reported fever (31%), weight loss (23%), and headache (22%); HIV infection was associated with fever (P < 0.05) and gastrointestinal symptoms (P < 0.05). Abnormalities were reported in 40% of chest X-rays (N = 101). Physicians suspected TB in 92 patients (76%), lymphoma in 19 patients (16%), and other malignancy in seven patients (5.8%). Histological diagnoses (N = 117) included tuberculosis (34%), hyperplasia (27%), lymphoma (13%), and nonlymphoma malignancy (14%). Hyperplasia was more common (P < 0.001) and lymphoma less common (P = 0.005) among HIV-positive than HIV-negative patients. There was a trend toward reduced frequency of caseous necrosis in samples from HIV-positive than HIV-negative TB patients (67 versus 93%, P = 0.055). The spectrum of diagnoses was broad, and clinical and radiological features correlated poorly with diagnosis. On the basis of clinical features, physicians over-diagnosed TB, and under-diagnosed malignancy. Although this may not be inappropriate in resource-limited settings where TB is the most frequent easily treatable cause of lymphadenopathy, diagnostic delays can be detrimental to patients with malignancy. It is important that patients with lymphadenopathy undergo a full diagnostic work-up including sampling for histological evaluation to obtain an accurate diagnosis.
AU  - Kirwan,D
AU  - Ugarte-Gil,C
AU  - Gilman,RH
AU  - Hasan,Rizvi SM
AU  - Cerrillo,G
AU  - Cok,J
AU  - Ticona,E
AU  - Cabrera,JL
AU  - Matos,ED
AU  - Evans,CA
AU  - Moore,DAJ
AU  - Friedland,JS
AU  - The,Lymph Node Tuberculosis LNTB Working Group
DO  - 10.4269/ajtmh.16-0961
EP  - 1276
PY  - 2017///
SN  - 1476-1645
SP  - 1271
TI  - Histological examination in obtaining a diagnosis in patients with lymphadenopathy in Lima, Peru
T2  - American Journal of Tropical Medicine and Hygiene
UR  - http://dx.doi.org/10.4269/ajtmh.16-0961
UR  - http://hdl.handle.net/10044/1/49842
VL  - 97
ER  -
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