[Lymph node tuberculosis in HIV-1 seropositive patients in Central Africa. A characteristic histopathologic picture]. / Tuberculose ganglionnaire chez des séropositifs pour VIH-1 en Afrique centrale. Un tableau histopathologique particulier.

ABSTRACT

PIP: During 1987-1988 in Burundi, 62 patients presented at Butare University Hospital with chronic lymphadenopathy syndrome. Physicians suspected that the syndrome was a result of HIV infection. 45 (73%) were indeed HIV seropositive. The biopsy of the lymph nodes revealed that 15 of the 62 patients (24%) had histologic characteristics of tuberculosis (TB). 12 of the patients with lymph node TB were HIV seropositive. The other three cases exhibited classical signs of follicular adenitis. All the HIV positive cases with lymph node TB had many enlarged lymph nodes which were superficial, easily palpated, and moveable. They also had little mass. Specifically, they had rather immature granulomas with considerable necrosis which turns the tissue into a dry mass resembling cheese, and, sometimes, granular necrosis. These granulomas had acid fast bacilli. The non-necrotic areas had many blood vessels and considerable excess of plasma cells in the blood. Thus, the lymph nodes of the HIV positive TB cases were different than those of the 3 HIV negative cases. The semi-quantitative evaluation of the components of the granulomatous TB reaction allowed the researchers to rank the lesions in a manner probably parallel to the degree of deterioration of the cellular immune response. This semi-quantitative evaluation could constitute a prognostic value. Lymph node biopsy and mycobacterial culture appear then to be indicated among HIV seropositive persons living where there is a joint HIV-1/TB endemic. This allows clinicians to detect concealed TB among HIV seropositive individuals and to introduce as fast as possible an adequate anti-TB treatment and to enable a fight against the progression of the illness and its propagation in a group of sick persons.