Jeena P M, Coovadia H M, Hadley L G, Wiersma R, Grant H, Chrystal V
Department of Paediatrics & Child Health, Faculty of Medicine, University of Natal, Congella, South Africa.
Int J Tuberc Lung Dis. 2000 Feb;4(2):139-46.
The diagnosis of opportunistic infections in children with persistent lung disease (PLD) who are infected with the human immunodeficiency virus (HIV) is difficult to establish, especially in resource-poor countries. Lymphadenopathy is a frequent associated clinical finding among these children. We evaluated the usefulness of excision lymph node biopsies in determining an aetiological diagnosis in HIV-infected and non-infected children with PLD.
Forty-five children with PLD and significant lymphadenopathy were subjected to lymph node biopsy. Of these, 27 were HIV-infected. All subjects had excision biopsies; 39 (86.7%) of these cases also underwent fine needle aspiration cytodiagnosis (FNAC) and trucut needle biopsies.
Tuberculosis was identified as the final diagnosis in 11 (40.7%) and 12 (66.7%) HIV-infected and noninfected children, respectively. Ancillary investigations (Mantoux, gastric washings) suggested a diagnosis of tuberculosis in eight (72.7%) and eight (66.7%) of the final diagnoses of tuberculosis among HIV-infected and non-infected children, respectively. Lymph node 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 showed 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 39 trucut biopsies.
Excision lymph node biopsies form a useful adjunct investigation in children with PLD and generalised lymphadenopathy. The most common disease identified among HIV-infected and non-infected children in Durban, South Africa, is tuberculosis. FNAC and trucut biopsies may also be useful in the evaluation of lymphadenopathy when appropriate specimens are obtained.
对于感染人类免疫缺陷病毒（HIV）且患有持续性肺病（PLD）的儿童，机会性感染的诊断很难确立，尤其是在资源匮乏的国家。淋巴结病是这些儿童中常见的相关临床症状。我们评估了切除性淋巴结活检在确定感染HIV和未感染HIV的PLD儿童病因诊断中的作用。
45例患有PLD且有明显淋巴结病的儿童接受了淋巴结活检。其中，27例感染了HIV。所有受试者均接受了切除活检；这些病例中有39例（86.7%）还接受了细针穿刺细胞诊断（FNAC）和切割针活检。
分别在11例（40.7%）感染HIV和12例（66.7%）未感染HIV的儿童中，结核病被确定为最终诊断。辅助检查（结核菌素试验、胃液检查）分别在感染HIV和未感染HIV儿童结核病最终诊断中的8例（72.7%）和8例（66.7%）中提示结核病诊断。与辅助检查相比，淋巴结活检在感染HIV和未感染HIV组中分别又多发现了3例（27.3%）和4例（33.3%）结核病病例。FNAC和切割活检结果与切除活检显示出良好的相关性：分别为96.4%和97.4%。然而，39例FNAC中只有23例获得了足够的样本，39例切割活检中只有33例获得了足够的样本。
切除性淋巴结活检是PLD和全身性淋巴结病儿童有用的辅助检查。在南非德班感染HIV和未感染HIV的儿童中发现的最常见疾病是结核病。当获得合适标本时，FNAC和切割活检在评估淋巴结病方面也可能有用。
