A Clinical Scoring System as Useful as FNAC in the Diagnosis of Tuberculous Lymphadenitis in HIV Positive Patients

Abstract

Among HIV positive patients, Fine needle aspiration cytology (FNAC) or biopsy for diagnosis of tuberculous lymphadenopathy is often avoided due to an unspoken stigma. Earlier, we had developed a clinical scoring scale for the diagnosis of tuberculous lymphadenitis (TBLN), which had 88% sensitivity and detected no false positives. In the present study, we attempted to develop similar scale that could assist in diagnosing TBLN in AIDS. All 42 HIV positive patients of adenitis attending Ramdeo Hospital and Research Centre, Jodhpur between August 2001 and December 2004 were studied. History of past tuberculosis, age, history of rapid weight loss, site, size, consistency, and the presence of matting and sinus formation of enlarged lymph nodes, result of tuberculin test, sputum smear and findings in chest radiograph were compared between patients diagnosed as TBLN and those showing non-tuberculous lymphadenitis (Non-TBLN) on cytopathological examination of material obtained by fine needle aspiration. Based on the results, clinical scores from zero to two were assigned to different clinical features. The total clinical score was then calculated for each patient. A total clinical score of five or more included all TBLN cases and only 10.5% false positives. This scoring system can be used in remote peripheral areas, which do not have the facility for biopsy or FNAC.