Polymerase chain reaction amplifying mycobacterial DNA from aspirates obtained by endoscopic ultrasound allows accurate diagnosis of mycobacterial disease in HIV-positive patients with abdominal lymphadenopathy

Ultrasound Med Biol. 2014 Sep;40(9):2031-8. doi: 10.1016/j.ultrasmedbio.2014.04.006. Epub 2014 Jul 9.


Abdominal lymphadenopathy in human immunodeficiency virus (HIV) infection remains a diagnostic challenge. We performed a prospective cohort study by recruiting 31 symptomatic HIV + patients with abdominal lymphadenopathy and assessing the diagnostic yield of endoscopic ultrasound fine-needle aspiration (EUS-FNA). Mean age was 38 years; 52% were female; and mean CD4 count and viral load were 124 cells/μL and 4 log, respectively. EUS confirmed additional mediastinal nodes in 26%. The porta hepatis was the most common abdominal site. Aspirates obtained by EUS-FNA were subjected to cytology, culture and polymerase chain reaction (PCR) analysis. Mycobacterial infections were confirmed in 67.7%, and 31% had reactive lymphadenopathy. Cytology and culture had low sensitivity, whereas PCR identified 90% of mycobacterial infections. By combining the appearance of aspirates obtained by EUS-FNA and cytologic specimens, we developed a diagnostic algorithm to indicate when analysis with PCR would be useful. PCR performed on material obtained by EUS-FNA was highly accurate in confirming mycobacterial disease and determining genotypic drug resistance.

Keywords: Abdominal lymphadenopathy; Endoscopic ultrasound; HIV; Human immunodeficiency virus; Tuberculosis.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen
  • Adult
  • Biopsy, Fine-Needle
  • Cohort Studies
  • DNA
  • Endosonography / methods*
  • Female
  • Flow Cytometry / methods
  • HIV Infections / complications*
  • Humans
  • Lymphatic Diseases / complications*
  • Male
  • Mycobacterium Infections / complications*
  • Mycobacterium Infections / diagnosis*
  • Polymerase Chain Reaction / methods*
  • Prospective Studies
  • Sensitivity and Specificity


  • DNA