Patterns of granulomatous responses in TB lymphadenitis and their correlation with treatment outcomes.

INTRODUCTION: Four patterns are noted in aspirates of TB lymphadenitis with or without concomitant HIV. They are granulomatous, necrotizing granulomatous, predominantly necrotizing and necrotizing suppurative designated pattern 1, 2, 3 and 4, respectively. The present study attempted to correlate granulomatous patterns, Acid Fast Bacilli (AFB) density with treatment outcomes.

MATERIALS AND METHODS: The MGG and Papanicolaou stained slides of 56 lymphadenitis patients, 38 TB and 18 TB with seropositive HIV were studied for two years. The AFB were stratified into: 0 - nil (1 - ≤1 AFB, 2 - >1 but <10 AFB, 3 - ≥10 AFB)/10 fields.

RESULTS: There were 35 males and 21 females. Eleven aspirates demonstrated AFB. TB+HIV lymphadenitis displayed a higher AFB score. TB+HIV lymphadenitis aspirates significantly showed higher grade granulomas and AFB. TB+HIV lymphadenitis required ≥8-month treatment. Granulomas (pattern 3 or 4) but not high AFB scores required longer treatment (>6 months). Treatment of AFB (≥1) often extended to >6 months.

CONCLUSION: TB with seropositive HIV, possibly due to defective immune regulation exhibited granulomas (pattern 3 or 4) necessitating treatment for ≥8 months. Pattern 3 or 4 granulomas irrespective of HIV status demanded >6-month treatment.