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Lymphadenopathy in African Children 247

The node sampled should be a representative node, preferably from Up to 18% of HIV-affected patients in Africa have lymphadenopathy
a deep site. The node should be divided into specimens for histology on presentation. A generalised lymphadenopathy (particularly cervical
and specimens for tissue culture (and TB culture). The specimen for and axillary nodes) has been reported as the most common presentation
histology should be further divided into a formalin fixed section and a of children with symptomatic HIV in Zimbabwe, but concomitant
section sent fresh for imprinting. Figure 37.9 outlines the handling of tuberculosis needs to be excluded. The histological picture of HIV-
biopsy specimens. affected lymphadenopathy is usually nonspecific with the immunologic
The surgical technique for lymph node excision is shown in Figure 37.10. reaction to HIV being the most prominent feature. The picture is further
Immunocompromised Patient complicated by the clinical and multiple HIV virus subtypes in sub-
Lymphadenopathy may be a much more serious problem in the immu- Saharan Africa and Nigeria.
nocompromised patient.

Key Summary Points

1. Lymphadenopathy is an extremely common clinical finding in 9. A special situation exists in lymphadenopathy related to the
the children of Africa as well as the rest of the world. Danish strain of bacille Calmette-Guérin, (BCG) particularly in
immunocompromised children.
2. It is most prevalent in the first decades of life and the majority
of children between the ages of 2 and 12 will have an enlarged 10. Up to 18% of HIV affected patients in Africa have
lymph node at one stage or another. lymphadenopathy on presentation.
3. A significant lymph node is >2cm. 11. Malignancy in enlarged lymph nodes occurs in 12% and 2/3
are lymphomas.
4. Lymphadenopathy may be the first (and sometimes only)
indication of underlying disease. 12. Fine needle Aspiration biopsy (FNAB) is a useful triage for the
rapid and definitive diagnosis of tuberculosis but may miss
5. Active management is justified of paediatric patients with malignancy.
persisting lymphadenopathy.
13. Early tissue sampling indicated with generalized symptoms
6. Atypical anatomic regions, persistence despite appropriate of unexplained fever and weight loss.and lymphadenopathy
treatment, absence of previous pyogenic infection, (especially mediastinal and abdominal lymph nodes.
geographical prevalence, history of cat scratch, a positive TB
history, are all important in assessment. 14. Where malignancy is suspected biopsy of an entire
representative lymph node is required and submitted for
7. The aetiology is mostly infective. This may be acute bacterial, appropriate culture and histology.
viral or chronic inflammation due to many different infective
agents.
8. Granulomas suggest chronic infective causes such as
mycobacteria (e.g., M. tuberculosis and other mycobacteria]
organisms.

References
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study of 1,877 surgical specimens. Pediatr Surg Int 2003; 19:240– among children in Malawi and infection with HIV, EBV and malaria:
244. results from a case-control study. PLoS ONE 2008; 3(6):e2505.
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L, Amir J. Management of nontuberculous mycobacteria-induced Marais BJ. Diagnosing mycobacterial lymphadenitis in children
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2008; 27:920–922. and autofluorescence—making more of less. Diagn Cytopathol
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