Isolated cervical tuberculosis in patients with HIV infection

Area of Science:

• Infectious Diseases
• Oncology
• Immunology

Background:

• Tuberculosis (TB) isolated to the head and neck is frequently observed in individuals with human immunodeficiency virus (HIV) infection.
• Limited literature exists on the management of isolated head and neck TB, particularly concerning its presentation and diagnosis in relation to HIV status.

Purpose of the Study:

• To characterize isolated head and neck tuberculosis in HIV-infected patients.
• To compare presentation and diagnostic approaches based on HIV status (HIV infection vs. acquired immunodeficiency syndrome [AIDS]).

Main Methods:

• Retrospective study of 38 HIV-infected patients with isolated head and neck TB over 10 years.
• Patients categorized into two groups: Group 1 (11 patients) with AIDS at presentation and Group 2 (27 patients) with HIV infection but not AIDS.
• Analysis of clinical presentation, diagnostic test sensitivity, and management outcomes.

Main Results:

• Cervical lymphatics were the most common site (89%), predominantly supraclavicular nodes (53%).
• Extralymphatic TB occurred in 11% of cases, affecting various head and neck sites.
• Purified protein derivative (PPD) test sensitivity was reduced in AIDS patients (14%) compared to HIV-infected patients (61%), while fine-needle aspiration biopsy (FNAB) showed 94% sensitivity irrespective of HIV status.
• Surgical biopsy, while definitive, was associated with draining fistulas in 14% of cases.

Conclusions:

• Head and neck TB should be considered in HIV-infected patients with unexplained lesions, even without pulmonary TB.
• PPD testing should be used cautiously in AIDS patients due to decreased sensitivity.
• FNAB is the preferred diagnostic method for head and neck TB in this population; surgical biopsy is reserved for ambiguous cases.