Diagnosing lymphoma in the shadow of an epidemic: lessons learned from the diagnostic challenges posed by the dual tuberculosis and HIV epidemics

Abstract

Infectious disease epidemics may overshadow and exacerbate existing challenges in diagnosing lymphoma. We describe pragmatic strategies we have implemented to overcome diagnostic obstacles caused by the local tuberculosis (TB) and HIV epidemics in South Africa, which may serve as a guide to minimize diagnostic delay during the COVID-19 pandemic. We report on the diagnostic utility of a rapid-access lymph node core-biopsy clinic, where lymph node biopsies are taken from outpatients at their first visit. Analysis of tissue biopsies (n = 110) revealed the three most common conditions diagnosed were TB adenitis (34%), lymphoma (29%), and disseminated malignancy (20%). A first-attempt core-biopsy was able to diagnose lymphoma in 27/32 (84%) of cases. Compared with a historical cohort, the diagnostic interval (time from first health visit to diagnostic biopsy) for patients with lymphoma was significantly shorter, 13.5 vs 48 days (p = 0.002).

Keywords:

• Lymphoma
• COVID-19
• HIV
• diagnosis
• tuberculosis

View correction statement:

Correction

Acknowledgements

The staff of E5 Clinical Haematology who kindly agreed to the additional administrative and clinical workload associated with the addition of a new clinic. Dr Francois Malherbe, the surgeon who trained the haematologists to perform a core-biopsy of a lymph node.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data is available upon reasonable request to the corresponding author.

Additional information

Funding

Research reported in this manuscript was supported by the Fogarty International Center of the National Institutes of Health grants [D43-TW010345, D43-TW010543]; the National Research Foundation Thuthuka grant [TTK14052267787]; and the Peter Jacobs Bursary Trust. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the funders.