Epidemiological and clinical patterns of intrathoracic lymph node tuberculosis in 60 human immunodeficiency virus-negative adult patients

We retrospectively evaluated a group of human immunodeficiency virus (HIV)-negative adult patients with hilar and/or mediastinal tubercular adenopathy to assess their epidemiological, clinical and radiological features. Out of 3,003 intrathoracic tuberculosis (TB) cases (of which 745 were immigrants from various developing countries) observed in our Institute from 1986-1996, 8 Italians and 52 immigrants were selected. Case history analysis, and standard chest radiography were performed in all cases, while other investigations such as a tuberculin test, sputum and culture examination for Mycobacterium tuberculosis, computed tomography (CT) scanning and biopsy were performed in the majority of patients. Less frequently, bronchoscopy, mediastinoscopy, and echography were also performed. Right paratracheal adenopathy was found most frequently (29 cases), as previously described. CT scanning showed a central necrosis pattern in 31 cases, while normo/hyperdensity occurred in 11 cases. M. tuberculosis was detected in sputum smear and/or culture in only 16 patients. Our study confirms that, when HIV-positive patients are excluded, this peculiar TB location occurs more frequently in immigrants than in the indigenous Italian population (7.0 versus 0.3%, p0.001). People from the Indian subcontinent and Senegal are the most frequently involved nationalities among the immigrants present in Milan.