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LYMPHADENOPATHY (enlarged lymph node/s)Approach to patient with enlarged lymph nodes• Lymphadenopathy is common in HIV. If status unknown, test for HIV 60 and• Ask about associated symptoms, especially TB symptoms (weight loss, cough ≥ 2 weeks, chest pain, night sweats) and manage on relevant page.Are nodes equally enlarged < 2cm or 1 or more ≥ 2cm?All lymph nodes enlarged equally but < 2cm in size1 or more lymph node/s ≥ 2cm in size Check for secondary syphilis with RPR or if unavailable, look for signs: rash especiallypalms and soles, mouth ulcers, genital wart-like lesions.RPR positive or signs ofsecondary syphilisTreat syphilis 28.HIV positiveGive routine HIV care61.HIV and/or RPR negative• Advise repeat test after 3month window period.• If asymptomatic, reassure andadvise to return if symptomsoccur.NoNoIs there a nearby infection (skin, throat) or Kaposi’s sarcoma lesion?Inguinal/groin swellingYesConfirm that this is a lymph node:discrete, movable and rubbery.Yes• Sore throat 14• Skin infection 40• Kaposi’s sarcoma lesion 44Refer for further investigation if after 2 weeks patient is unwell withlymphadenopathy and no obvious cause.YesSwelling hot, painfuland/or red?NoRefer to excludehernia, aneurysm.How to aspirate lymph node for TB and cytology• Clean skin over largest node with alcohol or povidone iodine.• Insert 16 or 18 gauge needle into node, partially withdraw and reinsert at differentangles several times.• Withdraw needle, attach to syringe filled with 2–3ml air, and gently spray needlecontents over glass slide.• Thinly spread material across slide with a second slide.• Fix one slide for cytology with cytology spray.• Allow second slide to air-dry (TB).• If the aspirate is unsuccessful, repeat. If again unsuccessful, refer to surgeon.No• Patient needs lymphnode aspirate for TBand cytology.• If patient iscoughing, alsoexclude TB withsputa 55.YesTreat patient and partner for buboFirst assess and advise the patient and partner 23.• Doxycycline 100mg 12 hourly for 14 days and• Ciprofloxacin 500mg 12 hourly for 3 days• Pregnant/breastfeeding: erythromycin 500mg 6 hourly for14 days instead of doxycycline and ciprofloxacin• Paracetamol 1g 6 hourly for pain• Look for genital ulcer. If present 23.• Aspirate fluctuant lymph node through intact skin.5