Cervical Tuberculous Lymphadenitis: Clinico-demographic profilesof patients in a secondary level hospital of Bangladesh

Abstract

Objective:Tuberculosis (TB) is a major public health problem in Bangladesh since long. The present incidence and prevalence rates of all forms of TB are 227 and 404/100,000 population respectively. The aim of this study was to find out the clinical characteristics of involved cervical lymph nodes, demographic characteristics of the patients and response to treatment of Cervical Tuberculous Lymphadenitis (CTL) cases.Methods:A prospective study was performed in Shaheed Shamsuddin Ahmed Hospital, Sylhet, Bangladesh from June 2012 to June 2014. Total 65 patients having CTL attending outpatient department of the hospital were enrolled.Results:Age of the patients ranged from 5 to 60 years with a mean of 25.6 years. Two third (67.7%) of the patients were female. Male: Female ratio was 1:2.1. More than half of the patients came from rural areas (53.8%) and from low socio-economic conditions (58.5%). Most of the patients presented with unilateral (87.7%), multiple (82.3%), matted (68.6%) lymph nodes, <3cm diameter (54%), commonly in right side (57.9%). Abscess was found in 21.5% cases. Discharging sinus was found in 9.2% cases. Most commonly involved lymph node group was level V (59.4%) followed by level II (42.2%). Systemic features were found in 63.07% patients. Associated lung lesion was found in 3.1% cases. FNAC was found positive for tuberculosis in 83.9% cases. Most of the patients (78.46%) were cured with six months anti-tubercular chemotherapy.Conclusions:Early diagnosis and treatment is critical in reducing the overall prevalence. It is essential to have awareness regarding common presentations of cervical tuberculous lymphadenitis among the general population as well as healthcare professionals working in the resource poor primary and secondary level hospitals.

A clinical study of tuberculous cervical lymphadenopathy: surgeon’s perspectives

“…25,26 The females (29,58.00%) were more affected with TCL as compared to males (M:F ratio-1:1.38). Females more involvement in TCL was found in study done in Bangladesh by Kamal 24,27,29 A majority of the patients (45, 90.00%) had unilateral TCL, particularly more involvement of right side of cervical region. The unilateral neck swelling was also commonest (87.7%) finding in a study done by Kamal MS et al, Similar higher involvement was reported in the study done by Frontanilla JM et al, (85%) but much higher than Jha BC et al, (67.8%).…”

“…Other studies also reported similar incidence as of the present study-Jha BC et al, 63%, Castro DJ et al, 46% and Dandapat MC et al, 41.5%. 17,20,21 The commonest age group affected by tuberculous cervical lymphadenopathy (TCL) was 20-35 years (27,54.00%) followed by 0-12 years (10, 20.00%) and 13-19years (8, 16.00%). Jha BC et al, found the age of the patients ranged from 9months to 62years with the commonest age group affected was 11-20years (41.07%).…”

“…Non-specific lymphadenitis Lymphoma According to Table 1, the commonest age group affected by tuberculous cervical lymphadenopathy (TCL) was 20-35years (27,54.00%) followed by 0-12years (10, 20.00%) and 13-19 years (8, 16.00%). The females (29,58.00%) were more affected with TCL as compared to males (21,42.00%) ( Figure 2).…”

“…The findings of involved lymph node groups in this study were consistent with the studies done by Magsi PB et al, (level V) and Chaudhary V et al, (level V). 27,29,31 Anti-tuberculous chemotherapy is the mainstay in the management of TB lymphadenopathy. 4 The six months treatment may be sufficient for many patients but ultimate outcome is difficult to assess because of delayed response of medications in extra-pulmonary TB.…”

Necrotizing Neck Mass in a Young Female

“…Fever (87.8%; 36), Weight loss (63.4%; 26), Night sweat (63.4%; 26) and Loss of appetite (80.5%; 33) were the common systemic features [7], interestingly, our patient was asymptomatic and with a previous history of TB prophylaxis treatment, needing a wider approach to her condition.…”