Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management

Abstract

Tuberculosis is one of the biggest health challenges the world is facing. In this study the clinical pattern of patients with cervical lymphadenitis, who presented to the ear, nose, and throat outpatient department of the Government Medical College Hospital, Chandigarh, India between June 1997 and May 1998 is recorded. Tuberculosis accounted for 60 out of 94 cases of cervical lymph node enlargement. The commonest age group aVected was 11-20 years. Constitutional symptoms were not present in most of the patients. Multiple matted nodes were seen in 23 patients but a single discrete node was seen in 18 patients. Upper deep jugular nodes were the most commonly aVected lymph nodes. Discharging sinus and abscess formation were uncommon. Fine needle aspiration cytology yielded a positive diagnosis in 52 out of 56 patients. Chest lesions on radiography were evident in 16% of the patients. Mantoux test was positive and was more than 15 mm in most of the patients. This study shows that the classical picture of "scrofula" is no longer seen nowadays and can probably be explained by the earlier presentation of the disease.All the patients were treated with short course daily chemotherapy for six months. Surgery was not required in the majority of patients except in four cases where excision biopsy was performed. Patients with abscess formation were managed with wide bore needle aspiration only. With a minimum six month period of follow up, no patient was found to have a recurrence of local or systemic disease.This study emphasises the role of fine needle aspiration cytology in diagnosis and confirms the eYcacy of six months short course chemotherapy.

Cervical Node Tuberculosis in Adults of an Urban Middle Class Community: Incidence and Management

“…Nodal TB presenting as matted or sinuses has been discussed in many previous studies [5,19,20], however, in contrast to these studies, we found very few patients with presenting with these signs. Matted nodes were seen only in 17 (22.9 %) patients and sinus was seen in only one patient, who did not respond to treatment, and was later diagnosed to have MDR TB.…”

“…Our study shows a significant association between those with cervical node TB and having a history of contact with a patient already having TB (p \ 0.001). Studies on constitutional symptoms of cervical node TB show a wide variability [2,5]. These constitutional symptoms mimic other conditions with cervical node and cannot be attributed solely to TB.…”

“…Amongst these sites, cervical nodes are the most commonly affected [3]. While many Indian studies have discussed the clinical presentations and management of cervical node TB, the burden of tuberculous cervical lymphadenopathy is not known in Indian population [1,2,[4][5][6]. The aim of this study is to estimate the incidence of cervical node TB in an urban middle class population and to describe an effective protocol for management of cervical lymphadenopathy.…”

Separated Axillary Tuberculous Lymphadenitis: A Case Report

“…[8] Cervical tuberculous lymphadenitis may represent a spread from the primary focus of infection in the tonsils. [9,10] Axillary tuberculous lymphadenitis is rare and has major prevalence between 20 and 50 years old.…”

“…Cervical lymph nodes constitute the most common site of involvement with axillary nodes affected in 3. [8][9][10][11][12][13][14][15][16][17][18][19][20].3% of tuberculous lymphadenitis [1,2]. Isolated axillary tuberculous lymphadenitis is rare and described in patients without previous or active pulmonary TB and no evidence of the origin of TB detected elsewhere [3,4].…”