Clinical Study of Extrapulmonary Head and Neck Tuberculosis: A Single-Institute 10-year Experience

Abstract

Introduction Although the incidence of tuberculosis (TB) in Japan has been decreasing yearly, Japan remains ranked as an intermediate-burden country for TB. Objective This study aims to investigate the current situation of head and neck extrapulmonary TB (EPTB) diagnosed in our department. Methods We retrospectively reviewed the clinical records of 47 patients diagnosed with EPTB in the head and neck in our department between January 2005 and December 2014. The extracted data included sex and age distribution, development site, chief complaint, presence or absence of concomitant active pulmonary TB (PTB) or history of TB, tuberculin skin test (TST) results, interferon-gamma release assay (IGRA) results, and duration from the first visit to the final diagnosis of EPTB. Results The subjects consisted of 20 men and 27 women, and age ranged from 6 to 84 years. The most common site was the cervical lymph nodes (30 patients), with the supraclavicular nodes being the most commonly affected (60%). Histopathological examination was performed on 28 patients. TST was positive in 9 out of 9 patients and the IGRA was positive in 18 out of 19 patients. We observed concomitant PTB in 15 out of the 47 patients. Mean duration from the first visit to the final diagnosis of EPTB was 56 days. Conclusion The clinical symptoms of TB, especially those in the head and neck region, are varied. Otolaryngologists should be especially aware of the extrapulmonary manifestations of TB to ensure early diagnosis and treatment from the public health viewpoint.

Clinical study of tuberculosis in the head and neck region—11 years’ experience and a review of the literature

“…In our cases, the most common site of HNTB was the cervical lymph nodes, which coincide with many recent reports 12 , 21 , 22 . However, a total review of the historical literature showed a similar ratio of laryngeal and cervical TB.…”

“…Laryngeal TB may cause cough, odynophagia, hoarseness of the voice, and even dyspnea 12 , 20 . Aural TB could be concomitant with otalgia, tinnitus, hearing loss, and facial nerve palsy 12 , 21 . Nasal TB mainly causes nasal obstruction, epistaxis, and purulent or bloody discharge, and when the paranasal sinus is involved, there may be bone destruction and optical symptoms, such as diplopia and exophthalmos 8 , 12 .…”

“…For diagnosing HNTB, an imaging examination, such as ultrasonography and computed tomography, can provide a general idea of the location, size and number of TB lesions. Other examinations, such as the TST and interferon-gamma release assays (IGRAs), can help make a diagnosis; however, false negative results have been reported 12 , 21 . According to previous reports, the TST positive rate is only 53% 12 and is much lower in patients with local primary TB lesions.…”

A Clinic-Epidemiological Study of Head and Neck Tuberculosis—A Single-Center Experience

“…In a large study on EPTB conducted in United States, cervical lymphatic TB accounted for more than 60% of lymphatic tuberculosis which was the most common site of TB [4]. The high prevalence of cervical lymph nodes involvement in EPTB was reported also in other studies [3,6,19], in some of them this form of TB affected mainly immigrants of Asian or African origin [3,19,20]. In the study from UK, during 10 years out of all 128 head and neck TB cases, 111 patients had cervical TB lymphadenitis, but 89% of them were of Asian origin [3].…”

“…In Menon et al study [3] anterior triangle nodes (mostly jugulodigastric ones) were involved in 70% and posterior triangle nodes in 21% of cases. Also Oishi et al [6] reported that supraclavicular nodes were affected in 60% while in a large study from India comprising 893 patients, posterior triangle nodes were involved in 43.8 %, followed by upper deep cervical nodes (33.9%) [21].…”