Mycobacterial Cervical Lymphadenitis

Abstract

Cervical lymphadenitis is the most common head and neck manifestation of mycobacterial infections. The incidence of mycobacterial cervical lymphadenitis has increased. It may be the manifestation of a systemic tuberculous disease or a unique clinical entity localized to neck. It remains a diagnostic and therapeutic challenge because it mimics other pathologic processes and yields inconsistent physical and laboratory findings. A high index of suspicion is needed for the diagnosis of mycobacterial cervical lymphadenitis. A unilateral single or multiple painless lump, mostly located in posterior cervical or supraclavicular region can occur. A thorough history and physical examination, tuberculin test, staining for acid-fast bacilli, radiologic examination, fine-needle aspiration and PCR will be instrumental in arriving at an early diagnosis early institution of treatment before a final diagnosis can be made by biopsy and culture. It is important to differentiate tuberculous from nontuberculous mycobacterial cervical lymphadenitis because their treatment protocols are different. Tuberculous adenitis is best treated as a systemic disease with antituberculosis medication. Atypical infections can be addressed as local infections and are amenable to surgical therapy.

A Study of Manifestations of Extrapulmonary Tuberculosis in the ENT Region

“…In the present study the pattern of lymph node involvement showed multiple lymph node group involvement in 96.5 % of the cases and the commonest lymph node group involved was of the posterior triangle (88 %). This corresponds to the findings in other studies [7]. Most of the times FNAC clinches the diagnosis as was the case in the present study (96.5 %) [6,7].…”

“…This corresponds to the findings in other studies [7]. Most of the times FNAC clinches the diagnosis as was the case in the present study (96.5 %) [6,7]. However in eight cases surgical excision biopsy was needed to confirm the diagnosis.…”

“…This is contrary to our findings wherein majority of the EPTB cases (91.7 %) were in the ENT region. TB lymphadenitis of the cervical region is the commonest manifestation of EPTB [2,4,[6][7][8]. In the present study too cervical TB lymphadenitis accounted for 87.4 % of cases of EPTB and 95.3 % of cases of EPTB in the ENT region.…”

“…The incidence of HIV positivity in patients with TB lymphadenitis has been reported around 8 % [9]. The cornerstone of management of TB lymphadenopathy is AKT which has proven very effective in the management in all studies [7]. However in certain situations there is limited role of surgery too [9].…”

Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource- constrained Setting: State of the Art, Challenges and the Need

“…In the past decade, Nucleic Acid Amplification techniques (NAAT) have led to the development of tests with high positive predictive value (98-99%) and relatively lower negative predictive value for early detection of M. tuberculosis from various extra-pulmonary clinical specimens [8][9][10][11][12][13][14][15]. The advantages of amplification technique over culture are higher sensitivity, as it can detect as few as 1-10 organisms in clinical specimens at least in research conditions.…”