Paradoxical reaction (PR) in tuberculous lymphadenitis among HIV-negative patients: retrospective cohort study

Rajendra, Akhil; Sabnis, Kirti; Jeyaseelan, Vishalakshi; Rupali, Priscilla

doi:10.1136/postgradmedj-2016-134326

Cited by 2 publications

(2 citation statements)

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“…Most cases of TBL involve the cervical lymph nodes so that clinicians can easily recognize deterioration of the condition with the unaided eye [1,5]. Such a worsening of the clinical status of the patient induces clinicians to administer their patients with more anti-TB treatment, and this explains the fact that several studies, including ours, report the continuation of therapy beyond the six-month recommendation, which is known to be equally effective [6,8,22,25]. However, the DR rate of EPTB is not different from that of PTB; therefore, culture-negative TBL can be treated with a standard short-course anti-TB regimen as used in culture-negative PTB.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is more difficult to successfully grow MTB species from TBL specimens than in samples from PTB because of the paucity of bacilli in the former. The rate of positive culture of MTB in a specimen from an affected lymph node is known to range widely from 18% to 62% in patients with TBL according to previous studies [1,5,6]. Although, recent advances in technology such as liquid media culture have led to an improvement in diagnostic yield, substantial numbers of TBL patients still remain culture-negative.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics and Treatment Outcomes of Definitive versus Standard Anti-Tuberculosis Therapy in Patients with Tuberculous Lymphadenitis

Kim

Park

et al. 2019

JCM

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Although it is necessary to culture Mycobacterium tuberculosis from tuberculous lymphadenitis (TBL) patients for definitive therapy, based on the drug-sensitivity test (DST), substantial cases remain culture-negative. Limited data are available regarding the treatment outcomes after standard anti-tuberculosis therapy in culture-negative TBL. The aim of this study was to compare the recurrence rates between definitive anti-tuberculosis therapy, based on DST and standard anti-tuberculosis therapy in culture-negative TBL. A multicenter retrospective cohort study was performed from 2011 to 2015 in South Korea. The study population was divided into two groups according to treatment type. A total of 234 patients with TBL were analyzed, who were treated with definitive (84 patients) and standard anti-tuberculosis (150 patients) therapy, respectively. During a 28.0 (24.0–43.0) month follow-up period, nine cases (3.8%) had recurrence of TB after treatment completion. The recurrence rate was not significantly different between the two groups (2/84, 2.4% in definitive anti-tuberculosis therapy group versus 7/150, 4.7% in standard anti-tuberculosis therapy group, p = 0.526). The recurrence in all nine cases was diagnosed as clinical recurrence rather than microbiological recurrence. Therefore, culture-negative TBL can be treated with standard anti-TB medication, although DST is not available but clinically stable after initiation of treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Treatment Outcomes of Definitive versus Standard Anti-Tuberculosis Therapy in Patients with Tuberculous Lymphadenitis

Kim

Park

et al. 2019

JCM

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Paradoxical reaction in peripheral lymph node tuberculosis: a review for its prevalence, clinical characteristics, and possible treatment

Rai,

Kant,

Gupta

2023

Monaldi Arch Chest Dis

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The paradoxical reaction (PR) is a transient worsening following tuberculosis treatment and it is not uncommon in lymph node tuberculosis (LNTB). PR in LNTB maybe wrongly considered as treatment failure or relapse. This review was undertaken to address various aspects of PR associated with lymph node tuberculosis prevalence, underlying mechanism, clinical pattern, predictors, and possible treatment in an immunocompetent individual. A literature review was performed using various databases (PubMed, Scopus, Science Direct, and Google Scholar) to identify relevant articles for review. The prevalence of paradoxical reactions associated with LNTB varies from as low as 13.3% to as high as 35.3% PR may occur during antitubercular treatment or be reported even after completion of treatment called post-therapy PR. An onset of PR may occur within a month of therapy to even 12 months from the initiation of an anti-tubercular drug. Delayed hypersensitivity reaction and reduction in immune suppression is believed to be possible mechanism leading to a paradoxical reaction. PR in LNTB is characterized by either progression of pre-existing nodal enlargement or formation of abscess, sinus formation, or appearance of new nodal enlargement or rarely extra-nodal involvement. PR is a diagnosis of exclusion and may show granuloma, positive AFB smear, or positive GeneXpert but AFB culture is always negative. Younger age, lymph node size of equal to or more than 3 cm, female gender, unilateral lymphadenopathy, and those with positive AFB on initial examination are predictors for PR in peripheral LNTB. The majority of PR in LNTB have a mild course and are generally self-limited.

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Paradoxical reaction (PR) in tuberculous lymphadenitis among HIV-negative patients: retrospective cohort study

Cited by 2 publications

References 4 publications

Clinical Characteristics and Treatment Outcomes of Definitive versus Standard Anti-Tuberculosis Therapy in Patients with Tuberculous Lymphadenitis

Clinical Characteristics and Treatment Outcomes of Definitive versus Standard Anti-Tuberculosis Therapy in Patients with Tuberculous Lymphadenitis

Paradoxical reaction in peripheral lymph node tuberculosis: a review for its prevalence, clinical characteristics, and possible treatment

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