Tuberculous Lymphadenitis in Manitoba: Incidence, Clinical Characteristics and Treatment

Abstract

BACKGROUND:Tuberculous lymphadenitis (TBL) is an important form of extrapulmonary tuberculosis (TB). Recent studies have shown an increase in TBL in Canada.OBJECTIVES:To determine the incidence of TBL in Manitoba and to identify the characteristics associated with its presentation, diagnosis and treatment.METHODS:Population data from the Manitoba Health Population Registry, the First Nations and Inuit Health Branch of Health Canada, and Statistics Canada were used to calculate incidence. Case characteristics and outcomes were determined by a systematic, retrospective review of all cases between January 1, 1990 and December 31, 2000.RESULTS:One-hundred forty seven cases of TBL were identified during the study period; 77% confirmed by culture; 68% women. TBL was found in Canadian-born/nonstatus Aboriginal (12%), status Aboriginal (29%) and foreign-born (59%) populations. Incidence of TBL was 1.17 per 100,000 person years (95% CI 0.98 to 1.36). The highest incidence was in status Aboriginals over 65 years (16.85 per 100,000 person years; 95% CI 3.37 to 30.33). TBL is seen most often in Western Pacific women. The most common presentation was a single, enlarged cervical node (80%). No atypical mycobacterium was found. Drug resistance occurred in 13% of cases and only in the foreign-born. Cure rates (81%) were influenced by comorbidity and burden of TB disease. Relapse occurred in 8.1 per 1000 person years of follow-up (95% CI 1.7 to 23.7).CONCLUSIONS:Respiratory physicians, who manage the majority of TB disease in Canada, need to remain aware that TB is an important and treatable cause of enlarged lymph nodes.

Molecular analysis of Mycobacterium isolates from extrapulmonary specimens obtained from patients in Mexico

“…In paraffin-embedded tissues, M. tuberculosis complex and M. genus were found in 5 and 3 lymph nodes, respectively. The predominant M. tuberculosis complex infection in lymph nodes found in our patients is consistent with results in patients with lymphadenitis reported by other researchers [ 4 , 15 , 16 ]. With respect to other tissues, M. genus was found in specimens of brain and vagina.…”

Diagnosis of tuberculous lymphadenitis using fine needle aspiration biopsy

“…This study evaluated tuberculous lymphadenitis diagnosis in a population representative of recent migration demographics in Australia. The preponderance of females (64%) with mostly cervical or supraclavicular nodes (75%) is typical of most settings 4–8,10,18–21 . The 6.7% known seroprevalence of human immunodeficiency virus (HIV) is lower than seen elsewhere 16 .…”

Acute tuberculous abscess of the thyroid gland: Figure 1

“…So the UK and WHO recommendation for tuberculous lymphadenitis is 2 months of INH, R, Z and E followed by 4 months of INH and R 9 10…”

“…The US recommendation is 2 months of INH, R, Z and E followed by 7 months of INH and R 9 10. A Drug Susceptibility Testing should always be performed.…”