Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management

Postgraduate Medical Journal - Tập 77 Số 905 - Trang 185-187 - 2001
Bhal Chandra Jha1,2, Arjun Dass1,2, Nitin M. Nagarkar1,2, Rashmi Gupta3, Surinder K Singhal1,2
1Department of Ear, Nose and Throat
2Government Medical College Hospital, Chandigarh, India
3Department of Chest Diseases and Tuberculosis

Tóm tắt

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 affected 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 affected 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 efficacy of six months short course chemotherapy.

Từ khóa


Tài liệu tham khảo

Canova, 1995, Problems in the diagnosis and therapy of lymph node tuberculosis in HIV-negative patients., Schweiz Med Wochenschr (Journal Suisse de Medicine), 125, 2511

Mukherjee, 1995, Tuberculosis control programme in India: progress and prospects., Indian Journal of Tuberculosis, 42, 75

Dandapat, 1990, Peripheral lymph node tuberculosis: a review of 80 cases., Br J Surg, 77, 911, 10.1002/bjs.1800770823

Kent, 1967, Tuberculous lymphadenitis: not a localised disease process., Am J Med Sci, 254, 866, 10.1097/00000441-196712000-00016

Challapalli, 1995, Tuberculous inguinal lymphadenitis., Pediatr Infect Dis J, 14, 723, 10.1097/00006454-199508000-00021

Subrahmanyam, 1993, Role of surgery and chemotherapy for peripheral lymph node tuberculosis., Br J Surg, 80, 1547, 10.1002/bjs.1800801218

Alvarez, 1984, Extrapulmonary tuberculosis revisited: a review of experience at Boston city and other hospitals., Medicine, 63, 25, 10.1097/00005792-198401000-00003

Monie, 1982, Management of extrapulmonary tuberculosis (excluding miliary and meningeal) in South and West Wales (1976–8)., BMJ, 285, 415, 10.1136/bmj.285.6339.415

Patel, 1987, Short term chemotherapy in tuberculous lymphadenitis., Indian Journal Surgery, 49, 336

Desa, 1981, Text book of tuberculosis., 476

Cheung, 1988, Tuberculous cervical abscess comparing the result of total excision against simple incision and drainage., Br J Surg, 75, 563, 10.1002/bjs.1800750620

Kheiry, 1992, Cervical lymphadenopathy in Khartoum., Journal of Tropical Medicine & Hygiene, 95, 416

Humphries, 1994, Clinical tuberculosis., 93

Lau, 1990, Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy., J Laryngol Otol, 104, 24, 10.1017/S0022215100111697

Shaha, 1986, Fine needle aspiration cytology in diagnosis of cervical lymphadenopathy., Am J Surg, 152, 420, 10.1016/0002-9610(86)90316-8

Lau, 1991, Combined use of fine-needle aspiration cytologic examination and tuberculin skin test in the diagnosis of cervical tuberculous lymphadenitis: a prospective study., Arch Otolaryngol Head Neck Surg, 117, 87, 10.1001/archotol.1991.01870130093023

Rajwanshi, 1987, Fine needle aspiration cytology in diagnosis of tuberculosis., Diagn Cytopathol, 3, 13, 10.1002/dc.2840030104

Dowd, 1905, The surgical treatment of tubercular cervical lymph nodes., Ann Surg, 42, 49, 10.1097/00000658-190507000-00004

Byrd, 1971, The role of surgery in tuberculous lymphadenitis in adults., Am Rev Respir Dis, 103, 816

Cambell, 1993, Six month versus nine months chemotherapy for tuberculosis of lymph nodes: final result., Respir Med, 87, 621, 10.1016/S0954-6111(05)80265-3

Yuen, 1997, Prospective randomized study of thrice weekly six-month and nine-month chemotherapy for cervical tuberculous lymphadenopathy., Otolaryngol Head Neck Surg, 116, 189

Thông tin
Thông tin xuất bản

Postgraduate Medical Journal

Tập 77 Số 905

185-187

Thông tin tác giả