ORIGINAL ARTICLES

TUBERCULOUS CERVICAL ADENITIS☆

Relatively little is known about the prevalence, risk factors, and public health consequences of peripheral lymph node (PLN)–associated pulmonary tuberculosis (PTB).

We developed a 10-year (2010-2019) population-based cohort of PLNTB patients in Canada. We used systematically collected primary source data and expert reader chest radiograph interpretations in a multivariable logistic regression to determine associations between sputum culture positivity and demographic, clinical, and radiographic features. Public health risks were estimated among contacts of PLNTB patients.

There were 306 patients with PLNTB, among whom 283 (92.5%) were 15-64 years of age, 159 (52.0%) were female, and 293 (95.8%) were foreign-born. Respiratory symptoms were present in 21.6%, and abnormal chest radiograph in 23.2%. Sputum culture positivity ranged from 12.9% in patients with no symptoms and normal lung parenchyma to 66.7% in patients with both. Respiratory symptoms, abnormal lung parenchyma, and HIV-coinfection (borderline) were independent predictors of sputum culture positivity (odds ratio [OR] 2.24 [95% confidence interval [CI] 1.15-4.39], P = 0.01, OR 4.78 [95% CI 2.41-9.48], P < 0.001, and OR 2.54 [95% CI 0.99-6.52], P = 0.05), respectively. Among contacts of sputum culture-positive PLNTB patients, one secondary case and 16 new infections were identified.

Isochronous PTB is common in PLNTB patients. Routine screening of PLNTB patients for PTB is strongly recommended.

The chemotherapy of tuberculous lymphadenopthy, the commonest form of extra-pulmonary tuberculosis, is reviewed and a recommendation made for the treatment of this condition in children. Fifteen papers were identified recording the treatment and follow-up of 1133 adults and children with six-month isoniazid and rifampicin based regimens. In 32 (2.8%) cases treatment was recommenced, but in only one case was relapse microbiologically confirmed and in a further four histology was compatible with tuberculosis. Four studies enrolling 484 adults and children, record the follow-up of patients receiving 6–18 months treatment with INH and RMP based regimens; treatment was recommenced in 24 (5%), but in no case was relapse confirmed microbiologically. Five papers describe the treatment and follow-up of 246 adults and children receiving nine-month INH and RMP based regimens and record the recommencement of treatment in 4 (1.6%) cases, but in no case was relapse confirmed microbiologically. Four controlled studies failed to show any advantage for treatment regimens longer than six months. Paradoxical recurrence and worsening of clinical features was common during and following all regimens being recorded in from 3 to20% of patients. Very seldom were these events accompanied by evidence of culture of Mycobacterium tuberculosis to confirm microbiological failure to respond or relapse. Tuberculous lymphadenopathy in children can be safely treated with six months of INH and RMP with PZA given for the first two months and accompanied by EMB in areas with a high prevalence of drug resistance. Every effort should be made to confirm the diagnosis and possible relapses microbiologically.

Three adult patients with tuberculous cervical (submandibular) lymphadenitis were treated in the past year in the Department of Oral and Maxillofacial Surgery, Evangelismos Hospital, University of Athens. None had a history of exposure to tuberculosis. In all, the chest X-rays were clear but the PPD tests were positive. All patients underwent excisional biopsy of grossly involved lymphnodes and histological examination and special stains confirmed the diagnosis. The patients were subsequently treated with triple drug administration. Antituberculosis chemotherapy consisted of isoniazid, rifampin and ethambutol and all are well after a follow-up of 9, 10 and 11 months respectively.

Medical approaches often failed to diagnose tuberculous cervical lymphadenitis conclusively, and this disease remains a diagnostic and therapeutic challenge, because it mimics other pathological processes.

The treatment of choice seems to be surgical excision and long term antituberculosis chemotherapy. Surgery provides a rapid tissue diagnosis, because the histological examination of the excisional biopsy is the most reliable diagnostic test.

Cultures for mycobacteria and histopathological studies were done on 265 consecutive lymph node biopsies. Of these, 128 nodes showed changes consistent with tuberculosis. Mycobacteria were cultured from 101 specimens: 1 was M. scrofulaceum and the remainder M. tuberculosis. It has been found that although tuberculous lymphadenitis is a common cause of lymphadenopathy, ‘atypical’ mycobacterial infection of lymph nodes is rare in South India.

Des cultures á la recherche de mycobacteries et des etudes histopathologiques ont été pratiquées sur 265 biopsies consécutives de ganglion. Parmi ceux ci, 128 montraient des altérations compatibles avec le diagnostic de tuberculose. Des mycobacteries ont été cultivées a partir de 101 échantillons : il s'agissait une fois de M. scrofulaceum et toutes les autres fois de M. tuberculosis. Il a été trouvé que, bien que l'adénite tuberculeuse soit une cause commune d'adénopathie, l'infection des ganglions lymphatiques par des mycobacteries “atypiques” est rare dans les Indes du sud.

Se efectuaron cultivos para micobacterias y estudios histopatológicos en 265 biopsias ganglionares. De ellas, 128 ganglios mostraron alteraciones compatibles con tuberculosis. Se cultivaron micobacterias en 101 especimenes : hubo 1 caso de M. scrofulaceum y el resto fueron M. tuberculosis. Se ha visto que a pesar de que la tuberculosis es una causa frecuente de adenopatia en South India la infection con micobacterias atipicas. es rara.

Von 265 aufeinanderfolgenden Lymphknotenbiopsien wurden Kulturen auf Mykobakterien angelegt, auβerdem erfolgte eine histologische Untersuchung. Letztere ergab in 128 Fallen Veränderungen, die mit der Annahme einer Tuberkulose zu vereinbaren sind. Mykobakterien wurden aus 101 Proben isoliert; einmal handelte es sich um M. scrofulaceum, bei alien übrigen um M. tuberculosis. Obgleich tuberculöse Lymphadenitiden in Indien häufig sind, finden sich Infektionen mit atypischen Mykobakterien selten als Ursache.