Pattern and predictors of paradoxical response in patients with peripheral lymph node tuberculosis

Area of Science:

• Infectious Diseases
• Immunology
• Public Health

Background:

• Peripheral lymph node tuberculosis (TB) can manifest paradoxical responses (PR) during treatment, including new or enlarged lymph nodes and worsening disease.
• The underlying predictors for PR in selective patients remain unclear, necessitating further investigation.

Purpose of the Study:

• To evaluate the pattern and identify predictors of paradoxical responses (PR) in patients with peripheral lymph node tuberculosis (TB).

Main Methods:

• A study included 110 patients over 6 years old with peripheral lymphadenopathy of tubercular etiology.
• Paradoxical response was defined as worsening of pre-existing disease or new lesions after at least 2 weeks of anti-TB therapy.

Main Results:

• Paradoxical response (PR) occurred in 25% of patients, with a mean onset of 6 weeks after starting anti-TB medication.
• PR was more frequent in younger patients, females, those with unilateral lymphadenopathy, and those with positive acid-fast bacilli (AFB) on initial examination (p<0.01).
• Common presentations of PR included enlarged lymph nodes (79%), new nodes (29%), and discharging sinuses (7%).

Conclusions:

• Paradoxical response in peripheral lymph node TB is associated with younger age, female gender, unilateral lymphadenopathy, and positive AFB smears at diagnosis.
• These findings can aid in identifying patients at higher risk for PR and tailoring management strategies.