Tuberculosis of the cervical lymph nodes : a clinical, pathological and bacteriological study

Biopsies taken from the lymph nodes of 59 consecutive patients with cervical lymph node tuberculosis were examined bacteriologically and histologically. The series consisted of 18 men (mean age 40 years) and 41 women (mean age 46 years). Mycobacteria were isolated from 41 specimens (69 per cent), M. tuberculosis from 40 patients and a mycobacterium of the M. avium-M. intracellulare complex from one. All the M. tuberculosis strains were sensitive to streptomycin, isoniazid and PAS. No mycobacteria were isolated from the biopsy specimens of the 10 patients who had received anti-tuberculosis drug previously. Mycobacteria were isolated equally often from caseating and non-caseating lymph nodes. In 10 specimens acid-fast bacilli could be demonstrated by staining, but attempts at isolation were unsuccessful. Nine of these 10 patients had been treated with anti-tuberculosis drugs previously. Histological examination of the specimen from which a growth of 'atypical' mycobacteria had been obtained failed to show any distinctive features. The results of treatment are given over a follow-up period of 2 years. Primary chemotherapy was not entirely successful. Of 52 patients treated in this way only 38 responded well. By contrast 19 patients were treated by a combination of chemotherapy and surgery and the outcome was satisfactory in all but one.