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Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management
B C Jha1, A Dass, N M Nagarkar
1Government Medical College Hospital, Chandigarh, India.
Insights
Tuberculosis caused most cervical lymph node enlargements in this Indian study. Six-month chemotherapy was effective, with fine needle aspiration cytology aiding diagnosis.
Area of Science:
- Otorhinolaryngology
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) remains a significant global health issue.
- Cervical lymphadenitis is a common presentation of extrapulmonary TB.
- Understanding the clinical patterns of TB cervical lymphadenitis is crucial for timely diagnosis and management.
Purpose of the Study:
- To describe the clinical characteristics of patients with cervical lymphadenitis presenting to an ENT outpatient department.
- To evaluate the diagnostic utility of fine needle aspiration cytology (FNAC) in suspected cases.
- To assess the efficacy of short-course chemotherapy for TB cervical lymphadenitis.
Main Methods:
- A retrospective study of 94 patients with cervical lymphadenitis from June 1997 to May 1998.
- Clinical data, including age, symptoms, lymph node characteristics, and diagnostic test results, were recorded.
- Treatment involved six-month short-course chemotherapy, with surgical intervention reserved for specific cases.
Main Results:
- Tuberculosis accounted for 60% of cervical lymph node enlargements.
- The most affected age group was 11-20 years; constitutional symptoms were infrequent.
- FNAC achieved a high diagnostic yield (52/56 patients), while chest radiography showed lesions in 16%.
Conclusions:
- The classical presentation of 'scrofula' is less common, possibly due to earlier disease presentation.
- FNAC is a valuable diagnostic tool for TB cervical lymphadenitis.
- Six-month short-course chemotherapy is highly effective, with minimal recurrence observed.
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.