Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-23T15:46:50.912Z Has data issue: false hasContentIssue false
  • English
  • Français

Cervical lymphadenopathy: scrofula revisited

Published online by Cambridge University Press:  10 October 2008

R Khan ,
S H Harris ,
A K Verma  and
A Syed
R Khan
Affiliation:
Department of Pathology, J N Medical College, Aligarh Muslim University, Uttar Pradesh, India
S H Harris*
Affiliation:
Department of Surgery, J N Medical College, Aligarh Muslim University, Uttar Pradesh, India
A K Verma
Affiliation:
Department of Surgery, J N Medical College, Aligarh Muslim University, Uttar Pradesh, India
A Syed
Affiliation:
Department of Radiodiagnosis, J N Medical College, Aligarh Muslim University, Uttar Pradesh, India
*
Address for correspondence: Dr S Hasan Harris, Hafeez Manzil, Marris Road, Aligarh, Uttar Pradesh, India202001. Fax: 0571 2721127 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The commonest form of extrapulmonary tuberculosis is tubercular cervical lymphadenitis, or scrofula.

Methods and results:

A total of 1827 patients with cervical lymphadenopathy who presented to various out-patients clinics of our institution were studied over a three-year period. Eight hundred and ninety-three (48.87 per cent) of these patients had lesions of tubercular origin. The most common observation was unilateral, matted adenopathy in female patients aged between 11 and 20 years and without constitutional symptoms of tuberculosis. Posterior triangle nodes were affected in 43.8 per cent of cases, followed by upper deep cervical nodes in 33.9 per cent. Fine needle aspiration cytology constituted the main diagnostic tool, with a positive yield in 90 per cent of patients. Polymerase chain reaction analysis was performed in 126 patients, with a sensitivity of 63 per cent. Only 18 per cent of patients had associated pulmonary tuberculosis, the rest having isolated involvement of cervical nodes. Medical treatment with anti-tubercular drugs for a period of six months formed the mainstay of treatment and cure. Surgical management was reserved for selected refractory patients.

Conclusion:

Tubercular cervical lymphadenitis can readily be diagnosed by fine needle aspiration cytology, a simple and cost-effective test. The disease can be cured completely by a short course of anti-tubercular chemotherapy, without surgical intervention.

Keywords

TuberculosisNeckLymph Node
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 7 , July 2009 , pp. 764 - 767
Copyright
Copyright © JLO (1984) Limited 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Shimao, T. Tuberculosis and its control – lessons from the past and future prospect [in Japanese]. Kekkaku 2005;80:481–9Google ScholarPubMed
2 Okada, M, Kobayashi, K. Recent progress in mycobacteriology [in Japanese]. Kekkaku 2007;82:783–99Google ScholarPubMed
3 Barnett, K, Medzon, R. Scrofula as a presentation of tuberculosis and HIV. CJEM 2007;9:176–9CrossRefGoogle ScholarPubMed
4 Fanlo, P, Tiberio, G. Extrapulmonary tuberculosis. An Sist Sanit Navar 2007;2:143–62Google Scholar
5 Golden, MP, Vikram, HR. Extrapulmonary tuberculosis: an overview. Am Fam Physician 2005;72:1761–8Google ScholarPubMed
6 Mukerjee, AK. Tuberculosis control programme in India: progress and prospects. Indian Journal of Tuberculosis 1995;42:75–85Google Scholar
7 Choudhury, N, Bruch, G, Kothari, P, Rao, G, Simo, R. 4 year's experience of head and neck tuberculosis in a south London hospital. J R Soc Med 2005;98:267– 9Google Scholar
8 Jha, BC, Dass, A, Nagarkar, NM, Gupta, R, Singhal, S. Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management. Postgrad J Med 2001;77:185–7CrossRefGoogle ScholarPubMed
9 Narang, P, Narang, R, Narang, R, Mendiratta, DK, Sharma, SM, Tyagi, NK. Prevalence of tuberculous lymphadenitis in children in Wardha district, Maharashtra State, India. Int J Tuberc Lung Dis 2005;9:188–94Google ScholarPubMed
10 Hussain, M, Rizvi, N. Clinical and morphological evaluation of tuberculous peripheral lymphadenopathy. J Coll Physicians Surg Pak 2003;13:694–6Google ScholarPubMed
11 Humphries, MJ, Lam, WK, Teoh, R. Non-respiratory tuberculosis. In: Davies, , ed. Clinical Tuberculosis. London: Chapman & Hall Medical, 1994;93–125Google Scholar
12 Lau, SK, Wei, WI, Hsu, C, Engzell, UC. Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy. J Laryngol Otol 1990;104:24–7CrossRefGoogle ScholarPubMed
13 Nemish, ZA, Mah, MW, Mahmood, SA, Bannatyne, RM, Khan, MY. Clinico-diagnostic experience with tuberculous lymphadenitis in Saudi Arabia. Clin Microbiol Infect 2000;6:137–41Google Scholar
14 Chao, SS, Loh, KS, Tan, KK, Chong, SM. Tuberculous and nontuberculous cervical lymphadenitis: a clinical review. Otolaryngol Head Neck Surg 2002;126:176–9CrossRefGoogle ScholarPubMed
15 Osores, F, Nolasco, O, Verdonck, K, Arévalo, J, Ferrufino, JC, Agapito, J et al. Clinical evaluation of a 16S ribosomal RNA polymerase chain reaction test for the diagnosis of lymph node tuberculosis. Clin Infect Dis 2006;43:855–9CrossRefGoogle ScholarPubMed
16 Ueda, T, Murayama, T, Hasegawa, Y, Bando, K. Tuberculous lymphadenitis: a clinical study of 23 cases [in Japanese]. Kekkaku 2004;79:349–54Google ScholarPubMed
17 Kim, SS, Chung, SM, Kim, JN, Lee, MA, Ha, EH. Application of PCR from the fine needle aspirates for the diagnosis of cervical tuberculous lymphadenitis. J Korean Med Sci 1996;11:127–32CrossRefGoogle ScholarPubMed
18 Singh, UB, Seth, P. PCR diagnosis of tuberculosis – experience in India. Indian J Pediatr 2002;69:20–4Google ScholarPubMed
19 Sharafeldin, GS, Khalil, EA, El Hag, IA, Elsiddig, KE, Elsafi, ME, Aijafari, AS et al. Haematogenous dissemination of tuberculous lymphadenitis. East Afr Med J 2007;84:3–7CrossRefGoogle ScholarPubMed
20 Campbell, IA, Ormerod, LP, Friend, JA, Jenkins, PA, Prescott, RJ. Six months versus nine months chemotherapy for tuberculosis of lymph nodes: final results. Respir Med 1993;87:621–3CrossRefGoogle ScholarPubMed
21 Sun, W, Liu, H, Liang, D. Clinical characteristics and management of primary cervical tuberculous lymphadenitis [in Chinese]. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2006;20:552–3Google ScholarPubMed