Tuberculous lymphadenitis: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
*Fine needle aspiration: sensitivity and specificity (77 and 93 percent respectively)<ref>Lau SK. Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy. J Laryngol Otol. 1990;104(1):24-7.</ref> | |||
*Excisional biopsy (if FNA is not diagnostic) | |||
**highest diagnostic yield | |||
**Submit specimens for histology, culture, and Nucleic acid amplification testing | |||
**caseating granulomas on histopathology is highly suggestive of TB | |||
* CT can be useful to identify involved lymph nodes for biopsy | |||
*CXR: most do not have evidence of active pulmonary TB in nonendemic contries | |||
*Sputum smear and culture: positive only in approximately 20% of cases<ref>Polesky A. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005;84(6):350-62.</ref> | |||
==Management== | ==Management== | ||
* Medical therapy | |||
**Rifampicin, isoniazid, ethambutol, and pyrazinamide (RIPE therapy) given daily x 2 months | |||
**Followed by rifampicin and isoniazid (given either daily or three times weekly) x 4 months | |||
* Surgical excision may be performed if medical therapy fails | |||
*Do not I&D, can result in permanent sinuses and prolonged drainage | |||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
*[[Lymphadenitis]] | |||
*[[TB]] | |||
==External Links== | ==External Links== | ||
Revision as of 07:25, 5 May 2017
Background
- Most common form of extrapulmonary TB
- Tuberculous lymphadenitis in the cervical region is known as scrofula
- TB causes up to 43% of peripheral lymphadenopathy in the developing world [1]
- Most cases occur in the setting of reactivation of latent infection
- In the US, more common amoung Asian Pacific Islanders and in females
Clinical Features
- Enlarging, painless, red, firm, mass, most commonly in the anterior or posterior cervical chain
- Can be complicated by ulceration, fistula, or abscess formation
- Systemic signs and symptoms are uncommon, except in HIV patients (in whom lymphadenitis is usually generalized)
Differential Diagnosis
- Lymphoma
- Metastatic cancer
- Fungal disease
- Cat-scratch disease
- Sarcoidosis
- Toxoplasmosis
- Reactive adenitis
- Bacterial adenitis
Evaluation
- Fine needle aspiration: sensitivity and specificity (77 and 93 percent respectively)[2]
- Excisional biopsy (if FNA is not diagnostic)
- highest diagnostic yield
- Submit specimens for histology, culture, and Nucleic acid amplification testing
- caseating granulomas on histopathology is highly suggestive of TB
- CT can be useful to identify involved lymph nodes for biopsy
- CXR: most do not have evidence of active pulmonary TB in nonendemic contries
- Sputum smear and culture: positive only in approximately 20% of cases[3]
Management
- Medical therapy
- Rifampicin, isoniazid, ethambutol, and pyrazinamide (RIPE therapy) given daily x 2 months
- Followed by rifampicin and isoniazid (given either daily or three times weekly) x 4 months
- Surgical excision may be performed if medical therapy fails
- Do not I&D, can result in permanent sinuses and prolonged drainage
Disposition
See Also
External Links
References
- ↑ Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg. 1990;77(8):911-2.
- ↑ Lau SK. Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy. J Laryngol Otol. 1990;104(1):24-7.
- ↑ Polesky A. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005;84(6):350-62.