Tuberculosis (TB) affecting the lymph nodes remain the most common extra pulmonary involvement by Mycobacterium Tuberculosis (MTB). In United States, over the last 35 years, the proportion of Tuberculous lymphatic disease has risen substantially, whereas reductions have been most pronounced in other forms of extra pulmonary TB. The aim of our study is to identify characteristics associated with its presentation, diagnosis and treatment.
Retrospective review of 50 cases of TB lymphadenitis seen between 1992 to 2005 in a community hospital. Diagnosis of TB lymphadenitis was proven by lymph node biopsy based on the histology and/or growth of MTB on culture.
The following results obtained.
Foreign born particularly immigrants from Indian subcontinent constituted the predominant patient subgroups with TB lymphadenitis. Cervical lymphadenopathy constituted predominant lymph node group involved. PPD was positive in only 60%, while only 8% had sputum growing MTB. 72% of patients had positive lymph node culture for MTB and in others pathology showing caseating granulomas was needed to establish diagnosis. 6 months of treatment was adequate in most of the patients. Major reasons for prolonged duration were adverse reactions and non compliance. 8% of paradoxical reaction seen was similar to that described with TB involving other systems.
In patients with subacute to chronic lymphadenitis especially from Indian subcontinent, TB should be strongly considered even if PPD is negative and sputum is negative for MTB. Lymph node pathology showing caseating granuloma establishes the diagnosis even if culture is negative.
VariableValue (%)Median age39 yearsMale: Female1:1Demography32 (64%)Indian subcontinent8 (16%)US born10 (20%)OthersPPD positive30 (60%)HIV positive7 (14%)Sputum culture + for MTB4 (8%)Lymph node Culture & Sensitivity36 (72%)Culture + for MTB35 (70%)Pansensitive1 (2%)Multi drug resistant TBDuration of treatment35 (70%)6 months6 (12%)9 months4 (8%)12 months3 (6%)18 months2 (4%)24 months*Adverse reactions11 (22%)Abnormal Liver function tests4 (4%)Skin rash4 (8%)Paradoxical reactionReasons for prolonged treatment6 (12%)Adverse reactions6 (12%)Non compliance2 (4%)Relapse1 (2%)Drug resistance*
One patient with multi drug resistance and another patient with relapse received 24 months of treatment
Tapan Gayen, None.