Incidence of tuberculosis in enlarged neck nodes, our experience

Abstract

Objectives: To determine the incidence of tuberculous lymphadenitis in enlarged neck nodes. Materials and methods: Continuous prospective study is carried out in the department of otorhinolaryngology head & neck surgery, Kathmandu Medical College, Kathmandu, during two years, from January 2006 to January 2008. The study included a group of 155 patients with cervical lymphadenopathy. Each patient underwent a detail clinical Ear, Nose and Throat (ENT) examination and a battery of investigations which included Fine Needle Aspiration Cytology (FNAC) of the nodes, Montoux's test, blood Erythrocyte Sedimentation Rate (ESR) and chest X-ray. Those patients with tubercular lymphadenitis were referred to Directly Observed Therapy System (DOTS) clinic for anti-tubercular therapy. Others with reactive lymphadenitis were treated with antibiotic and those with metastatic neck nodes were treated accordingly. Results: Of the 155 cases with enlarged neck nodes, 83 (54%) had tubercular lymphadenitis. Fifty two (33%) cases had reactive lymphadenitis and 17 (11%) cases were diagnosed with metastatic neck nodes. Fine needle aspiration cytology was found to be highly effective in the diagnosis of tubercular lymphadenitis with 94% accuracy. Majority of patients were otherwise healthy adults, aged between 8 - 71 years. No difference was observed between male and female in this study. Posterior triangle (PT) nodes were most commonly affected group of nodes accounting for 35 (42%) cases and preauricular region 1 (1%) case being the least commonly affected site. Fifteen (18%) cases presented with abscess formation. Only 42 (50%) cases had family history of tuberculosis but 8 (9%) patients had previous history of various forms of tuberculosis. Twelve (14%) patients had positive chest X-ray findings suggesting of concurrent pulmonary tuberculosis. All the patients were referred to DOTS clinic and were treated with category (CAT) - III anti tubercular therapy (ATT). Others with concurrent pulmonary tuberculosis were treated with CAT I regime. None of the patients required surgical treatment. Conclusion: There is high incidence of tubercular cervical lymphadenitis in patients with enlarged neck nodes in developing countries like Nepal. Involvement of cervical lymphnodes are the most commonly affected group of nodes. Therefore, it is important that otolaryngologists are aware of tuberculosis in the head and neck region. Key words: Tuberculosis, Lymph node, Fine needle aspiration cytology, Lymphadenitis doi: 10.3126/kumj.v7i1.1766 Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 54-58

Cervical Node Tuberculosis in Adults of an Urban Middle Class Community: Incidence and Management

“…Studies from Saudi Arabia and Nepal had their average age of patients with cervical lymphadenopathy between 36 and 39 years which was similar to ours [15,16]. in our study malignant etiology group have their peak incidences between 55 and 65 years.…”

“…In a recent study done in Saudi Arabia by Tawfiq et al showed reactive lymph nodes to be commonest (52 %) followed by malignancy (32 %) followed by granulomatous disease (15.5 %) [15]. Studies done in Nepal showed the commonest cause for cervical node was TB, followed by reactive lymphadenitis and then malignancy [16]. In a study done in Mexico TB was seen in 48 % of individuals having cervical lymphadenopathy [18].…”

Cervical lymphadenopathy: a clinicopathological study

“…Submandibular lymph node group involved in 33.91%. [10][11][12][13] In the present study, Neck swelling was present in all cases (100%). Fever was the second most common symptom in 60%, followed by loss of weight in 46.96 %, malaise in 36.52%, loss of appetite in 23.48%, cough in 18.26%, difficulty in swallowing in 6.96%, and change in voice was present in 6.96% respectively.…”

“…Other causes were unknown primary in 1.74% and non-Hodgkin's lymphoma in 0.87% of cases. 3,7,8,12,15,16 Age distribution according to aetiology showed that nonmalignant cervical lymphadenopathy was common in age less than 40 years, while malignant cervical lymphadenopathy was common after 40 years of age. This difference was not significant statistically.…”

Prevalence and pattern of neck masses in pediatric patient: in Aseer Central Hospital, KSA

“…The broad spectrum of etiology of neck masses that ranged from congenital benign to acquired neoplastic lesions is varied and related to multiple factors. [3][4][5] The demographic characteristics of children presented with neck masses varied with the location and residency of patients. 5,6 Clinical and radiographic evidences are enough to establish accurate diagnoses in pediatric neck masses except in cases of nonspecific clinical conditions as in inflammatory lymphadenopathy or malignancies in which open biopsy is required.…”