Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management
B C Jhaa, A Dassa, N M Nagarkara, R Guptab, S Singhala
a Government Medical
College Hospital, Chandigarh, India: Department of Ear, Nose and Throat, b Department of Chest Diseases and Tuberculosis
Correspondence to: Dr Arjun Dass, Department of ENT, Government Medical College Hospital, Chandigarh, India 160047 arjundr{at}usa.net
Submitted 7 January
2000;
Accepted 1 August 2000
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.
Keywords: cervical lymphadenitis; tuberculosis; antitubercular chemotherapy
© 2001 by The Fellowship of Postgraduate Medicine
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