Tuberculosis - I.T. Piatnochka 2005

Extrapulmonary Tuberculosis
Peripheral Lymph Node Tuberculosis

Peripheral Lymph node tuberculosis is predominantly a manifestation of Primary tuberculosis, though it can also result from exogenous superinfection, which is more typical in adults. The causative agent is most commonly Mycobacterium bovis. The entry portal may be the mucosa of the Oral Cavity, oropharynx, or Tonsils. Cervical and submandibular nodes are most frequently affected, while axillary, cubital, and inguinal nodes are involved less often.

Pathomorphologically, three forms of lymphadenitis are distinguished: infiltrative, caseous, and indurative. In the infiltrative form, lymphoid tissue hyperplasia predominates in the affected nodes. The caseous form is more severe, often involving multiple lymph node groups with massive caseous necrosis, and is frequently complicated by suppuration leading to fistula and ulcer formation. The indurative or fibrous form of lymphadenitis has a milder clinical course, albeit a more prolonged one. This form represents the outcome of a protracted caseous—and less frequently infiltrative—process running an unfavorable course.

Clinical Features. The onset of the disease is usually insidious, though it can occasionally be acute with pronounced symptoms of intoxication. The clinical course is undulating. The inflammatory process may spread from the Lymph Nodes to the surrounding subcutaneous tissue and Skin. Large, relatively fixed, painful conglomerates are formed, with hyperemic skin overlying them. Without Treatment, these clusters undergo suppuration, fluctuation appears, and a fistula develops through which pus discharges. Subsequently, under METABOLISM/18.html">The Influence of antimycobacterial drugs, the lymph nodes become firmer and decrease in size, while irregular scars form at the site of the fistula; the nodes become indurated, sometimes showing signs of calcification. Blood count alterations depend on the phase and acuteness of the specific process.

Diagnostic indicators of significance include a history of contact with a tuberculosis patient, a history of childhood lymphadenitis, paraspecific reactions, and frequently hyperergic tuberculin skin tests. Elements of tuberculosis granuloma and MBT are found in puncture aspirates or fistula discharges.

Cytology/practical/136.html">Differential Diagnosis OF peripheral lymph node tuberculosis is conducted with non-specific lymphadenitis, lymphogranulomatosis, and both malignant and benign tumors.

Treatment. Peripheral lymph node tuberculosis is treated under dispensary registration categories 1 and 3, depending on the extent of the disease. Treatment must be comprehensive, incorporating isoniazid, rifampicin, pyrazinamide (and streptomycin). Local application of isoniazid and rifampicin solutions, particularly solutisone, is also utilized. Vitamins B₁, B₆, C, and desensitizing agents are prescribed. If conservative treatment proves ineffective, or in cases of caseous-fistulous lymphadenitis, surgical removal of the affected lymph nodes is indicated, followed by antimycobacterial therapy for 3–4 months. The total duration of antimycobacterial therapy for peripheral lymph node tuberculosis is 6–8 months. The main course of treatment is carried out in inpatient, outpatient, and sanatorium settings. Chemoprophylaxis is not administered.