Tuberculosis Study Guide - M.M. Savula 2002

Extrapulmonary tuberculosis
Tuberculosis of mesenteric lymph nodes (mesadenitis)

Tuberculosis of the mesenteric Lymph Nodes is most commonly diagnosed in children or adolescents, although it is generally rare.

Pathogenesis. Mesenteric lymphadenitis is predominantly the result of primary infection, although it can also develop in secondary forms of tuberculosis due to the lymphogenous spread of infection. It is believed that the alimentary route of infection via contaminated food products, often with Mycobacterium bovis, plays a significant role in The Development of this specific lymphadenitis localization during Primary tuberculosis.

There are infiltrative (lymphoid tissue hyperplasia with sparse tuberculous granulations) and caseous (near-total caseation of the lymph node) phases of mesenteric lymph node tuberculosis. From the mesenteric lymph nodes, the process can spread to the Peritoneum, intestines, and pelvic Organs.

Clinical Features. Tuberculosis of the mesenteric lymph nodes begins gradually and runs a chronic course. Patients occasionally complain of a dull, poorly localized abdominal pain, sometimes cramping in nature, which is exacerbated after meals, physical exertion, during menstruation, and upon abdominal Palpation. Sometimes the pain is localized in the periumbilical or right iliac region. Periodic nausea, vomiting, bloating, and bowel disturbances occur. Mild signs of systemic toxicity are noted, such as low-grade fever, sweating, weakness, poor appetite, and weight loss (with diarrhea alternating with constipation). The disease can mimic appendicitis, cholecystitis, pancreatitis, or PEPTIC ULCER DISEASE. Rarely, in cases of significant enlargement of the mesenteric lymph nodes, they can be palpated as discrete, poorly mobile nodes or conglomerates. Palpation reveals tenderness in the right iliac region and on the left at the level of the II lumbar vertebra, 2-3 cm lateral to the midline of the abdomen. If the process is complicated by exudative Peritonitis, dullness can sometimes be detected on Percussion, especially with the patient in the lateral decubitus position. Tuberculous mesadenitis has a fluctuating course with periods of exacerbation and remission. It can be associated with Other forms of tuberculosis. During exacerbations, the complete Blood count reveals decreased Hemoglobin, mild leukocytosis, lymphocytosis, and an elevated ESR. Tuberculin Skin tests are positive. In complex cases, a provocative subcutaneous Koch test is performed. An increase in clinical symptoms after tuberculin administration (increased pain, elevated body Temperature) confirms the Diagnosis of tuberculous mesadenitis.

With a prolonged course of the disease, a plain abdominal radiograph may sometimes reveal multiple, partially calcified lymph node opacities on the right along the lumbar spine or in the pelvis. More reliable Methods for detecting enlarged lymph nodes include Ultrasonography, computed tomography, and laparoscopy with lymph node biopsy.

Treatment. Treatment consists of prescribing prolonged antituberculous Chemotherapy and Vitamins. In rare cases, if therapy is ineffective, the affected lymph nodes are surgically removed.