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Tuberculous cervical lymphadinitis

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Tuberculous cervical lymphadenitis is caused by Mycobacterium tuberculosis infection of the cervical lymph nodes, usually through the tonsils. Clinically, it presents with fever, cough, and swollen lymph nodes in the neck. Left untreated, the infection can progress from a non-tender cold abscess to a collar stud abscess under the skin that ruptures, forming draining sinus tracts. Diagnosis involves aspiration or biopsy of lesions for staining, culture and cytology. Treatment consists of a 6-9 month course of anti-tuberculosis drugs. Aspiration or incision and drainage may be used for abscesses. Surgery is indicated for drug-resistant cases or persistent sinuses.

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Tuberculous cervical lymphadenitis RAHNA 66
Causative organism : Mycobacterium tuberculosis Site : Juglodigastric lymph nodes ( most common) posterior triangle group of lymph nodes Mode of infection usually through tonsils , occasionally through blood from lungs
Clinical features The patient has the usual general manifestations of tuberculosis: evening pyrexia, cough (maybe from pulmonary tuberculosis),malaise Locally there will be regional lymphadenopathy
Stages
Cold abscess is soft, smooth, nontender, fluctuant, without involvement of the skin. It is not warm. This is a clinical manifestation of underlying caseation Left untreated, as a result of increased pressure, cold abscess ruptures out of the deep fascia to form collar stud abscess which is adherent to the overlying skin. Eventually collar stud abscess bursts open, discharging sinus is formed. It can be multiple, wide open mouth, often undermined, nonmobile with bluish color around the edge. It is usually not indurated.
Investigations Aspiration of the pus in a cold abscess for cytology (for epithelioid cells),staining (Ziehl-NeelsenAFB) and culture If the mass is still in the early stages of adenitis, excision biopsy should be done. Raised ESR and CRP Mantoux test may be useful; but not very reliable. Chest X-ray to look for pulmonary tuberculosis.
Treatment Drugs Antitubercular drugs has to be started: Rifampicin 450 mg OD , INH 300 mg OD ,Ethambutol 800 mg OD, Pyrazinamide 1500 mg OD. Duration of treatment is usually 6-9 months. Aspiration Zig-zag aspiration of cold abcess by wide bore needle in non dependent area to prevent sinus formation
Incision and drainage If recurs, caseating material should be drained through a nondependent incision. After draining the, wound is closed without placing a drain Surgical removal indicated when 1. no local response to drugs or 2. When sinus persists. It is done by raising skin flaps and removing all caseating material and lymph nodes Excision of the sinus track when sinus develops.
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Differential Diagnosis 1. Nonspecific lymphadenitis. 2. Lymphomas, and chronic lymphatic leukaemia. 3. Secondaries in the neck. 4. Branchial cyst mimics cold abscess. 5. Lymph cyst mimics cold abscess. 6. HIV with lymph node involvement. 7. When there is discharging sinusactinomycosis

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Tuberculous cervical lymphadinitis

  • 2. Causative organism : Mycobacterium tuberculosis Site : Juglodigastric lymph nodes ( most common) posterior triangle group of lymph nodes Mode of infection usually through tonsils , occasionally through blood from lungs
  • 3. Clinical features The patient has the usual general manifestations of tuberculosis: evening pyrexia, cough (maybe from pulmonary tuberculosis),malaise Locally there will be regional lymphadenopathy
  • 5. Cold abscess is soft, smooth, nontender, fluctuant, without involvement of the skin. It is not warm. This is a clinical manifestation of underlying caseation Left untreated, as a result of increased pressure, cold abscess ruptures out of the deep fascia to form collar stud abscess which is adherent to the overlying skin. Eventually collar stud abscess bursts open, discharging sinus is formed. It can be multiple, wide open mouth, often undermined, nonmobile with bluish color around the edge. It is usually not indurated.
  • 6. Investigations Aspiration of the pus in a cold abscess for cytology (for epithelioid cells),staining (Ziehl-NeelsenAFB) and culture If the mass is still in the early stages of adenitis, excision biopsy should be done. Raised ESR and CRP Mantoux test may be useful; but not very reliable. Chest X-ray to look for pulmonary tuberculosis.
  • 7. Treatment Drugs Antitubercular drugs has to be started: Rifampicin 450 mg OD , INH 300 mg OD ,Ethambutol 800 mg OD, Pyrazinamide 1500 mg OD. Duration of treatment is usually 6-9 months. Aspiration Zig-zag aspiration of cold abcess by wide bore needle in non dependent area to prevent sinus formation
  • 8. Incision and drainage If recurs, caseating material should be drained through a nondependent incision. After draining the, wound is closed without placing a drain Surgical removal indicated when 1. no local response to drugs or 2. When sinus persists. It is done by raising skin flaps and removing all caseating material and lymph nodes Excision of the sinus track when sinus develops.
  • 10. Differential Diagnosis 1. Nonspecific lymphadenitis. 2. Lymphomas, and chronic lymphatic leukaemia. 3. Secondaries in the neck. 4. Branchial cyst mimics cold abscess. 5. Lymph cyst mimics cold abscess. 6. HIV with lymph node involvement. 7. When there is discharging sinusactinomycosis