Publication: Incidence of tuberculosis in enlarged neck nodes, our experience
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Date
2009
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
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
Description
Maharjan M1 , Hirachan S1 , Kafle PK2 , Bista M2 , Shrestha S 2 , Toran KC 3, Lakhey M 3
1 Lecturer, 2 Assistant Professor, 3 Associate Professor, Department of ENT, Kathmandu Medical College