Br. J. Surg. 1990, Vol. 77. August, 911-91 2

M. C. Dandapat, B. M. Mishra, S. P. Dash and P. K. Kar Department of Surgery, M.K.C.G. Medical College, Berhampur ( G M ) , Orissa, India Correspondence to: Professor M. C. Dandapat

Peripheral lymph node tuberculosis: a review of 80 cases One hundred and ninety-two patients with peripheral lymphadenopathy were screened and 80 patients with tubercular lymphadenitis were studied. Their ages ranged from I to 65 years; most were younger than 30 years and there was a slight female preponderance (1.2:l). Seventy per cent of patients were of low socioeconomic status. Of the 80 patients, 56 had affected cervical nodes, seven had inguinal nodes, Jive had axillary nodes and I2 had multiple sites of lymph node involvement. All had enlarged nodes which were matted in 44 cases and discrete in 18 cases, while the rest had either an abscess or a discharging sinus. Fifty-nine cases (74 per cent) showed a positive Mantoux test and four cases (5 per cent) had associated pulmonary tuberculosis. Fine needle aspiration cytology gave a positive diagnosis in 66 cases (83 per cent). Fifty-two cases showed a positive culture for Mycobacterium tuberculosis of human type in Lowenstein-Jensen medium. Short-term chemotherapy ( 9 months) consisting of rifampicin, isoniazid and ethambutol gave an excellent result. Surgery was not required in any of the cases. Keywords: Tubercular lymphadenitis, Mantoux test, fine needle aspiration cytology, antitubercular chemotherapy

Tuberculosis is widely prevalent in all age groups and in most countries of Asia and Africa. It ranks high as one of the killers of children in our region of India and causes a major public health problem with enormous sociological and economic implications. The diagnosis and management of peripheral lymph node tuberculosis remains a major problem in such areas owing to illiteracy, ignorance and lack of awareness of the complications of the disease. The lack of facilities for investigation and adequate medical treatment, coupled with the poor economic condition of the people, plays a major role in the late presentation of patients with complications. The present study was carried out to determine the incidence of peripheral lymph node tuberculosis in our area, its clinical presentation and pathological aspects, and to assess the value of short-term chemotherapy.

Patients and methods The present study involved 80 patients with peripheral lymph node tuberculosis from various parts of Orissa who attended the surgical, paediatric, medicine, and chest and tuberculosis departments of M.K.C.G. Medical College Hospital, Berhampur, Orissa from January 1987 to July 1988. They were drawn from a total of 192 patients presenting with peripheral lymphadenopathy over this period. For the purpose of this study peripheral lymph nodes were taken to include the cervical, axillary and inguinal groups of nodes. Other sites such as epitrochlear,popliteal and scaleni nodes were excluded because lesions at these sites are extremely rare. After a detailed history and clinical examination, investigations performed included the erythrocyte sedimentation rate (ESR), haemaglobin concentration, Mantoux test (positive result > 10 mm in diameter),sputum examination for acid-fast bacilli, chest radiography, biopsy of enlarged node and culture in Lowenstein-Jensen medium. After confirmation of the diagnosis all patients were given

short-term chemotherapy consisting of ethambutol plus isoniazid plus rifampicin for 2 months followed by isoniazid plus rifampicin for 7 months. All the drugs were taken orally in a single dose, preferably on an empty stomach. Dosage was determined by the patient's weight (Table I ) . Patients were followed at 3-monthly intervals for 9 months and progress was assessed by local and general examination and determination of the ESR and haemoglobin concentration.

Results Tuberculosis was the commonest cause of peripheral lymphadenopathy, accounting for 43 per cent of such cases in our practice. The total number of patients with peripheral lymph node tuberculosis was 83, of which 80cases were included in the present study as three patients did not return for follow-up. Other causes of lymphadenopathy were chronic non-specific lymphadenitis (n= 58), lymphoma (n= 22), metastatic lesions ( n = 19) and leukaemia ( n = 10). The commonest age group involved by tubercular lymphadenitis in this study was 21-30 years (30 per cent) followed by 11-20 years (27 per cent); the male:female ratio was 1:1.2. Fifty-eight patients (73 per cent) were of low socioeconomic status whereas 23 and 8 per cent of patients respectively were from middle and high economic groups. The cervical lymph nodes were most frequently involved by tuberculosis, followed by the inguinal and axillary nodes (Table 2); 55 per cent of the cases presented with the typical features of matting and fixity of the nodes to the surrounding structures while the nodes were discrete in 18 cases. Abscess formation and discharging sinuses were noted in 15 and 13 per cent of cases respectively. The majority of the cases (78 per cent) presented within 4 months of onset of illness. Besides lymph node enlargement in all patients, weight loss was noted

Table 1 Dosages used for antituberculous chemotherapy

Dosage Drug Rifampicin Isoniazid Ethambutol

0007-1323/90/08091l-02

Adults

Peripheral lymph node tuberculosis: a review of 80 cases.

One hundred and ninety-two patients with peripheral lymphadenopathy were screened and 80 patients with tubercular lymphadenitis were studied. Their ag...
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