Journal Article

Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis

Jose-Mario Fontanilla, Arti Barnes and C. Fordham von Reyn

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 53, issue 6, pages 555-562
Published in print September 2011 | ISSN: 1058-4838
Published online September 2011 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1093/cid/cir454
Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis

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Peripheral tuberculous lymphadenitis accounts for ∼10% of tuberculosis cases in the United States. Epidemiologic characteristics include a 1.4:1 female-to-male ratio, a peak age range of 30–40 years, and dominant foreign birth, especially East Asian. Patients present with a 1–2 month history of painless swelling of a single group of cervical lymph nodes. Definitive diagnosis is by culture or nucleic amplification of Mycobacterium tuberculosis; demonstration of acid fast bacilli and granulomatous inflammation may be helpful. Excisional biopsy has the highest sensitivity at 80%, but fine-needle aspiration is less invasive and may be useful, especially in immunocompromised hosts and in resource-limited settings. Antimycobacterial therapy remains the cornerstone of treatment, but response is slower than with pulmonary tuberculosis; persistent pain and swelling are common, and paradoxical upgrading reactions may occur in 20% of patients. The role of steroids is controversial. Initial excisional biopsy deserves consideration for both optimal diagnosis and management of the otherwise slow response to therapy.

Journal Article.  4254 words. 

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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