Mycobacterial cervical lymphadenitis: Difference between revisions

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Mycobacterial Cervical Lymphadenitis

Mycobacterial cervical lymphadenitis, also known as scrofula, is a condition characterized by the infection and inflammation of the cervical lymph nodes due to mycobacterial species. This condition is most commonly caused by Mycobacterium tuberculosis and non-tuberculous mycobacteria (NTM), such as Mycobacterium avium complex.

Etiology

The primary causative agents of mycobacterial cervical lymphadenitis are mycobacteria, which are a type of bacteria known for their acid-fast properties. The most common mycobacteria involved are:

Mycobacterium tuberculosis: The bacterium responsible for tuberculosis, which can spread to the lymph nodes.
Non-tuberculous mycobacteria (NTM): These include species such as Mycobacterium avium and Mycobacterium intracellulare, which are more commonly associated with scrofula in children.

Pathophysiology

Infection typically occurs when mycobacteria enter the body through the respiratory tract or skin and are transported to the cervical lymph nodes via the lymphatic system. The immune response to the infection leads to the formation of granulomas, which are collections of immune cells that attempt to contain the bacteria. Over time, these granulomas can become necrotic and caseous, leading to the characteristic swelling and inflammation of the lymph nodes.

Clinical Presentation

Patients with mycobacterial cervical lymphadenitis often present with:

Painless swelling of the cervical lymph nodes
Firm, rubbery nodes that may become fluctuant over time
Possible overlying skin changes, such as erythema or ulceration
Systemic symptoms such as fever, night sweats, and weight loss, particularly in cases caused by Mycobacterium tuberculosis

Diagnosis

Diagnosis of mycobacterial cervical lymphadenitis involves a combination of clinical evaluation, imaging, and laboratory tests. Key diagnostic steps include:

Fine needle aspiration or excisional biopsy of the affected lymph node for histopathological examination and culture.
Polymerase chain reaction (PCR) testing to identify mycobacterial DNA.
Imaging studies such as ultrasound or CT scan to assess the extent of lymph node involvement.

Treatment

The treatment of mycobacterial cervical lymphadenitis depends on the causative organism:

For Mycobacterium tuberculosis: A standard anti-tuberculous regimen is used, typically including isoniazid, rifampicin, ethambutol, and pyrazinamide.
For non-tuberculous mycobacteria: Treatment may involve surgical excision of the affected nodes and antibiotics such as clarithromycin or azithromycin.

Prognosis

The prognosis for patients with mycobacterial cervical lymphadenitis is generally good with appropriate treatment. However, untreated or inadequately treated cases can lead to complications such as fistula formation or dissemination of the infection.

Related Pages

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-'''Mycobacterial cervical lymphadenitis''', also known as '''scrofula''' or '''King's Evil''', is a type of [[lymphadenitis]] that involves the cervical lymph nodes. It is primarily caused by infection with ''[[Mycobacterium tuberculosis]]'' or ''[[Mycobacterium scrofulaceum]]''. This condition is characterized by the swelling of the neck lymph nodes due to the infection. It is more common in children and immunocompromised individuals, such as those with [[HIV/AIDS]].
+== Mycobacterial Cervical Lymphadenitis ==
-==Etiology==
+[[File:Scrofula.jpeg|thumb|right|A depiction of scrofula, historically associated with mycobacterial cervical lymphadenitis.]]
-Mycobacterial cervical lymphadenitis is caused by two main types of bacteria: ''Mycobacterium tuberculosis'', the bacterium responsible for [[tuberculosis]], and ''Mycobacterium scrofulaceum'', a non-tuberculous mycobacterium. Infection with ''Mycobacterium avium complex'' (MAC) can also lead to this condition, especially in immunocompromised patients.
-==Symptoms==
+'''Mycobacterial cervical lymphadenitis''', also known as '''scrofula''', is a condition characterized by the infection and inflammation of the cervical lymph nodes due to mycobacterial species. This condition is most commonly caused by [[Mycobacterium tuberculosis]] and non-tuberculous mycobacteria (NTM), such as [[Mycobacterium avium complex]].
-The primary symptom of mycobacterial cervical lymphadenitis is the enlargement of one or more cervical lymph nodes. These swollen nodes may be painless or tender. Over time, the affected lymph nodes may become fluctuant and may suppurate, leading to the formation of a sinus tract that drains to the skin surface. Other symptoms may include fever, night sweats, weight loss, and general malaise, especially if the infection is due to ''Mycobacterium tuberculosis''.
-==Diagnosis==
+== Etiology ==
-Diagnosis of mycobacterial cervical lymphadenitis involves a combination of clinical examination, imaging studies, and laboratory tests. Imaging studies such as [[ultrasound]] or [[computed tomography]] (CT) scan of the neck can help assess the extent of lymph node involvement. The definitive diagnosis is made by isolating the causative organism from the lymph node material, which can be obtained through fine-needle aspiration or lymph node biopsy. Polymerase chain reaction (PCR) tests and cultures are used to identify the specific mycobacterial species.
-==Treatment==
+The primary causative agents of mycobacterial cervical lymphadenitis are mycobacteria, which are a type of [[bacteria]] known for their acid-fast properties. The most common mycobacteria involved are:
-Treatment depends on the causative organism. For lymphadenitis caused by ''Mycobacterium tuberculosis'', a combination of anti-tuberculosis medications is used, typically for a duration of 6 to 9 months. In cases caused by non-tuberculous mycobacteria, treatment may involve surgical excision of the affected lymph nodes in addition to or instead of antibiotics. The choice of antibiotics and the duration of treatment vary depending on the specific mycobacterial species and the patient's response to therapy.
-==Prevention==
+* [[Mycobacterium tuberculosis]]: The bacterium responsible for [[tuberculosis]], which can spread to the lymph nodes.
-Prevention of mycobacterial cervical lymphadenitis primarily involves measures to prevent tuberculosis, such as vaccination with the [[BCG vaccine]] in countries where tuberculosis is common, and prompt treatment of individuals with active tuberculosis to reduce transmission. For non-tuberculous mycobacterial infections, avoiding exposure to environmental sources of these organisms, such as soil and contaminated water, may reduce risk.
+* Non-tuberculous mycobacteria (NTM): These include species such as [[Mycobacterium avium]] and [[Mycobacterium intracellulare]], which are more commonly associated with scrofula in children.
+== Pathophysiology ==
+Infection typically occurs when mycobacteria enter the body through the respiratory tract or skin and are transported to the cervical lymph nodes via the lymphatic system. The immune response to the infection leads to the formation of granulomas, which are collections of immune cells that attempt to contain the bacteria. Over time, these granulomas can become necrotic and caseous, leading to the characteristic swelling and inflammation of the lymph nodes.
+== Clinical Presentation ==
+Patients with mycobacterial cervical lymphadenitis often present with:
+* Painless swelling of the cervical lymph nodes
+* Firm, rubbery nodes that may become fluctuant over time
+* Possible overlying skin changes, such as erythema or ulceration
+* Systemic symptoms such as fever, night sweats, and weight loss, particularly in cases caused by [[Mycobacterium tuberculosis]]
+== Diagnosis ==
+Diagnosis of mycobacterial cervical lymphadenitis involves a combination of clinical evaluation, imaging, and laboratory tests. Key diagnostic steps include:
+* [[Fine needle aspiration]] or excisional biopsy of the affected lymph node for histopathological examination and culture.
+* [[Polymerase chain reaction]] (PCR) testing to identify mycobacterial DNA.
+* Imaging studies such as [[ultrasound]] or [[CT scan]] to assess the extent of lymph node involvement.
+== Treatment ==
+The treatment of mycobacterial cervical lymphadenitis depends on the causative organism:
+* For [[Mycobacterium tuberculosis]]: A standard anti-tuberculous regimen is used, typically including [[isoniazid]], [[rifampicin]], [[ethambutol]], and [[pyrazinamide]].
+* For non-tuberculous mycobacteria: Treatment may involve surgical excision of the affected nodes and antibiotics such as [[clarithromycin]] or [[azithromycin]].
+== Prognosis ==
+The prognosis for patients with mycobacterial cervical lymphadenitis is generally good with appropriate treatment. However, untreated or inadequately treated cases can lead to complications such as fistula formation or dissemination of the infection.
+== Related Pages ==
-==See Also==
 * [[Tuberculosis]]
-* [[Lymphadenitis]]
+* [[Lymphadenopathy]]
-* [[Mycobacterium tuberculosis]]
+* [[Non-tuberculous mycobacteria]]
-* [[Mycobacterium scrofulaceum]]
-* [[HIV/AIDS]]
+{{Infectious diseases}}
 [[Category:Infectious diseases]]
-[[Category:Mycobacterial diseases]]
+[[Category:Bacterial diseases]]
-[[Category:Diseases of the lymphatic system]]
+[[Category:Lymphatic system disorders]]
-{{Medicine-stub}}