Search

Tuberculosis is a common occurrence in developing countries. Drug resistance, co-morbidities, and limited availability of new rapid tests such as the GeneXpert/MTB Rif assay make diagnosis and treatment of extrapulmonary tuberculosis burdensome. A cross-sectional study was carried out at Employees' State Insurance Corporation Medical College and Hospital, Faridabad, Haryana of patients treated for tubercular cervical lymphadenopathy from December 2021 to March 2023 in the department of ENT. This study included 58 patients. The clinicopathological profile of patients and the outcome of treatment with antitubercular therapy were noted. The majority of patients had level V (39.6%) involvement. Incidental diagnosis of diabetes mellitus was seen in 2 cases (3.4%). Fever was the commonest constitutional symptom observed in 27.5% of cases. FNAC was suggestive of tubercular abscess in 48.2% and the GeneXpert MTB/RIF assay detected Mycobacterial tuberculosis in all the cases with rifampicin resistance in only one case. 56 cases (96.5%) had complete resolution after completion of antitubercular therapy including patients with rifampicin resistance and patients with diabetes mellitus. In the remaining two cases, treatment was prolonged for a few months before the resolution of the disease was observed. Timely diagnosis, patient compliance to antitubercular therapy, and adequate management of comorbidities lead to successful treatment outcomes in tubercular cervical lymphadenitis. Delayed response to treatment in a few cases needs further research into factors like immune status, nutrition, living conditions, and quality of drugs available to the public. [ABSTRACT FROM AUTHOR]

Suppurative cervical lymphadenitis sometimes resolves with oral antibiotic treatment; however, many children are hospitalized for intravenous treatment due to lack of improvement. When there is no substantial improvement, the possibility of a liquefaction process is considered, and as a result, source control such as needle aspiration or open surgical drainage is recommended. We examined, among pediatric patients hospitalized with suppurative cervical lymphadenitis, clinical and laboratory predictors for invasive intervention that may lead to early imaging and intervention, hasten recovery, and shorten length of hospitalization. We compared laboratory and clinical characteristics of pediatric patients hospitalized with suppurative cervical lymphadenitis during 2010-2017, according to 3 treatments: needle aspiration (N = 54), open surgical drainage (N = 37), and conservative adequate antibiotic treatment only (N = 292). Physical indicators such as local erythema and fluctuation were found as predictors for invasive interventions in hospitalized pediatric patients diagnosed with suppurative cervical lymphadenitis. No significant associations were found between invasive interventions and laboratory parameters assessed in this study. Children who underwent interventions displayed a prolonged average length of hospitalization and received extended antibiotic treatment prior to hospital admission. In hospitalized pediatric patients diagnosed with suppurative cervical lymphadenitis, physical examination findings are the main predictive factors for invasive interventions. Consequently, when such straightforward clinical findings are observed in the context of insufficient improvement during antibiotic treatment, they should prompt consideration of invasive intervention. [ABSTRACT FROM AUTHOR]

Background: Kikuchi–Fujimoto disease (KFD) presents with painful cervical lymphadenopathy, persistent high-grade fever, leukopenia, and deranged liver function tests. KFD usually has a benign course and is self-limiting but may sometimes cause fatal complications such as secondary histiocytic lymphohistiocytosis (HLH). Case report: We report a 13-year-old boy, a known case of thalassemia major on regular blood transfusions with post-splenectomy status and on chelators. He presented with persistent high-grade fever and cervical lymphadenopathy. The initial diagnosis of KFD was confirmed by lymph node biopsy. Given persistent fever, bicytopenia, and high ferritin levels, HLH was considered. Lymph node biopsy confirmed the diagnosis of KFD with secondary HLH. The child had neurological manifestations in the form of convulsions. He recovered with steroids and supportive care. Conclusions: This case report emphasizes that although KFD is benign, complications, including secondary HLH and neurological complications, may occur that need to be recognized and managed.

Purpose: To describe a case of a macular tuberculoma in a young and healthy woman after developing a tuberculous lymphadenitis caused by Mycobacterium bovis. Methods: Retrospective case report. Results: Tuberculous lymphadenitis caused by M. bovis was detected after biopsy and histological examination as well as polymerase chain reaction test testing of cervical lymph nodes in a 20-year-old patient. An interferon gamma was positive. Shortly starting antitubercular therapy, the patient developed visual deterioration caused by a single yellowish subretinal structure in the macula of the right eye. Optical coherence tomography showed a dome-shaped, hyperreflective, subfoveal choroidal lesion with subtle subretinal fluid. Antitubercular therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide was performed, and the deescalation therapy with isoniazid and rifampicin was extended to 7 months. Further examinations showed regression of choroidal tuberculoma to a scar. Conclusion: This is the first reported case of choroidal tuberculoma after tuberculous lymphadenitis caused by M. bovis. [ABSTRACT FROM AUTHOR]

Objective: To analyze the role of Fine Needle Aspiration Cytology (FNAC) in the detection of tubercu- lous cervical lymphadenitis. Methods: A retrospective cross-sectional study was carried out at the Dr. Ruth K. M. Pfau Civil Hospi- tal Karachi’s ENT-Head and neck surgery department, from April 2021 till March 2022. Patients with ages between 30-70 years having cervical lymphadenopathy lasting for more than or equal to 3 months and having 1 or more palpable lymph nodes of more than or equal to 1 cm were included in the study. A questionnaire was designed for data collection from the patients. The names, ages, gen- der of the patients, the duration of disease noted down. The dominating nodes’ FNAC and ultrasound neck were done. Inconclusive FNAC were followed by excisional biopsy. The sample size was taken as 50, with analysis done through SPSS version 23. Results: There were 34 (64%) females and 16 (32%) males present. The patients’ average age was 52.94 ± 9.43 years; 33 patients were below the age of 55, out of which 25 (75.7%) had positive and 8 (24.2%) had negative FNAC. Of the patients over the age of 55, 11 (64.7%) had positive and 6 (54.5%) had negative FNAC. The illness lasted 5.84 ± 2.63 months on average, 2 months being the minimum duration of disease, while maximum duration was 15 months. The duration of less than or equal to six months was observed in 40 (80%) and the duration of more than 6 months was ob- served in 10 (20%) of patients. With a mean size of 2.5 ± 1.14 cm, 29 patients (58%) had unilateral nodes and 21 (42%) had bilateral nodes. FNAC has a sensitivity of 97% and specificity of 72.2%, meaning that it was positive in 36 individuals and negative in 14. Conclusion: FNAC plays a significant role in the diagnosis of tuberculous cervical lymphadenitis.

ABSTRACT Cervical tuberculous lymphadenitis (CTL), the most frequent extrapulmonary form of tuberculosis, is a serious health problem in Tunisia. CTL diagnosis is challenging mainly due to the paucibacillary nature of the disease and the potential misdiagnosis as cervical non-tuberculous lymphadenitis (CNTL). Here, we evaluated the performance of heparin-binding hemagglutinin (HBHA) interferon-gamma (IFN-γ) release assay (IGRA) for the diagnosis of CTL. In addition, we evaluated granzyme B, granulysin, and perforin release assays as CTL biomarkers and assessed their potential contribution to improve HBHA-IGRA performance. Peripheral blood mononuclear cells from CTL-suspected patients were stimulated with HBHA, early secreted antigenic target 6 (ESAT-6), or purified protein derivative (PPD) for 24 h in the presence of IL-7. Cytotoxic mediators and IFN-γ release were assessed by enzyme-linked immunosorbent assay. Receiver operating characteristic curves were used to evaluate the capacity of HBHA, ESAT-6, and PPD to discriminate between CTL (n = 27) and CNTL (n = 21). After applying bivariate and multivariate analyses, IFN-γ responses to HBHA appeared to offer the best distinction between CTL and CNTL, with an area under the curve of 0.9947, associated with 95.24% and 100% sensitivity and specificity, respectively. A principal component analysis showed clear clustering of the CTL versus the CNTL groups. This clustering was mainly attributed to HBHA-induced IFN-γ, PPD-induced granzyme B, and PPD-induced IFN-γ. These results thus suggest that the HBHA-IGRA provides high diagnostic accuracy for CTL versus CNTL, with high sensitivity and specificity. Combining HBHA-induced IFN-γ and PPD-induced granzyme B improves the accuracy to identify CTL. IMPORTANCE Cervical tuberculous lymphadenitis (CTL), the most frequent extrapulmonary form of tuberculosis, is currently a major health problem in Tunisia and in several regions around the world. CTL diagnosis is challenging mainly due to the paucibacillary nature of the disease and the potential misdiagnosis as cervical non-tuberculous lymphadenitis. This study demonstrates the added value of the heparin-binding hemagglutinin-interferon-gamma release assay as an immunoassay in the context of CTL.

Copyright of Pediatrie pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A woman diagnosed with rheumatoid arthritis and treated with Janus kinase (JAK) inhibitors presented with a gradually enlarging bilateral submandibular lymph nodes swelling that had lasted several weeks. A lymph node biopsy showed epithelioid granulomatous lymphadenitis with caseous necrosis. Mycobacteria grew in acid-fast bacteria culture and were identified as Mycobacterium avium by polymerase chain reaction. The patient was diagnosed with cervical lymphadenitis caused by M. avium. A computed tomography scan showed no evidence of a mass or infection at other sites, including the lungs; therefore, the mass was excised without any antimicrobial treatments. Her neck mass had not recurred at 9 months after the excision. JAK inhibitors have emerged as an important new class of oral therapy for rheumatoid arthritis and other diseases. Physicians should be aware of the relatively rare complications, such as cervical lymphadenitis caused by nontuberculous mycobacteria, when using JAK inhibitors.

Background: Tuberculosis is a specific infectious disease caused by bacteria belonging to the "Mycobacterium tuberculosis complex". It presents a great social and economic problem and is one of the major factors responsible for high morbidity and mortality in India. The incidence of tuberculous cervical lymphadenopathy accounts for two third of extra pulmonary tuberculous lymphadenopathy. Higher proportion of tuberculous origin is because of greater incidence of pulmonary tuberculosis in our country. Perhaps there are many other causes of lymphadenopathy which are usually misdiagnosed as tuberculosis. Thus, it has been a common problem for both the clinicians as well as the pathologists to diagnose tuberculosis. Methods and Materials: The present work is carried out in 100 clinically suspected cases of tuberculous cervical lymphadenitis attending E.N.T., Surgery, Paediatrics and Medicine Department of central India institute as an outdoor/indoor patient during the period of one year. Patients with enlarged cervical lymph nodes with a history suggestive of tuberculosis were included after taking an informed consent. Results: Study was conducted on 100 clinically suspected cases of tuberculous cervical lymphadenitis, Tuberculosis was diagnosed in 57% cases by FNAC, smear and culture together, the maximum incidence of tuberculosis was observed in second and third decades, Females were more affected (64%) than males with the ratio of 1:2.3. FNAC showed accuracy of 42%, 30% cases were AFB smear positive in our study which nearly matches to other authors. The culture studies could diagnose 57 cases as tuberculous and 4 cases as non-tuberculous cervical lymphadenitis. Culture positive was higher in granulomatous necrotic lesions. Sensitivity, specificity and predictive values of culture study were significantly higher than FNAC and smear. These methods of investigation require considerable experience and confidence of the pathologist who perform the procedure for better results. When culture was taken as Gold Standard, cytology was found to be more sensitive than smear. Conclusions: From this study we concluded that Both FNAC and smear are quick, simple, less traumatic and cost-effective methods and are used as routine investigating procedures in OPDs of urban and semi-urban hospitals. Simplicity of these techniques (FNAC & Smear) combined with early availability of results and good diagnostic accuracy warrants their clinical application. Missed cytological diagnosis and isolation of nontuberculous mycobacteria justify the use of culture studies in all suspected tuberculous lymphadenitis cases. [ABSTRACT FROM AUTHOR]

Mycobacterium kansasii extrapulmonary infections are infrequent in immunocompetent adults. Rifampin (RIF), clarithromycin (CLR), isoniazid (INH) and ethambutol (EMB) are included in all the standard regimens against M.kansasii. We report a case of a healthy 65-year-old male farmer who presented with isolated right supraclavicular lymphadenopathy. The lymph node FNA showed acid-fast-bacilli and granulomatous inflammation. Quantiferon TB Gold test, HIV serology, and functional immunological studies were all negative or normal. He was put on a standard 4 drugs anti-tuberculous regimen that was switched to RIF + CLR+ INH after the Microbiology lab demonstrated an EMB-resistant Mycobacterium kansasii isotype I strain. The patient was cured after 12 months of therapy. This is the 6th reported case of M. kansasii extrapulmonary lymphadenitis in an immunocompetent adult and the 2nd showing EMB resistance in the world literature. Antimycobacterial regimens against M. kansasii, classically resistant to pyrazinamide (PZA) might also exclude EMB due to its increasing resistance in Europe. A 612 months therapy with at least 2 effective antimycobacterial drugs including RIF + CLR might be enough to treat extrapulmonary M. kansasii infections in immunocompetents.

Abstract Background Post-COVID-19 multisystem inflammatory syndrome (MIS) has been increasingly recognized but fever with isolated tender cervical lymphadenitis as the initial presentation has been rarely reported. We present 2 female patients one a child and the other an adolescent. Case presentation Case 1 was a 13-year-old girl who presented with tender cervical lymphadenopathy and fever 3-weeks post-COVID-19, and then developed features of MIS 5 days later. Case 2, also female, was 18 years old. She had no history of COVID-19 infection or immunization but had a serologic diagnosis of COVID-19. She similarly presented with fever and tender cervical lymphadenopathy, and then progressed rapidly to develop features of MIS. Both patients responded well to treatment with immunosuppressants and intravenous immunoglobulin. Conclusion Tender cervical lymphadenopathy could be the herald of multi-system inflammatory syndrome following COVID-19 infection among children and adolescents, which the clinicians must have a good suspicion about.

Background: Post-COVID-19 multisystem inflammatory syndrome (MIS) has been increasingly recognized but fever with isolated tender cervical lymphadenitis as the initial presentation has been rarely reported. We present 2 female patients one a child and the other an adolescent. Case presentation: Case 1 was a 13-year-old girl who presented with tender cervical lymphadenopathy and fever 3-weeks post-COVID-19, and then developed features of MIS 5 days later. Case 2, also female, was 18 years old. She had no history of COVID-19 infection or immunization but had a serologic diagnosis of COVID-19. She similarly presented with fever and tender cervical lymphadenopathy, and then progressed rapidly to develop features of MIS. Both patients responded well to treatment with immunosuppressants and intravenous immunoglobulin. Conclusion: Tender cervical lymphadenopathy could be the herald of multi-system inflammatory syndrome following COVID-19 infection among children and adolescents, which the clinicians must have a good suspicion about. [ABSTRACT FROM AUTHOR]

• Mycobacterium avium lymphadenitis may have a risk of using a Janus kinase inhibitor. • M. avium cervical lymphadenitis can occur without lung disease. • Lymph node excision should be done in M. avium cervical lymphadenitis. • The need for antibiotics for M. avium cervical lymphadenitis is unclear. • Immunosuppression during Mycobacterium infection should be discussed with specialists. A woman diagnosed with rheumatoid arthritis and treated with Janus kinase (JAK) inhibitors presented with a gradually enlarging bilateral submandibular lymph nodes swelling that had lasted several weeks. A lymph node biopsy showed epithelioid granulomatous lymphadenitis with caseous necrosis. Mycobacteria grew in acid-fast bacteria culture and were identified as Mycobacterium avium by polymerase chain reaction. The patient was diagnosed with cervical lymphadenitis caused by M. avium. A computed tomography scan showed no evidence of a mass or infection at other sites, including the lungs; therefore, the mass was excised without any antimicrobial treatments. Her neck mass had not recurred at 9 months after the excision. JAK inhibitors have emerged as an important new class of oral therapy for rheumatoid arthritis and other diseases. Physicians should be aware of the relatively rare complications, such as cervical lymphadenitis caused by nontuberculous mycobacteria, when using JAK inhibitors. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim. Comparision of the incidence of cervical lymphadenitis caused by nontuberculous mycobacteria in two equal time periods before and after the ending of widespread calmetization (tuberculosis vaccination). Backgroung. From 2011 to 2018, 89 children were registered in the Tuberculosis Register with cervical lymphadenitis caused by nontuberculous mycobacteria, as confirmed by cultivation. In the majority of cases, the infection was caused by a mycobacterium belonging to the Mycobacterium avium complex. Only 7 cases of cervical lymphadenitis of the same etiology were registered during the same time interval between 2003 and 2010. The authors consider the ending of widespread calmetization (tuberculosis vaccination) in 2010 to be the main cause of the growing incidence. Method. A comparison of data for the period 2003-2018 about cases of the illness caused by atypical mycobacteria as reported in the Tuberculosis Register. Results. The average incidence per year in the first interval was 0.04/100 000 children and in the second interval 0.53/100 000 children. During the second time interval, there was an increase from 0.14/100 000 children in 2011 to 1.40/100 000 children in 2018. While the incidence during the first time interval did not show any time trend (P=0.885), the year 2010 marks a significant turning point, with growth during the second interval being highly statistically significant (P

Mycobacterium tilburgii , a nonculturable mycobacterium, is an important nontuberculous mycobacterium that occasionally causes serious infections in patients with cellular immune deficiencies. Due to its nonculturable nature, information about its drug susceptibility is not available, and data about its clinical response to antimycobacterial treatment remains insufficient. Here, we report a case of a patient who presented with neck swelling and was finally diagnosed with cervical abscess caused by M. tilburgii carrying anti-interferon gamma autoantibodies using a molecular method. The relevant literature was reviewed in the context of epidemiological and clinical data on M. tilburgii infections. In this report, 15 patients were reported to be infected with M. tilburgii. Almost all patients had a cellular immune deficiency and presented with disseminated infections. Multiple refractory or relapse cases that often required prolonged antimycobacterial treatment have been reported, although a few fatal cases have also been reported. In conclusion, M. tilburgii is an important pathogen in patients with cellular immune deficiency. Physicians should thoroughly investigate cellular immune deficiency, including adult-onset immune deficiency with anti-interferon gamma autoantibodies, in patients with M. tilburgii infection. [ABSTRACT FROM AUTHOR]

Objective: To correlate different cytomorphological presentations of cervical lymphadenitis suspected for Myco-bacterium Tuberculosis (MTB) on Fine Needle Aspiration Cytology (FNAC) with Mycobacterium Tuberculosis detection by geneXpert on aspirated material. Study Design: Comparative, cross sectional study. Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology Rawalpindi, Jan 2017 to Nov 2018. Methodology: Fine needle aspirates of total 100 patients with cervical lymphadenitis suspected for Mycobac-terium Tuberculosis were included and the cytomorphology was compared with geneXpert. Data was analyzed using SPSS version 23. Results: A total of 100 cases were included. A total of 78 cases were positive for Mycobacterium Tuberculosis while 22 cases were negative when compared with molecular analysis on aspirated material. Positivity for Mycobacterium Tuberculosis by geneXpert was seen in 93% of cases with both caseous necrosis and granulomas, 80% of cases with caseous necrosis only, 80% of cases having granulomas along with neutrophilic abscess, 70% of cases showing granulomas and 14% of cases with neutrophilic abscess (p-value

Cervical tuberculous lymphadenitis (CTL), also known as scrofula, is an extrapulmonary manifestation of tuberculosis, a disease that is endemic to many developing countries, particularly Sub-Saharan Africa and Asia, but may also be found worldwide in developed countries like the United States. CTL can be difficult to detect and may mimic other similar-appearing conditions, so a high index of suspicion is required to accurately diagnose the condition when a patient presents with one or more neck masses. Incision and drainage and excisional surgery are aggressive options available to treat CTL but are not preferred due to a high risk of serious adverse events like fistulization and hematological dissemination. Clinicians typically opt for traditional tubercular RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) therapy for its high efficacy in treating extrapulmonary tuberculosis. Despite this preference, RIPE therapy has been known to elicit a myriad of side effects that demand close monitoring by clinicians. One side effect of the RIPE regimen that has yet to be reported is acanthosis nigricans (AN), a dermatological sign that presents as thickening and darkening of the skin, often in intertriginous areas. AN frequently occurs in conjunction with insulin resistance, and interestingly, the RIPE drug isoniazid has been implicated in insulin derangements in patients, most notably diabetics. However, the incidence of AN secondary to isoniazid use has not been explicitly recorded in the literature to date. Herein we present a novel case of a young man from Nepal with CTL treated via RIPE therapy who developed AN likely secondary to isoniazid use., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Meade et al.)

Recurrent cervical lymphadenitis is a common clinical presentation often managed with empiric antibiotic therapy. However, despite antibiotic treatment, persistent lymphadenopathy warrants consideration of alternative etiologies, including malignancy. We present the case of a 71-year-old female with recurrent cervical lymphadenitis that initially responded to antibiotics but was ultimately diagnosed as lymphoma upon biopsy. Despite conservative management, the patient's symptoms persisted, prompting surgical excision of the lymph node. Histopathological examination confirmed the lymphoma diagnosis, highlighting the importance of considering malignancy in cases of persistent lymphadenitis. This case underscores the significance of prompt evaluation, including biopsy, to ensure timely diagnosis and appropriate management in patients with recurrent cervical lymphadenitis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sharma et al.)

Background: To describe sonographic characteristics of cervical tuberculous lymphadenitis (CTBL) in children, clinical information, and sonograms of 348 lymph nodes (LNs) from 57 children with CTBL were retrospectively analyzed in this study. Methods: We retrospectively reviewed the clinical data and sonograms of 348 LNs from 31 boys and 26 girls with CTBL, who were confirmed by pathology or laboratory examination, at the Hangzhou Red Cross Hospital between June 2014 and December 2020. The age of the children ranged from 1 to 14 years (average 7.1 ± 2.9 years). Results: Night sweats, fatigue and loss of appetite were the most common clinical symptoms observed in children with CTBL. Unilateral LN involvements were common. Occasionally, CTBL was found in healthy children with no symptoms. On sonography, the hilus was absent or unclear in all LNs. The short-to-long axis (S/L) ratio was ≥ 0.5, and the edges were unclear in most LNs. Other accompanying findings included necrosis (47.4%), an echogenic thin layer (36.8%), surrounding soft-tissue edema (38.5%), multiple intra-nodal strong echo (28.2%), sinus (22.7%) and abscess formation (6.9%). The Doppler ultrasound showed that the majority of vascularity patterns of CTBL were capsular or peripheral (33.3%). Conclusions: Ultrasound is a recommended examination method for children from different age groups with cervical lymphadenitis. The ultrasonic signs of hilus absence, S/L ratio ≥ 0.5, unclear edge, necrosis, echogenic thin layer, strong echoes and capsular or peripheral vascularity may aid in the diagnosis of cervical tuberculous lymphadenitis. [ABSTRACT FROM AUTHOR]

Aim. Comparision of the incidence of cervical lymphadenitis caused by nontuberculous mycobacteria in two equal time periods before and after the ending of widespread calmetization (tuberculosis vaccination). Backgroung. From 2011 to 2018, 89 children were registered in the Tuberculosis Register with cervical lymphadenitis caused by nontuberculous mycobacteria, as confirmed by cultivation. In the majority of cases, the infection was caused by a mycobacterium belonging to the Mycobacterium avium complex. Only 7 cases of cervical lymphadenitis of the same etiology were registered during the same time interval between 2003 and 2010. The authors consider the ending of widespread calmetization (tuberculosis vaccination) in 2010 to be the main cause of the growing incidence. Method. A comparison of data for the period 2003-2018 about cases of the illness caused by atypical mycobacteria as reported in the Tuberculosis Register. Results. The average incidence per year in the first interval was 0.04/100 000 children and in the second interval 0.53/100 000 children. During the second time interval, there was an increase from 0.14/100 000 children in 2011 to 1.40/100 000 children in 2018. While the incidence during the first time interval did not show any time trend (P=0.885), the year 2010 marks a significant turning point, with growth during the second interval being highly statistically significant (P<0.001). [ABSTRACT FROM AUTHOR]

Objective: To analyze the role of Fine Needle Aspiration Cytology (FNAC) in the detection of tuberculous cervical lymphadenitis. Methods: A retrospective cross-sectional study was carried out at the Dr. Ruth K. M. Pfau Civil Hospital Karachi's ENT-Head and neck surgery department, from April 2021 till March 2022. Patients with ages between 30-70 years having cervical lymphadenopathy lasting for more than or equal to 3 months and having 1 or more palpable lymph nodes of more than or equal to 1 cm were included in the study. A questionnaire was designed for data collection from the patients. The names, ages, gender of the patients, the duration of disease noted down. The dominating nodes' FNAC and ultrasound neck were done. Inconclusive FNAC were followed by excisional biopsy. The sample size was taken as 50, with analysis done through SPSS version 23. Results: There were 34 (64%) females and 16 (32%) males present. The patients' average age was 52.94 ± 9.43 years; 33 patients were below the age of 55, out of which 25 (75.7%) had positive and 8 (24.2%) had negative FNAC. Of the patients over the age of 55, 11 (64.7%) had positive and 6 (54.5%) had negative FNAC. The illness lasted 5.84 ± 2.63 months on average, 2 months being the minimum duration of disease, while maximum duration was 15 months. The duration of less than or equal to six months was observed in 40 (80%) and the duration of more than 6 months was observed in 10 (20%) of patients. W ith a mean size of 2.5 ± 1.14 cm, 29 patients (58%) had unilateral nodes and 21 (42%) had bilateral nodes. FNAC has a sensitivity of 97% and specificity of 72.2%, meaning that it was positive in 36 individuals and negative in 14. Conclusion: FNAC plays a significant role in the diagnosis of tuberculous cervical lymphadenitis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effecst of Pudilan combined with acupuncture on cervical lymphadenitis in children on the expression of C-reactive protein (CRP). Methods: From August 2017 to June 2019, 84 cases children with cervical lymphadenitis diagnosed and treated in our hospital were selected as the research object. All the cases were divided into the combined group and control group of 42 cases in each groups accorded to the random number table method. The control group were given Pudilland treatment, and the combined group were given Pudilland combined with acupuncture treatment for 14 days. The treatment effects and CRP expression changes were recorded. Results: The total effective rates of the combined group were 97.6 % after treatment, which were significantly higher than 85.7 % of the control group (P<0.05). The local swelling time, local tenderness remission time and fever remission time in the combined group were significantly shorter than those in the control group (P<0.05). The serum CRP value of the two groups after treatment were lower than that before treatment, and the combined group were lower than that of the control group, compared the difference were statistically significant (P<0.05). After treatment, the proportion of CD4+T lymphocytes in both groups were higher than before treatment, and the combined group were higher than the control group, compared the difference between the two groups were statistically significant (P<0.05). There were no significant difference in the proportion of CD8+T lymphocytes between the two groups before and after treatment (P>0.05). Conclusion: Pudilland combined with acupuncture in the treatment of cervical lymphadenitis in children can inhibit the release of CRP and improve the immune function of children, thereby promote the disappearance of clinical symptoms and improve the overall treatment effects. [ABSTRACT FROM AUTHOR]

Kawasaki disease (KD) is an acute systemic vasculitis of unknown cause that mainly affects infants and children and can result in coronary artery complications if left untreated. A small subset of KD patients with fever and cervical lymphadenitis has been reported as node-first-presenting KD (NFKD). This type of KD commonly affects the older pediatric population with a more intense inflammatory process. Considering its unusual initial presentation, a delay in diagnosis and treatment increases the risk of coronary artery complications. Herein, we report the case of a 9-year-old female with fever and neck mass that rapidly deteriorated to shock status. A diagnosis of KD was made after the signs and symptoms fulfilled the principal diagnostic criteria. The patient’s heart failure and blood pressure improved dramatically after a single dose of intravenous immunoglobulin. This case reminds us that NFKD could be the initial manifestation of KDSS, which is a potentially fatal condition. We review the literature to identify the overlapping characteristics of NFKD and KDSS, and to highlight the importance of early recognition of atypical KD regardless of age. We conclude that unusually high C-reactive protein, neutrophilia, and thrombocytopenia serve as supplemental laboratory indicators for early identification of KDSS in patients with NFKD.

Since its introduction in 1976, Bacille Calmette-Guerin (BCG) has become the standard of care in high risk non-muscle-invasive bladder cancer. Apart from its efficacy, BCG immunotherapy is also considered to be safe. However, in addition to its common adverse effects, which are mild, it can rarely cause serious adverse effects, which can be life threatening. In this report, the case of an 85-year old male, who developed tuberculous cervical lymphadenitis and abscess after BCG immunotherapy is described. the patient pre- sented with acute renal failure. During his hospitalization he also developed hepatitis because of the anti-tuberculous therapy and eventually passed away, probably by septic emboli originated from his right jugular vein which was infiltrated by his abscess. tubercu- lous cervical lymphadenitis accompanied with abscess is a quite rare complication of BCG immunotherapy, but clinicians should be aware of it, as it can be proved fatal. [ABSTRACT FROM AUTHOR]

Copyright of Paediatrics & Family Medicine / Pediatria i Medycyna Rodzinna is the property of Medical Communications Sp. z o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To correlate different cytomorphological presentations of cervical lymphadenitis suspected for Mycobacterium Tuberculosis (MTB) on Fine Needle Aspiration Cytology (FNAC) with Mycobacterium Tuberculosis detection by geneXpert on aspirated material. Study Design: Comparative, cross sectional study. Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology Rawalpindi, Jan 2017 to Nov 2018. Methodology: Fine needle aspirates of total 100 patients with cervical lymphadenitis suspected for Mycobacterium Tuberculosis were included and the cytomorphology was compared with geneXpert. Data was analyzed using SPSS version 23. Results: A total of 100 cases were included. A total of 78 cases were positive for Mycobacterium Tuberculosis while 22 cases were negative when compared with molecular analysis on aspirated material. Positivity for Mycobacterium Tuberculosis by geneXpert was seen in 93% of cases with both caseous necrosis and granulomas, 80% of cases with caseous necrosis only, 80% of cases having granulomas along with neutrophilic abscess, 70% of cases showing granulomas and 14% of cases with neutrophilic abscess (p-value<0.05). Sensitivity of Fine Needle Aspiration Cytology was 97% and specificity was 54%. Positive Predictive Value was 88% and Negative Predictive Value was 85%. Conclusion: Mycobacterium Tuberculosis was detected by GeneXpert in a significant percentage of the Fine Needle Aspiration Cytology samples included in our study. Fine Needle Aspiration Cytology is a rapid, safe, easily available, minimally invasive, outpatient procedure and GeneXpert analysis can be performed on the aspirated material. [ABSTRACT FROM AUTHOR]

Lymph node enlargement may be an incidental finding on examination, or may be associated with a patient complaint. It is likely that over half of all patients examined each day may have enlarged lymph nodes in the head and neck region. There are no written guidelines specifying when further evaluation of lymphadenopathy is necessary. With such a high frequency of occurrence, oral health care providers need to be able to determine when lymphadenopathy should be investigated further. Although most cervical lymphadenopathy is the result of a benign infectious etiology clinicians should search for a precipitating cause and examine other nodal locations to exclude generalized lymphadenopathy. Lymph nodes larger than 1 cm in diameter are generally considered abnormal. Malignancy should be considered when palpable lymph nodes are identified in the supraclavicular region, or when nodes are rock hard, rubbery, or fixed in consistency Patients with unexplained localized cervical lymphadenopathy presenting with a benign clinical picture should be observed for a 2- to 4-week period. Generalized lymphadenopathy should prompt further clinical investigation. This article reviews common causes of lymphadenopathy, and presents a methodical clinical approach to a patient with cervical lymphadenopathy. [ABSTRACT FROM AUTHOR]

Importance: Cervical tuberculous lymphadenitis (CTL), the most frequent extrapulmonary form of tuberculosis, is currently a major health problem in Tunisia and in several regions around the world. CTL diagnosis is challenging mainly due to the paucibacillary nature of the disease and the potential misdiagnosis as cervical non-tuberculous lymphadenitis. This study demonstrates the added value of the heparin-binding hemagglutinin-interferon-gamma release assay as an immunoassay in the context of CTL., Competing Interests: The authors declare no conflict of interest.

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Tuberculosis (TB) is a major killer with a majority of 80–100 per lakh and 2–3% of patients attending our hospital are suffering from tuberculosis. Glandular TB appears to be high in our society. Fifty cases of cervical lymph nodes were collected in ENT department and studied. The diagnosis of TB cervical lymph nodes by disease process is only on 'Histopathological ground'.The aim of the present study is to establish the claim of TB cervical lymph node as a disease process. [ABSTRACT FROM AUTHOR]

Paraclostridium bifermentans (current nomenclature of Clostridium bifermentans since 2016) is a gram-positive, spore-forming anaerobic bacterium. Here, we describe two cases associated with this organism. The first, primarily a case of tubercular brain abscess where P. bifermentans was isolated as part of a polymicrobial flora, following a neurosurgical procedure for the same and the second, a case of cervical lymphadenitis from which it was isolated as the sole causative agent. There are only a few reported cases of P. bifermentans in literature and these cases illustrate the widening spectrum of infections related to it. [ABSTRACT FROM AUTHOR]

Making an accurate diagnosis of tuberculous cervical lymphadenitis (TCL) has been a problem to clinicians because it is a versatile masquerader and is often confused with lymphomas or cervical metastases. Ultrasound (US) has advantages over other examination modalities in that it is noninvasive, inexpensive, time-saving, and able to guide procedures such as fine-needle aspiration and core-needle biopsy. It is increasingly being recognized as a primary tool for the evaluation of cervical lymph nodes. In this article, we present six cases with microscopically and/or pathologically confirmed TCL and illustrate the US features. A literature review was also conducted. The key US features of TCL include hypoechogenecity, strong internal echoes, echogenic thin layers, nodal matting, soft tissue changes, and displaced hilar vascularity. US is a reliable and effective tool in assessing cervical lymphadenopathies. When TCL is suspected under US, US-guided procedures such as fine-needle aspiration or core-needle biopsy can be conducted concomitantly to obtain the microscopic or pathological proof.

Lateral neck lumps are very common in children, and are largely benign in nature. The majority of lumps may be diagnosed on history and clinical examination alone, and further investigations are often not required. The most common pathologies in young children include reactive lymphadenopathy, lymphadenitis and atypical mycobacterial infections. A lateral neck lump is an uncommon presentation for malignancy and is largely restricted to older children and adolescents. The paediatric surgeon plays an important role in the assessment and management of lateral neck lumps, often in the form of reassurance to the patients and their carers. [ABSTRACT FROM AUTHOR]

Non-tuberculous mycobacterial (NTM) infection commonly manifests as subacute or chronic cervicofacial lymphadenitis in immunocompetent children. The optimal management of this pathology remains controversial. This international consensus guideline aims to understand the practice patterns for NTM cervicofacial lymphadenitis and to address the primary diagnostic and management challenges. A modified three-iterative Delphi method was used to establish expert recommendations on the diagnostic considerations, expectant or medical management, and operative considerations. The recommendations herein are derived from current expert consensus and critical review of the literature. Multinational, multi-institutional, tertiary pediatric hospitals. Consensus recommendations include diagnostic work-up, goals of treatment and management options including surgery, prolonged antibiotic therapy and observation. The recommendations formulated in this International Pediatric Otolaryngology Group (IPOG) consensus statement on the diagnosis and management of patients with NTM lymphadenitis are aimed at improving patient care and promoting future hypothesis generation. [ABSTRACT FROM AUTHOR]

Objectives: The indications and benefits of surgery in the management of pediatric acute suppurative cervical lymphadenitis (ASCL) remain unclear. We aimed to design a management protocol focusing on the avoidance of unnecessary operation in pediatric ASCL patients. Methods: The study population consisted of 45 pediatric patients with ASCL treated with antibiotics alone and 30 surgically treated patients. The primary outcome was the determination of differences in patient characteristics and radiologic findings in the 2 groups. The secondary outcome, after matching 20 cases with 20 controls, was to determine the benefits of surgery to patients. Results: There were no significant differences between the 2 groups in patient characteristics and radiologic findings at initial presentation. In the matched case-control analysis, intravenous antibiotics alone yielded successful treatment outcomes when compared with surgery, with no significant differences in time to symptom resolution, normalized laboratory test results, and duration of hospitalization (all P > .05). Conclusions: The size and location of suppurated lymph nodes are not absolute determinants for surgical drainage in the stable pediatric ASCL patients. If patients show no clinical improvements despite appropriate second- and third-line antibiotics, patients should be carefully reevaluated and image-guided aspiration considered. [ABSTRACT FROM AUTHOR]

Background: Tularemia is a disease caused by a Gram-negative coccobacillus Francisella tularensis. This bacterium may cause different types of clinical pictures owing to acquisition route and entrance site, such as ulceroglandular, oropharyngeal, glandular, pneumonic, typhoid and ocular forms. Oropharyngeal tularemia (OPT) is the most common form of tularemia in some regions. OPT may cause tonsillopharyngitis followed by cervical lymphadenopathies (LAPs). Without treatment LAP may persist for several months and may mimic other diseases causing cervical LAPs. Materials and Methods: A total of six cases of OPT, five male and one female, between 21 and 31 years old, diagnosed serologically and clinically recorded in GATA Haydarpasa Training Hospital were included in this study. Detailed story including the region they lived for last 6 months, their occupation, family and neighborhood story with similar complaints were obtained. Patient data were also obtained from manually written patients files and electronical patient file system. Formalin fixed paraffin embedded tissue blocks of all biopsy material were submitted for polymerase chain reaction (PCR) study for F. tularensis. Results: A total of six cases with head and neck mass following a story of tonsillopharyngitis admitted to different clinics including infectious diseases, ear-nose-throat and internal medicine in our tertiary care hospital. Physical examination revealed immobile, hard, conglomerated unilateral cervical lymphadenopathy in all cases. Histopathological examination revealed granulomatous inflammation in four cases. Acute suppurative inflammatory changes were also seen in two cases. Large necrotic areas mimicking casseifying necrosis were seen in two cases. PCR amplification of F. tularensis genom from isolated deoxyribonucleic acids was successful in five cases. Conclusion: Tularemia should be kept in mind in patients with tonsillopharyngitis not responding to penicillins and beta lactam antibiotics. Furthermore, persisting LAPs mimicking tumor with or without the story of previously experienced sore throat or tonsillopharyngitis in past few days or weeks should be evaluated for glandular or OPT. At this point, easily applicable serological tests such as tularemia micro-agglutination tests will confirm the diagnosis of OPT. However, if lymph node were already sampled to exclude especially malignancy or T cell lymphoma, tularemia PCR test may be used to make a certain diagnosis.