Resumen. AGUILAR-DURAN, Silvia y SANCHEZ MARTINEZ, Francesca. Epidemiological Analysis of Tuberculous Lymphadenopathy in a District of Barcelona. English Translation, Synonyms, Definitions and Usage Examples of Spanish Word ‘linfadenitis tuberculosa’. Tuberculous lymphadenitis (or tuberculous adenitis) is the most common form of tuberculosis infections that appears outside the lungs. Tuberculous.
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Tuberculosis is a very serious disease and incidence is once again on the rise. Lymph node tuberculosis is one of the most common extrapulmonary manifestations of tuberculosis. In differential diagnosis of chronic, painless cervical lymphadenopathy, cervical tuberculous lymphadenitis should be kept in mind. A high index of suspicion is needed for diagnosis of tuberculous lymphadenitis, which is known to mimic a number of pathological conditions.
This article reviews epidemiology, clinical manifestations, and diagnostic techniques for cervical tuberculous lymphadenitis. Tuberculosis TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis [ 1 tubercylosa.
Today in developing countries tuberculosis is still a major health problem. As a consequence of increased human immunodeficiency virus HIV prevalence and increasing immigration rate, tuberculosis TB is also re-emerging as a tuberculoaa care problem in developed countries [ 2 ].
Tuberculosis which mainly involves the lungs can also cause infection in almost all other organs and tissues in the body. TB bacilli enter the lymphatic system and blood stream to reach the extrapulmonary organs. Notable extrapulmonary infection sites include the pleura, the central nervous system, the lymphatic system, the genitourinary system, and the bones and joints [ 3 ]. Although new diagnostic methods have been developed, especially in patients without a history of tuberculosis, the cervical tuberculous lymphadenitis CTL diagnosis is still elusive.
In differential diagnosis of CTL, other granulomatous lymphadenitis should be considered such as non-tuberculous mycobacteria including M. The diagnosis is necessitating a high index of suspicion. Kent and et al. According to Powell, this entity is a hyperreaction of lymph nodes against previous pulmonary tuberculosis [ 10 ].
And also Yew et al. However, the pathogenesis of CTL without pulmonary tuberculosis cannot be explained by this theory, and also alternate routes of spread to lymph nodes, such as the tonsils and adenoids, have been proposed [ 12 ].
linfadenitis tuberculosa – English Translation – Word Magic Spanish-English Dictionary
Lymph node tuberculosis could be also occurring by direct exposure to infection [ 3 ]. In this review, we aimed to discuss the diagnostic methods of CTL and to evaluate the usefulness of these diagnostic methods. Age and gender distribution of CTL is different from the pulmonary tuberculosis. CTL is more frequent in females and in the younger age groups, whereas pulmonary tuberculosis is more common in males and in the older age groups [ 21314 ].
In the differential diagnosis of a cervical mass, CTL should be kept in mind especially in endemic areas. CTL may present as a unilateral single or multiple painless lump, mostly located in the posterior cervical or supraclavicular region [ 616 ].
The duration of lymphadenopathy at time of presentation is typically 1—2 months, varying from 3 weeks to 8 months [ 817 ].
There is a significant variability in the literature on the occurrence of clinical signs and symptoms of LNT other than the cervical mass. However night sweats, weakness, cough and fever could be also seen in these patients in different ratios [ 215 ].
These systemic symptoms are more commonly seen in HIV positive patients [ 20 ]. Also in HIV-positive patients the lymphadenopathies are more commonly seen as symmetrical and multiple contrasted with presentation with focal and asymmetrical lymphadenopathies of HIV-negative patients [ 21 ]. In order to make a diagnosis of CTL suspicion is mandatory.
A detailed history and physical examination which is supported with hematological tests, tuberculin test, imaging techniques, fine-needle aspiration FNAand molecular tests will help arrive at an early diagnosis of tuberculous lymphadenitis and allow early initiation of treatment before the final diagnosis can be made by incisional biopsy and culture [ 82324 ]. Although there is no specific blood test, leukocytosis, thrombocytosis, anemia, hyponatremia and increased ALP results are associated with chronic disease condition and these results create a doubt about an infective condition.
Also elevated ESR show up a non-specific inflammatory response [ 2526 ]. Because of the co-infection risk of extrapulmonary forms of tuberculosis in HIV-positive patients, all patients with CTL suspects have to be tested for HIV [ 142627 ]. Tuberculin skin test TST is used to show delayed-type hypersensitivity reactions against mycobacterial antigen, in which the reagent is mostly protein purified derivative PPD.
The test becomes positive 2—10 weeks after the mycobacterial infection. Suspicious reactions 5- to 9-mm induration can occur after BCG vaccination, M. The test may also be false positive in different conditions, like other infections, metabolic disease, malnutrition, live virus vaccination, malignancy, immunosuppressive drugs, newborns, elderly people, stress, sarcoidosis and inadequate test application [ 28 ].
However, the normal chest X-ray should not exclude the CTL diagnosis. It can also be used as an imaging tool for the guided aspirations. Therefore, when combined with fine-needle aspiration, it has a very high sensitivity and specificity [ 32 ]. However, they are not sufficient to make a certain diagnosis. They accurately demonstrate the sites, pattern and extend of the disease. Imaging features are varied and nonspecific, although rim enhancement or calcification, if present, can be a strong indicator of the disease [ 33 ].
There are three patterns of nodal involvement in tuberculosis lymphadenitis on CT or MR images [ 3435 ]. In the early course of disease, the nodes are homogenous in attenuation and after administration of intravenous contrast they enhance homogeneously.
As the disease progress, the second and the most common pattern, a node with central area of necrosis, is seen. At CT, the affected nodes have center of low attenuation with an enhancing rim. At MRI, the enhancing areas are of intermediate signal intensity with T1-weighted sequences and are hypointense with T2-weighted sequences, whereas non-enhancing areas are relatively hypointense with T1-weighted sequences and markedly hyperintense with T2-weighted sequences.
The non-enhancing areas indicate caseation or liquefaction necrosis, and the enhancing areas indicate granulation tissue with an inflammatory hypervascularity and increased vascular permeability. The third pattern is a fibrocalcified node that is usually seen in patients who have been treated. At CT, the node is homogenous and the calcification could be noticed. At MRI, it is homogenously hypointense both in T1- and T2-weighted sequences and does not enhance after injection of contrast material [ 3334 ].
In fine-needle aspiration FNAa thin needle is inserted into an infected, swollen, superficial lymph node.
Fine-needle aspiration cytology shows up a well-formed epithelioid granuloma and the presence of caseous necrosis [ 36 ]. These finding are highly suggestive of tubercular etiology, especially in developing countries where the incidence of tuberculosis is high [ 36 ]. However, typical granulomas and caseation are less likely to be found in HIV-positive tuberculosis lymphadenitis because of the impaired T-cell function [ 20 ].
Therefore bacteriological confirmation is essential. ZN staining and microscopic evaluation is rapid, cheap and easy. But the sensitivity ratio varies according to the source of the sample.
A definitive diagnosis of tuberculosis lymphadenitis can be made by demonstration of M. However, a negative culture result should not exclude the diagnosis of CTL [ 28 ]. And also the long duration of culture 6—8 weeks cause delay in initiation of treatment and is assessed as time-consuming. Polymerase chain reaction PCR which is a nucleic acid amplification test, provide a rapid, specific and sensitive diagnosis of M.
In one of these studies, Suzuki K. And the tubercilosa of these techniques were Histopathologic examination and PCR of an excisional biopsy should be recommended only for patients in whom FNA-PCR is negative or when there is discrepancy with the clinical impression [ 24 ].
Histopathologic examination is one of the most important diagnostic method of CTL [ 6444546 ]. Langerhans tubercukosa cells, caseating necrosis, granulomatous inflammation and calcification can be seen in histopathological examination [ 47 ]. Though histopathology is most reliable method for diagnosis of cervical lymphadenitis, its feasibility is limited due to its non-acceptability, as it is an invasive procedure [ 20 ]. So surgical excision has been recommended for treatment failure cases of tuberculosis lymphadenitis and for patients who have discomfort from tense, fluctuant lymph nodes [ 1731 ].
Preferred surgical method is excision of an infected lymph node.
Linfadenitis de causa tuberculosa: diagnóstico por punción aspirativa con aguja fina
Because incisional biopsy is associated with sinus tract and fistula formation and therefor is contraindicated [ 48 ]. Tuberculosis TB is a major health concern in developing countries. This disease is a systemic disease which may give rise to cervical lymphadenitis as an extrapulmonary manifestation of the disease. The most usual signs and symptoms are the appearance of a chronic, painless mass in the neck, which is persistent and usually grows with time.
Because of no other remarkable symptom their diagnosis and distinction need a high index of suspicion, and application of a variety of diagnostic modalities. However, it is not possible or practical to apply all of the diagnostic procedures in all patients. This would be time consuming and expensive. Increased ESR, leukocytosis thrombocytosis, anemia, hyponatremia and increased ALP results put forward a non-specific inflammation or a chronic disease status.
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Chest radiographs do not have any diagnostic value. And tuberculin skin test is also not valuable in areas tubercukosa BCG vaccination is mandatory. CT and MRI scans may show characteristic signs and the localization of the CTL which may help if the surgical excision would be planned in future. Therefore, the value of FNA is indisputable. The definitive diagnosis of tuberculous lymphadenitis is done by excisional biopsy and histopathologic examination if all other techniques fail.
The authors declared that this study has received no financial support. National Center for Biotechnology Information linfdenitis, U.
Journal List North Clin Tuberculowa v. Published online Sep Author information Article notes Copyright and License information Disclaimer. Received Jan 25; Accepted Jun This article has been cited by other articles in PMC. Abstract Tuberculosis is a very serious disease and incidence is once again on the rise. Cervical tuberculous lymphadenitisextrapulmonary tuberculosistuberculosis.
Dermographic findings Age and gender distribution of CTL is different from the pulmonary tuberculosis. Clinical presentation In the differential diagnosis of a cervical mass, CTL should be kept in mind especially in endemic areas.
Diagnostic tools In order to make a diagnosis of CTL suspicion is mandatory. Hematological tests Although there is no specific blood test, leukocytosis, thrombocytosis, anemia, hyponatremia and increased ALP results are associated with chronic disease condition and these results create a doubt about an infective condition.
Tuberculin skin test Tuberculin skin test TST is used to show delayed-type hypersensitivity reactions against mycobacterial antigen, in which the reagent is mostly protein purified derivative PPD.