A CLINICAL STUDY OF PERIPHERAL EXTRA PULMONARY TUBERCULAR LYMPHADENOPATHY

Patel Bhavik N, Shil Suman, Pandey Arvind S

Abstract


Background & Objectives:

Since an ancient time tuberculosis is a widely distributed in all over world more particularly in a country like India. Extra-pulmonary involvement is also common in which Peripheral lymphnode involvement is the commonest form of extra-pulmonary mycobacterial disease and cervical region is the most frequent site nowadays, there is increased incidence of Tuberculous lymphadenitis due to increased prevalence of HIV. Even with the best treatment available, tuberculosis of lymphnode still remains a problem for the clinician, because of late diagnosis,

poverty and ignorance of symptoms.

                        Hence this study has been undertaken to evaluate tuberculosis cervical lymphadenitis with special emphasis based on FNAC. Surgical excision biopsy followed by histopathological examination is time consuming, costly, required hospitalization, pre and post procedure complications hence patients compliance is poor. While fine needle aspiration cytology is simple, rapid, cheaper and outpatient department procedure. The success rate of diagnosis from FNAC is around 75-90% in various studies.

 

Methods:

A prospective, observational study was conducted among the patients who attended Tuberculosis & Respiratory Diseases Department from June 2011 to March 2013 in a tertiary care hospital with features of Peripheral Extra pulmonary Tubercular Lymphadenopathy. A total of 124 cases of peripheral extra pulmonary tubercular Lymphadenopathy were studied  from June 2011 to March 2013. A detailed history, complete physical examination, various laboratory work and radiological studies carried out. Diagnosis of TB made by histopathological & Tuberculin test was done with 10 TU PPD (0.1 ml) on left forearm and reading was taken after 48 hours. Majority patients were sent to pathology department for fine needle aspiration cytology of affected gland. Patients were having private FNAC report suggestive of tuberculous lymphadenitis were also considerd in study.

 

Result:

In the present study of 124 patients having Tuberculous Lymphadenopathy, the commonest age group affected is below 40 years (85% patients).Females are affected more than males (M:F ratio 1:1.03). With most of the patients coming from lower socioeconomic status. Majority of patients (72%) were presented with painless swelling in neck and 91% patients had attended health facility within 3 months.Family history positive in 04 (03%) of patients. Most of the time in tuberculous lymphadenopathy patients present with swelling only i.e 106 (86%) and 18 (14%) patients with either cold abscess or pus discharge so simple lymph node enlargement is common. 67 % patients show raised ESR. It may help in supportive diagnosis of tuberculous aetiology.67% patients show tuberculin test positive which also may help in diagnosis of tubercular aetiology. 10(08%) patients of lymphadenopathy had abnormal chest radiogram. Majority of the patients have normal leukocyte count with normal lymphocyte.Only 03 patients are found sputum positive in 124 tubercular lymphadenitis patients.It might be due to direct spread of infection from tonsil to regional lymphnode.Primary infection may occur in lymphoid tissue of tonsil.Only 1 patient is found HIV reactive in this study.This might be due to less HIV prevalence in rural population.

Conclusion:

It was observed that cervical region lymph node was more commonly involved and fine needle aspiration cytology (FNAC) was found to be a safe, useful, reliable, effective method for early diagnosis of tubercular lymphadenitis and early institution of definitive therapy. It is a comparatively cheap and less time consuming method. Adults are more affected than old people and females are affected more than males. ESR help in supportive diagnosis of Tuberculous etiology and tuberculin test positive also may help in diagnosis of tubercular etiology.

 


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