Tb or Not Tb: Paradoxical Response and The Role of Selective Lymphadenectomy in Tuberculous Cervical Lymphadenitis.
Journal Title: IJAR-Indian Journal of Applied Research - Year 2016, Vol 6, Issue 10
Abstract
Introduction: Worsening of symptoms, a paradoxical response during anti-tuberculous therapy is a known phenomenon. There is an imbalance in responses that restrain inflammation and pro-inflammatory T cells. Additionally, granuloma formation occurs as a result of increased IFN-γ. The role of surgical treatment in tuberculous cervical lymphadenitis is not well-defined. We report a series of symptomatic cases of tuberculous cervical lymphadenits on anti-tubercular treatment that underwent surgical intervention to treat. Methods: A retrospective review of medical records of 19 patients diagnosed to have tuberculous cervical lymphadenitis over a 15-month period from June 2012 to August 2013 was done. Pre-operative diagnosis of tuberculosis was made based on FNAC, mycobacterial culture of aspirated fluid or histopathological examination of lymph nodes. All patients underwent excision of one or more groups of lymph nodes. Specimens were subjected to histopathological examination, MGIT culture and sensitivity and Xpert MTB/RIF tests.Rifampicin resistance on Xpert was diagnostic of drug-resistant tuberculosis while the absence of rifampicin resistance with documentation of acid-fast bacilli by either of the diagnostic modalities was considered as an evidence of paradoxical response. Results: Fourteen patients were diagnosed to have cervical tuberculous lymphadenitis were retrospectively analysed while on anti-tubercular treatment for 3 months or more. All patients presented with a swelling while, 6 (42.9 %) patients presented with a discharging sinus or the constitutional symptoms. Disseminated tuberculosis was present in 3 patients (21.4 %). All patients underwent excision of lymph nodes while 42.1% patients underwent selective neck dissection. The incidence of tuberculous infection was 85.7% by Xpert TB PCR and 31.6%. Drug-resistance was noted in 14.3% of the patients while paradoxical response to anti-tubercular treatment was made in 85.7% of the patients. Conclusion: Paradoxical response in tuberculous cervical lymphadenitis receiving anti-tubercular treatment is common in patients with persistent symptoms. There appears to be a definite beneficial role of selective neck dissection in a significant number of patients.
Authors and Affiliations
Pranay Gaikwad, Vasanth M. Samuel, Priscilla Rupali Rupali
Keywords
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