Screening of susceptibility genes and an immunological study in a patient with recurrent cervical lymphadenitis caused by Candida albicans / 中华皮肤科杂志

Objective:To explore genetic etiology and evaluate antifungal immunity in a patient with recurrent cervical lymphadenitis caused by Candida albicans. Methods:Next-generation sequencing was performed to screen susceptibility genes for mycosis in a patient with recurrent cervical lymphadenitis caused by Candida albicans and his parents. Peripheral blood mononuclear cells (PBMCs) and neutrophils were extracted from the patient and 6 healthy controls, and subjected to in vitro co-culture with Candida albicans. Western blot analysis was performed to determine the expression of caspase recruitment domain-containing protein 9 (CARD9) in PBMCs of the patient, enzyme-linked immunosorbent assay to detect levels of tumor necrosis factor-α (TNF-α), interleukin (IL) -6, IL-17A, IL-1β and granulocyte-macrophage colony-stimulating factor (GM-CSF) in the co-culture medium, and a colony-counting method was used to detect the survival rate of Candida albicans after treatment with neutrophils. Statistical analysis was carried out by using t test for comparisons between two groups. Results:Two compound heterozygous mutations were identified in the CARD9 gene of the patient, including c.68C>A (p.S23X) in exon 2 inherited from his father and c.820dupG (p.D274Gfs*61) in exon 6 inherited from his mother. Western blot analysis showed that the relative expression level of CARD9 protein in the PBMCs was 0.41 ± 0.07 in the healthy control group, but CARD9 expression was absent in the patient. After stimulation with heat-inactivated Candida albicans spores, the levels of TNF-α, IL-6, IL-17A, IL-1β and GM-CSF secreted by PBMCs of the patient were significantly lower than those by PBMCs of the healthy controls (all P < 0.001). After 30- and 120-minute in vitro co-culture with neutrophils, the survival rates of Candida albicans were significantly higher in the patient (78.00%, 74.00%, respectively) than in the healthy controls (70.91% ± 1.75%, 34.55% ± 5.35%, t = 3.74, 6.99, respectively, both P < 0.05) . Conclusion:Compound heterozygous mutations were identified in the CARD9 gene of the patient with recurrent cervical lymphadenitis caused by Candida albicans, which led to the absence of CARD9 protein expression, and the patient had a defect in the immunity against Candida albicans.

Cluster of Lymphadenitis due to Nontuberculous Mycobacterium in Children and Adolescents 8–15 Years of Age

BACKGROUND: Nontuberculous mycobacteria (NTM) lymphadenitis is an under-recognized entity, and data of the true burden in children are limited. Without a high index of suspicion, diagnosis may be delayed and microbiological detection is challenging. Here, we report a cluster of NTM lymphadenitis experienced in Korean children. METHODS: Subjects under 19 years of age diagnosed with NTM lymphadenitis during November 2016–April 2017 and April 2018 were included. Electronic medical records were reviewed for clinical, laboratory and pathological findings. Information regarding underlying health conditions and environmental exposure factors was obtained through interview and questionnaires. RESULTS: A total of ten subjects were diagnosed during 18 months. All subjects were 8–15 years of age, previously healthy, male and had unilateral, nontender, cervicofacial lymphadenitis for more than 3 weeks with no significant systemic symptoms and no response to empirical antibiotics. Lymph nodes involved were submandibular (n = 8), preauricular (n = 6) and submental (n = 1). Five patients had two infected nodes and violaceous discoloration was seen in seven subjects. Biopsy specimens revealed chronic granulomatous inflammation and acid-fast bacteria culture identified Mycobacterium haemophilum in two cases and NTM polymerase chain reaction was positive in two cases. Survey revealed various common exposure sources. CONCLUSION: NTM lymphadenitis is rare but increasing in detection and it may occur in children and adolescents. Diagnosis requires high index of suspicion and communication between clinicians and the laboratory is essential for identification of NTM.

Linfadenitis cervical por Salmonella no Typhi en una paciente diabética / Cervical lymphadenitis caused by no typhoid Salmonella in a diabetic patient

Resumen La infección por Salmonella no Typhi es una de las enfermedades transmitidas por alimentos más común y ampliamente extendida en el mundo. Aunque la mayoría de los casos se limitan al tracto gastrointestinal, el compromiso extraintestinal no es infrecuente. Sin embargo, la adenitis como manifestación aislada, es una forma inusual de presentación de la enfermedad. Comunicamos el caso clínico de una mujer de 67 años de edad con diagnóstico de diabetes mellitus y una linfadenitis cervical por Salmonella no Typhi tratada con ciprofloxacina y y que requirió resección quirúrgica.

No Typhoid Salmonella infection is one of the most common and widely spread foodborne diseases worldwide. Although most cases are limited to the gastrointestinal tract, extraintestinal involvement is not uncommon. However, adenitis as an isolated manifestation, is an unusual form of the disease. We report a case of Salmonella no Typhoid cervical lymphadenitis in a 67-year-old female with a recent diagnosis of diabetes mellitus, who was treated with surgery and ciprofloxacin.

Toxoplasmic Lymphadenitis of the Head and Neck Region / 대한이비인후과학회지

Toxoplasmosis is a ubiquitous protozoan infection caused by coccidian Toxoplasma gondii. In an immunocompetent host, the primary infection is generally oligosymptomatic and self-limiting. Fewer than 10% of infected subjects are symptomatic, with lymphadenopathy as the most frequent clinical finding. Here, two cases of Toxoplasmic lymphadenitis are reported for otolaryngologists to consider the clinical findings and natural history aspects of this infection.

Differential diagnosis of cervical lymphadenitis mimicking malignancy due to tularemia: Our experiences.

Background: Tularemia is a disease caused by a Gram-negative coccobaci llus 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 p ersist for several months and may mimic other diseases causing cervical LAPs. Materials and Methods: A total of six cases of OPT, fi ve 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 fi les and electronical patient fi le system. Formalin fi xed paraffi n 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 infl ammation in four cases. Acute suppurative infl ammatory changes were also seen in two cases. Large necrotic areas mimicking casseifying necrosis were seen in two cases. PCR amplifi cation of F. tularensis genom from isolated deoxyribonucleic acids was successful in fi ve 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 confi rm 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.

Diagnosis and Treatment of Cervical Lymphadenitis from a Standpoint of Infectious Disease Specialists

Cervical lymphadenitis is one of the common causes which make the patients visit the outpatient clinic. Extensive differential diagnoses are required to identify causative illness including viral or bacterial infection, Kikuchi's disease, tuberculosis, etc. In this review, several important key points are discussed with regards to clinical course, pathological diagnosis and treatment in patients with cervical lymphadenitis.

Diagnosis and Treatment of Cervical Lymphadenitis from a Standpoint of Infectious Disease Specialists

Cervical lymphadenitis is one of the common causes which make the patients visit the outpatient clinic. Extensive differential diagnoses are required to identify causative illness including viral or bacterial infection, Kikuchi's disease, tuberculosis, etc. In this review, several important key points are discussed with regards to clinical course, pathological diagnosis and treatment in patients with cervical lymphadenitis.

Deep Neck Space Infection Along with Tuberculous Cervical Lymphadenitis in an HIV Patient / 대한이비인후과학회지

Recent literature indicates that the incidence of deep neck space infection is on the decline because of the availability of better antibiotics used for upper respiratory infection, but cases of deep neck space infection that do not respond to conventional antibiotic therapy are on the rise. This may be due to reduced immunity, debility, human immunodeficiency virus (HIV) infection, and improper or inadequate treatment. With the emergence of the HIV, the incidence of deep neck space infections and life threatening complications has been on the rise. We describe a case of tuberculous cervical lymphadenitis in an HIV infected patient who developed deep neck space infection and was treated by incision and drainage.

A Case of Scrofuloderma with Cervical Lymphadenitis / 대한피부과학회지

Scrofuloderma results from contiguous extension of an underlying tuberculous focus secondary to local tissue breakdown. The underlying focus may be a tuberculous bone or joint or even epididymis, but it occurs most commonly over a lymph node, particularly the cervical lymph node. A 29-year-old man presented with a tender, erythematous, linear, fluctuating plaque and nodules on the right side of his neck. He had pulmonary and intestinal tuberculosis. A biopsy specimen from the skin lesion showed caseation necrosis surrounded by granulomatous infiltration, composed of epithelioid cells, mononuclear cells and Langhans' giant cells in the dermis. Acid-fast bacilli were identified on AFB staining. Herein, we report a typical case of scrofuloderma associated with cervical lymphadenitis.

Surgical Treatment of Tuberculous Cervical Abscess / 대한이비인후과학회지

BACKGROUND: Tuberculous cervical lymphadenitis is presently well controlled with surgical treatment and medication. In the case of tuberculous cervical abscess, variable treatment modalities are introduced by many authors. MATERIALS AND METHODS: In our cases, surgical treatments such as incision and drainage, mass excision and selective neck dissection, combined with chemotherapy were performed in 15 patients with tuberculous cervical abscesses. The results were reviewed retrospectively. RESULTS: The results showed that in cases of simple drainage, a second operation was required to excise the residual infected tissues which were caused by persistent sinus discharge. In the case of mass excision, some local problems occurred, albeit less commonly. In both groups, local wound problems took up a lot of time and effort for treatment. In cases of selective neck dissection, which is a more wide excision around the abscess, there were no recurrence nor any local wound problems. Tuberculous cervical abscess treated with selective neck dissection showed better surgical outcomes with low morbidity and no severe complications. CONCLUSIONS: Therefore, we recommend a wide excision as a therapeutic modality in cases of tuberculous cervical abscess.

Diagnosis of Tuberculous Cervical Lymphadenitis with Fine Needle Aspiration Cytology and Nested Polymerase Chain Reaction

BACKGROUND: Molecular methods have rapidly replaced the classic diagnostic procedures of tuberculosis. Especially, the nested polymerase chain reaction (nPCR) is widely used for the diagnosis of tuberculosis in various specimens. In our previous publication, we suggested the availability of nPCR in specimens of solid tissues and in fine needle aspirates for the diagnosis of tuberculous cervical lymphadenitis (TCL), but nPCR has the possibility of false positive due to its repetitive amplification and contamination. Also, nPCR shows variable sensitivity and specificity, depending on the kind of target sequence and the probe used. We intended to improve the diagnostic efficacy of nPCR by the means of combination with the result of fine needle aspiration cytology (FNAC). And we applied restriction fragment length polymorphism (RFLP) to the amplicon of nPCR to rule out false positives. METHODS: Thirty five specimens of aspirates from enlarged cervical lymph nodes of suspected TCL cases were examined by cytological examination and nPCR. Fifteen amplicons from nPCR were analyzed by RFLP. The sensitivity and the specificity were calculated in each nPCR and FNAC. The sensitivity and the specificity based on the result from combining nPCR and FNAC were also calculated. The results of RFLP were compared with the results of the corresponding nPCR. RESULTS: Twenty patients were definitely diagnosed as having tuberculosis based on the result of FNAC, nPCR, and tissue pathology. The sensitivity of FNAC was calculated to be 0.8, and the specificity was 0.92. The sensitivity of nPCR was calculated to be 0.76 and the specificity was 1.0. When we analyzed the patients infected with tuberculosis who had had positive results in FNAC or nPCR, the results showed a sensitivity of 0.95 and a specificity of 0.92. There were no different RFLP fragmentation patterns between the individual amplicons of the same nPCR results. CONCLUSIONS: The result of combining FNAC and nPCR offered good sensitivity and specificity in the diagnosis of TCL. It is suggested that anti-tuberculosis medication be immediately started when the result of FNAC or nPCR reveals a positive reaction. RFLP did not show any diagnostic value in our series, but it could be a great help in differential diagnosis of another strain of M. tuberculosis or atypical mycobacterium in treatment-resistant cases of TCL.

A Clinical Study of the Treatment of Tuberculous Cervical Lymphadenitis

BACKGROUND: Tuberculous cervical lymphadenitis is a granlomatous lymphadenitis which is the most common extra-plumonary tuberculosis in Korea. There are several controversies about the methods and the duration for the treatment of the disease. METHODS: We have studied 208 cases of tuberculous cervical lymphadenitis which were treated at Chung-Goo Sung-Shim Hospital from January 1992 to December 1996. RESULTS: The result of the study are as follows: The most prevalent age group was the third decade followed by the fourth decade. For the sexual distribution, females predominated over males by 1.9 to 1. the unilateral location was the most common one (76.2%). The most frequent lesion was on the anterior cervical triangle (28.6%) Simple excision was performed in 194 cases and incision plus drainage in 14 cases. Antituberculous medication was applied to the patients in two different groups. Isoniazid, Rifampin and Ethambutol were administered every day to the patients in one of the groups. To the other group, Pyrazinamide was additionally administered - Isoniazid, Rifampin, Ethambutol, and Pyrazinamide were administered every day. The average duration of medication for the former group was 13 months, and that for the latter group was 11 months. We experienced 17 cases of recurrence in both groups. The recurrence rate was 3.7% (4 cases) for the group with Pyrazinamide included and 13.0% (13 cases) for the other. For the patients with recurrence who were treated with the pyrazinamide, extending the medication from 6 to 12 months brought about a complete treatment for all cases. However, for the cases of recurrence in the other group, in which Pyrazinamide were not applied, only 8 cases were treated completely by 12 months after the additional administration of Pyrazinamide. Surgical treatment was performed for the remaining 5 cases, and all 5 cases were cured completely after additional antituberculous medication for 6 months. CONCLUSIONS: We conclude that the best choice for the treatment of tuberculous cervical lymphadenintis is the use of both surgical excision and antituberculous medication. In addition, the use of Pyrazinamide is recommended for the antituberculous medication.

A Clinical Study on Tuberculous Cervical Lymphadenitis / 대한내과학회지

OBJECTIVES: Tuberculous cervical lymphadenitis is one of the common cause of cervical mass in young adult in Korea. Sometimes it appears to be difficult in defining the role of surgery and duration of antituberculous treatment. To clarify the duration of medical treatment and to define the cause of prolonged treatment duration METHODS: we analyzed the clinical data of 62 patients with tuberculous cervical lymphadenitis diagnosed at the Chungnam National University Hospital from Jan. 1994 to July 1996 and all patients were divided into two groups (standard and prolonged) by treatment duration. RESULTS: The most prevalent age group was 20 to 39 years old (67%) and male to female ratio was 1:2.6. The most common physical finding was painless swelling on neck, standard group was 52%, prolonged group was 42%. The average size of lymph node was 2.7cm and 3.2cm, respectively (p<0.05). In prolonged group, incidence of associated pulmonary tuberculosis and previous antituberculous treatment history were higher than that in standard group (27%, 35% respectively). The most common affected site was right side of neck , whereas 19% of prolonged regimen group were involved in both side of neck. Bacteriological study from node aspirates showed relatively higher positivity in prolonged group (27%) than in standarded group (5%). The causes of prolonged treatment were increased mass(27%) or remnant mass(23%) and the develoment of new node formation and existing nodes after completion of treatment were found in both groups(10% of standard group , 19% of prolonged group). CONCLUSION: A new, prospective trial for proper regimens or duration of antituberculosis treatment is strongly needed.

A Clinical Study of Tuberculous Cervical Lymphadenitis

A clinical review of 212 cases of tuberculous cervical lymphadenitis during the past 6 years from January 1990 to December 1995 was made at the Department of General Surgery, Eul ji Medical College Hospital,Taejeon. The results are as follows: 1) The age of peak incidence was the 3rd decade (43.3%), and females predominated over males by 3.1 : 1. 2) The time interval from the onset of symptoms to the first visit was less than 3 months in 53.3% of the patients. 3) The location of lymphadenitis was the right neck in 59.9%, the left neck 38.7%, and bilateral in 1.4% of the patients. 4) Signs on the first visit were a mass, a cold abscess and/or a discharge. A palpable mass was the most frequent symptom (86.8%). 5) The incidence of associated pulmonary tuberculosis was 26.9%. 6) Seventy patients (33.0%) had a past history of tuberculosis. Among them, 55.7% had lymphadenitis, 28.6% pulmonary tuberculosis, and 15.7% medical problems at other sites. 7) Treatments of tuberculous cervical lymphadenitis were chemotherapy alone (68.4%) or surgical management combined with chemotherapy (31.6%). The surgical treatments included excision, incision and drainage, and neck dissection in 17.5%, 13.2%, and 0.9% of the patients, respectively. 8) The rate of recurrence was 3.1% (5 cases) for 160 cases, among them, 1.2% (2 cases) involved chemotherapy alone and 1.9% (3 cases) surgery with chemotherapy. The other 52 cases were lost from follow up.

Diagnosis of Tuberculous Cervical Lymphadenitis using Nested Polymerase Chain Reaction

Tuberculous cervical lymphadenitis(TCL) has some problems in microbiologic, pathologic, immunologic diagnostic procedures. More accurate diagnostic means has been needed beacuse TCL requires long-term antituberculous chamotherapy as long as 18 months. Recently, polymerase chain reaction (PCR) which amplifies known DNA segments was applied to the diagnosis of tuberculosis. However, the sensitivity of PCR is low with the samples of low-microorganism-burden. Nested PCR (nPCR) was introduced as a good alternative increasing the sensitivity of PCR by repeated amplification of DNA segment with inner primers which exist in the DNA sequence of first PCR products. Fifteen cases which were suspected to TCL were undertaken fine needle aspiration (FNA) and/or excisonal biopsy from enlarged cervical lymph nodes. All samples were examined with pathologic studies, simple PCR using INS-1/INS-2 primers, and nPCR using outer SCL-1/SCL-2 primers and inner SCL-3/SCL-4 primers. Eeight in fifteen patients were pathologically diagnosed to tuberculosis. Aspiration cytology diagnosed 2 cases to tuberculosis and did not confirm but suspect tuberculosis in 3 cases of thier 12 cases. A case of cases compatible with tuberculosis was diagnosed to subacute necrotizing lymphadenitis with tissue...

Clinical Investigation of Neck Masses in Children

PURPOSE: Neck masses are frequently encountered in pediatric practice, and have various underlying diseases. If the underlying diseases of the neck mass are not confirmed by its clinical characteristics, it can be done by neck mass biopsy. To define the necessity and the appropriate time of neck mass biopsy is very difficult and also important. Therefore the authers have conducted this study to have aids in differential diagnosis of neck mass in children by analyzing the clinical manifestations of underlying diseases of neck mass. METHODS: The authors have reviewed 390 children under 15 years of age who visited and admitted with neck masses to Shinchon Severance Hospital between Jan. 1987 and Dec. 1994. In order to elucidate the nature and etiologic diseases of neck masses, we classify and analyze the neck masses by age and sex distribution, duration of symptoms and signs, size and consistencies and by site and number of neck masses, and finally by underlying diseases. RESULTS: 1)Of the overall sex distribution, male patients were more than female, the male to female ratio was 1.32 : 1(222:168). The most common age group was 2-5 years of age. The most common acompanying symptoms were upper respiratory tract infection symptoms, comprising 37.7 % of all, and the most common duration of symptoms and signs was within 3 months, comprising 65.6 % of all. 2)Of the underlying diseases of the neck masses, the largest proportions were inflammatory masses, which comprising 49.2 % of all cases, among these, nonspecific cervical lymphadenitis was most common(65.6 %). 3)We could also confirm the nonspecific cervical lymphadenitis by clinical manifestations, blood exams and neck ultrasonography except neck mass biopsy. 4)For the diagnosis of tuberculous lymphadenitis, the family history of tuberculosis, PPD skin test, and chest X- ray findings are almost helpful, but the neck mass biopsy was essential. 5)Malignant tumors were 24 cases, which comprise 6.2 % of all. CONCLUSIONS: For the appropriate differential diagnosis of neck masses in children, we should observe and describe accurately the clinical characteristics of the neck masses. On physical examination, if we can not rule out the possibility of tuberculous lymphadenitis or malignant tumors, the neck mass biopsy should be done immediately, but if it is likely the nonspecific cervical lymphadenitis, we must wait until the size of neck masses decrease or other symptoms disappear after empirical antibiotics therapy.

Diagnosis of Tuberculous Cervical Lymphadenitis Using Polymerase Chain Reaction / 결핵

BACKGROUND: Tuberculous cervical lymphadenitis can be diagnosed by clinical findings, chest X-ray, Mantoux test, but confirmed only by excisional biopsy. The polymerase chain reaction(PCR) is now widely applied to test very small amount of pathogen and would be used to detect Mycobacterium tuberculosis in biopsied tissues and fine needle aspirates. METHOD: We carried out the PCR using IS-1 and IS-2 primers in 16 samples from tuberculous cervical lymphadenitis patients, and 13 samples from non-tuberculous cervical lymphadenopathy patients. Acid fast staining and culture for Mycobacterium were all negative. RESULTS: All of 8 pathologically confirmed tuberculous cervical lymphadenitis samples showed positive PCR results, and of 5/8 clinically diagnosed samples were positive. None of 6 pathologically excluded samples were positive, and among 7 clinically undiagnosed samples 2 showed positive PCR results. CONCLUSION: In patients with suspected tuberculous cervical lymphadenitis, PCR could be used to detect Mycobacterium tuberculosis using biopsied tissues and even fine needle aspirates with good sensitivity and specificity.