Tuberculosis ganglionar / Ganglionar tuberculosis

Introducción: La tuberculosis es una enfermedad que aún se diagnostica en Cuba. Aunque la forma pulmonar predomina, se presentan en ocasiones diversas formas localizadas a otros órganos y tejidos, dentro de ellas la forma ganglionar. Caso clínico: Se presenta una joven de 21 años con fiebre de 15 días de evolución y aumento de volumen no doloroso de los ganglios del cuello y preauricular izquierdo. Luego de tratamiento antibiótico la fiebre desaparece pero las adenopatías persisten. Se hace una primera exéresis ganglionar la cual arroja una adenitis crónica agudizada con abscedación. Se realiza Mantoux el cual arroja un resultado de 32 mm. El Rx de tórax y la tomografía axial computadorizada tóraco-abdominal no arrojaron ninguna alteración. Se hace una nueva exéresis ganglionar cuyo estudio anatomopatológico informa la presencia de granulomas caseificados. El estudio microbiológico del tejido arrojó Mycobacterium tuberculosos, codificación 8. Comentarios: La tuberculosis ganglionar es la primera forma de tuberculosis extrapulmonar en aquellos países con baja incidencia de esta enfermedad. Es más frecuente en mujeres y en la localización cervical. La cutirreacción de Mantoux hiperérgica es orientadora en el diagnóstico, pero se requiere del estudio histológico de un ganglio con la presencia de granulomas caseificados y la demostración del bacilo en este tejido. Se presenta este caso para recordar que esta entidad debe ser tenida en cuenta en el estudio de todo síndrome adénico febril y que es necesario que en el estudio histológico de toda exéresis ganglionar deben realizarse las técnicas necesarias para llegar a este diagnóstico(AU)

Introduction: Tuberculosis continues to be a disease diagnosed in Cuba. Although the pulmonary form continues to predominate, several localized forms are sometimes presented to other organs and tissues, including the ganglionic form. Clinical case: A 21-year-old girl presented with a fever of 15 days of evolution and a non-painful volume increase of the neck and left preauricular lymph nodes. After antibiotic treatment the fever disappears but the adenopathies persist. A first lymph node excision is performed, which results in acute chronic adenitis with abscess. Mantoux is performed with a result of 32 mm. The chest X-ray and the thoraco-abdominal CT scan did not show any alteration. A new lymph node excision is performed, whose anatomopathological study reports the presence of caseified granulomas. The microbiological study of the tissue resulted tuberculous Mycobacterium, coding 8. Comments: Lymph node tuberculosis is the first form of extrapulmonary tuberculosis in those countries with low incidence of this disease. It is more frequent in women and in the cervical location. The hyperergic Mantoux is a guide in the diagnosis, but the histological study of a ganglion with the presence of caseified granulomas and the demonstration of the bacillus in this tissue is required. This case is presented to remember that this entity must be taken into account in the study of any febrile adenic syndrome and that it is necessary that in the histological study of any lymph node excision the necessary techniques must be performed to reach this diagnosis(AU)

Manifestaciones tomográficas extrapulmonares de TBCy algunas de sus complicaciones asociadas / Extrapulmonary TB Tomography and some Associated Complications

La Tuberculosis (TBC) es una patología infecto-contagiosa de alta morbimortalidad en Chile y en el mundo, siendo la segunda causa de muerte por cuestión infecciosa y es considerada una patología de alta relevancia a nivel de salud pública. Es causada por una bacteria de alta virulencia y contagio llamada mycobacterium tuberculosis. En la actualidad contamos con protocolos de detección y tratamiento muy eficaces, que la convierten en una enfermedad prevenible y curable. El diagnóstico se realiza con estudios bacteriológicos específicos frente a una sospecha clínica-epidemiológica sugerente. Sin embargo, el uso de imágenes forma parte casi obligatoria de su estudio y control. Debido a que el órgano diana de la TBC es el pulmón, es habitual utilizar como apoyo diagnóstico una radiografía de tórax, la cual es útil, en caso de TBC pulmonar, al presentar hallazgos característicos y orientadores para su diagnóstico. Es importante destacar que el mycobacterium tuberculosis tiene alto potencial de diseminación por contigüidad, vía linfática y/o hematógena, siendo esa última vía la causante de la mayoría de las TBC extrapulmonares, las cuales se presentan en un 20% de pacientes inmunocompetentes y hasta en un 60% de inmunocomprometidos. La principal localización de una TBC extrapulmonar es a nivel pleural, seguida del compromiso ganglionar, urogenital y osteoarticular, siendo el resto de las localizaciones muy infrecuentes. Para esos casos la tomografía computada (TC) es el estudio por imágenes de elección para el diagnóstico y control, además de ser una herramienta muy útil para la detección de complicaciones.

Tuberculosis (TB) is an infectious disease of high morbility and mortality in Chile and in the world. It is the second cause of death due to infectious causes in the world, and is considered of high relevance to public health. TB is caused by a highly pathogenic and virulent bacterium denominated mycobacterium tuberculosis. Nowadays, there are effective protocols for detection and treatment of this disease, which make it preventable and curable. Diagnosis is reached by specific bacteriological studies in the presence of a clinical epidemiological suspicion. Nevertheless, imagining methods are almost an obligatory part of tuberculosis study and control. Since the lung is the target organ of TB, chest X-ray is commonly used as a support for diagnosis, which is very useful in case of pulmonary TB because it provides characteristic findings to guide diagnosis. It is important to highlight that the mycobacterium tuberculosis has a high potential for dissemination by contiguity, via lymphatic and/or haematogenous, the latter being the cause of the majority of extrapulmonary TB, which are presented in 20% of immunocompetent patients and by up to 60% of immunocompromised. The main site of extrapulmonary TB is into the pleural space, followed by the lymph node, urogenital and osteoarticular involvement, the remainder being infrequent localizations. In these cases, a computed tomography (CT) study based on the selection of images, is the tool used for diagnosis and control, which is also useful for the detection of complications.

Tuberculosis como causa de adenopatías cervicales / Tuberculosis as a cervical lymphadenopathy cause

La tuberculosis (TBC) es una enfermedad infecto-contagiosa de distribución mundial causada por Mycobacterium tuberculosis, y otras micobacterias atípicas. La afectación ganglionar es tardía y sus manifestaciones clínicas asociadas suelen ser inespecíficas, por eso, el diagnóstico de tuberculosis ganglionar a menudo se retrasa y es un hallazgo inesperado en numerosas ocasiones. Este artículo pretende realizar una revisión bibliográfica sobre la tuberculosis ganglionar y hacer hincapié en que la TBC ha de ser tenida en cuenta como diagnóstico diferencial en las masas cervicales, que muchas veces se presentan con escasa sintomatología acompañante. En este artículo presentamos dos casos de TBC ganglionar diagnosticados en nuestro servicio en los últimos meses, ambos casos se manifestaron exclusivamente como masa cervical de crecimiento lento, sin síntomas pulmonares acompañante y fueron diagnosticados de TBC tras el estudio anatomopatológico resultante de la exéresis quirúrgica de la lesión.

The tuberculosis (TB) is an infect-contagious worldwide distribution disease caused by Mycobacterium Tuberculosis and other atypical Mycobacteria. Lymph node involvement is late, and its associated clinical manifestations are usually unspecifics, therefore the diagnosis of tuberculosis lymph node is often delayed and is an unexpected finding in numerous occasions. This article aims to carry out a literature review of lymph node tuberculosis and to emphasize that TB must be taken into account as differential diagnosis in cervical masses, which often occur with few associated symptoms. In this article we present two cases of lymph node TB diagnosed in our department in last months, both cases presented exclusively as cervical mass of slow growth, without any accompanying pulmonary symptoms and were diagnosed as TB after the surgical removal of the lesion and its histopathological study.

Tuberculosis ganglionar cervical simulando una enfermedad de Kikuchi: reporte de un caso y revisión de la literatura / Cervical lymph node tuberculosis simulating Kikuchi's disease: a case report and review of the literature

La linfadenitis cervical tuberculosa es la manifestación más común de tuberculosis en cabeza y cuello. La enfermedad de Kikuchi es una enfermedad rara que consiste en una linfadenitis necrotizante histocitiaria. La presentación clínica en ambas entidades suele consistir en una o más masas cervicales dolorosas, que pueden ser duras o fluctuantes. Los hallazgos por imagen no permiten distinguir de manera absoluta la linfadenitis tuberculosa de la enfermedad de Kikuchi. Por lo tanto es imprescindible para interpretar los hallazgos por imagen no sólo conocer el origen demográfico del paciente, sino su estado inmunológico con respecto a la tuberculosis y el estudio histopatológico y microbiológico de las adenopatías.

Tuberculous cervical lymphadenitis is the most common manifestation of tuberculosis in the head and neck. Kikuchi's disease is a rare disease that is histocitiaria necrotizing lymphadenitis. The clinical presentation in both entities is usually a painful neck masses or more, which can be hard or fluctuating. The imaging findings do not distinguish in absolute tuberculous lymphadenitis Kikuchi's disease. Therefore it is essential to interpret the imaging findings not only know the origin of the patient population, but their immune status with regard to Tuberculosis and histopathological and microbiological lymphadenopathy.

Papillary thyroid carcinoma with tuberculous cervical lymphadenopathy mimicking metastasis

To determine the frequency of tuberculous cervical lymphadenopathy mimicking metastasis from papillary thyroid cancer. Case series. Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Centre, Karachi, from March 2005 to March 2010. All patients above 12 years of age of either gender diagnosed on investigations as papillary thyroid cancer [PTC] were included in the study. Ultrasound and fine needle aspiration cytology [FNAC], neck of solitary thyroid nodules [STN] and cervical lymph nodes were done. Total thyroidectomy and excision biopsy of cervical lymph nodes was performed, histopathological results were recorded and patients were managed accordingly. A total of 55 patients had PTC and 25 had cervical lymphadenopathy. Eighteen patients of PTC with cervical lymphadenopathy were diagnosed after investigations as cases of tuberculous cervical lymphadenopathy [TCL] initially considered as metastasis from PTC; 5 patients had metastasis from PTC. Two patients proved to be of reactive hyperplasia which initially showed tuberculous cervical lymphadenopathy on FNAC. So 80% patients of cervical lymphadenopathy with PTC were due to benign disease and 20% had metastasis in lymph node due to PTC. PTC with cervical lymphadenopathy due to co-existent tuberculosis is common. Metastasis from PTC in lymph nodes were less common than tuberculous lymphodenitis in this study. Tuberculosis should be considered before deciding for neck dissection in cases of PTC

Fine needle aspiration cytology in childhood TB lymphadenitis.

Objective. To evaluate the efficacy of Fine Needle Aspiration Cytology (FNAC) to diagnose Tuberculous (TB) lymphadenitis with compare to excision biopsy and to correlate TB lymphadenitis with clinical, cytological, radiological and mantoux test features. Methods. This was a prospective correlational study. FNAC was done by a pediatrician for 135 children with persisting lymphadenitis after two weeks of antibiotic therapy in the period of January 2005 to June 2006 and compared with excision biopsy in a tertiary care hospital. Results. Forty Six cases (34.07%) were TB lymphadenitis diagnosed by FNAC. Excision biopsy and cytological correlation was done in 100 cases. Sensitivity, specificity and diagnostic accuracy for TB lymphadenitis were found to be 98%, 100% and 99% respectively. Positive and negative predictive values were 100 and 98 respectively. Large (>2cm) (86.9%), multiple (52.1%), matted (47.8%), posterior cervical and submandibular group nodes with history of contact (P=0.0016), positive mantoux test (P=0.0001) and Grade III and IV Protein Energy Malnutrition (PEM) (P=0.0041) were significantly seen in TB lymphadenitis. Ziehl Neelson staining for Acid Fast Bacilli (AFB) was positive in 32.5% cases of TB Lymphadenitis. Conclusion. Pediatrician himself can do FNAC which is an excellent first line method to diagnose TB lymphadenitis and it has equal accuracy to excision biopsy.

Role of ultrasonography and computed tomography in complicated cases of tuberculous cervical lymphadenitis.

AIM: To evaluate complicated cases of tuberculous cervical lymphadenitis by ultrasonography and computed tomography in order to detect more lymph nodes, and to study their lesions. MATERIAL AND METHODS: Total 27 patients of tuberculous cervical lymphadenitis previously proved bacteriologically or histopathologically on anti-tuberculosis treatment (ATT) presenting with complications were taken for study. Each case was subjected to ultrasound (USG) and computed tomography (CT) of involved area. Based on USG and CT findings, patients were subjected to repeat fine needle aspiration cytology (FNAC) of involved lymph node or drainage of pus. RESULTS: On USG, all lesions were hypoechoic and showed necrosis. Other findings were: sharp margins in 70.4 %, hilum in 22.2 %, abnormal surrounding tissue in 85.2 %, matting in 37 %, calcification in 29.6 % and posterior enhancement in 22.2 % patients. On CT, majority of lesions were with central low density (CLD) in 16 (59.3 %), followed by large confluent low density (LCLD) in 7 (25.9 %), multilocular central low density (MCLD) in 4 (14.8 %) and homogeneous soft tissue density (HSTD) in 2 (7.4 %) patients. Necrotising granulomatous lymphadenitis was the most common diagnosis in 17 (63%), followed by necrotising in 6 (22.2 %) and granulomatous in 4 (14.8 %) patients. Fifteen (55.5 %) patients were positive for AFB on ZN smear examination. In 17 patients, culture and sensitivity test for Mycobacterium Tuberculosis from lymph node aspirate was done and 12 (70.6 %) patients were found culture positive. Out of these, 2 (16.7 %) were found to be multi-drug resistant (MDR) cases. CONCLUSION: USG and CT modalities are complementary in diagnosis and management of tuberculous lymphadenitis presenting with complications. USG helps in better localization of site for biopsy/FNAC procedure and drainage of pus with high diagnostic yield. While CT helps in better anatomical localization of lymph nodes not usually detected on clinical examination.

CT manifestations of tubercular mediastinal lymphadenopathy.

A retrospective analysis was done of computerized tomographic (CT) scans of 29 patients with image guided histologically proven mediastinal tubercular lymphadenitis. Amongst these 19 patients were males while 10 were females in the age range of 2-65 years. Plain radiographs of all the patients revealed mediastinal lymphadenopathy. There was a high incidence of involvement of right paratracheal and tracheobronchial lymph nodes. The lymph nodes larger than 2 cm showed central low density area with peripheral enhancing walls. However, nodes less than 2 cm in size were mostly homogenous.