De la escrófula a la linfoadenitis micobacteriana / From scrophula to mycobacterial lymphadenitis

Resumen En el siglo XIX se pensaba que la tuberculosis y la tumefacción ganglionar cervical llamada escrófula afectaban a individuos predispuestos por una "constitución diatésica" heredada. En 1882 Robert Koch demostró que lesiones tuberculosas y escrofulosas humanas eran causadas por el bacilo Mycobacterium tuberculosis. A principios del siglo XX se estableció que Mycobacterium bovis, bacilo de la tuberculosis del ganado, podía también causar linfoadenitis cervical en humanos, especialmente en niños, por la ingestión de leche de vacas enfermas. La condición disminuyó después que se controló la infección en el ganado y se introdujo la pasteurización de la leche. En 1956 se describió la linfoadenitis cervicofacial granulomatosa necrosante y supurada causada por micobacterias no tuberculosas. Afecta principalmente a niños bajo los cinco años, especialmente en países sin endemia de tuberculosis. Las linfoadenitis cervicales tuberculosas predominan en adultos jóvenes en países con tuberculosis endémica y en individuos infectados por VIH.

In the 19th century it was widely believed that both tuberculosis and cervical lymph node swelling, known as scrophula, affected individuals predisposed to an inherited "diathetic constitution". In 1882 Robert Koch proved that human tuberculosis and scrophulous lesions were caused by the bacillus Mycobacterium tuberculosis. In the early twentieth century it was stated that Mycobacterium bovis, the bacillus of cattle tuberculosis, could also cause cervical lymphoadenitis in humans, especially in children, by the intake of milk from sick cows. The incidence of this condition decreased after the infection was controlled in cattle and pasteurization of the milk was introduced. A type of granulomatous necrotizing and suppurative cervico-facial lymphadenitis associated to non-tuberculous mycobacteria was described in 1956. It mainly affects children younger than 5 years old, particularly those born in countries with non-endemic tuberculosis. Tuberculous cervical lymphadenitis is prevalent in young adults from tuberculosis-endemic countries and in HIV-infected subjects. Infectious etiology displaced the importance of a personal disposition in the development of scrophula. Nevertheless, mutations that confer susceptibility to mycobacterial infection are currently investigated.

La escrófula en el siglo XIX / Scrofula in the 19th century

In the 19th century scrofula or scrofulous adenitis was a frequent condition estimated by the finding of swollen cervical lymph nodes or scars, occurring in both sexes at all epochs of life, mainly in children. It was thought that it principally affected people with an inherited phlegmatic constitution that involved a scrofulous disposition or "diathesis". The disease would be triggered by environmental agents, bad habits or excesses in style of life. Besides injuring cervical lymph nodes, in some cases scrofula could compromise other groups of lymph nodes, bones, joints, lungs or other viscera. In some of its clinical presentations the disease could be healed while others were often lethal disorders. The finding of multiorgan compromise, caseation and "tuberculization" of the lesions originated discussion whether scrofula and tuberculosis were one or two different diseases and if they affected subjects with a common diathesis or people with a distinct scrofulous or tuberculous diathesis. Along the 19th century, before the discovery of Koch's bacillus, the notion of contagion as a cause of scrofula and tuberculosis was not predominant in Europe.

En el siglo XIX la escrófula era frecuente, estimada por la percepción de nódulos o cicatrices en el cuello. Paulatinamente se le empezó a denominar adenitis escrofulosa. Podía presentarse en personas de ambos sexos en todas las épocas de la vida; pero era más frecuente en la infancia. Se pensaba que afectaba principalmente a sujetos con una constitución flemática heredada que implicaba una susceptibilidad o diátesis escrofulosa. La enfermedad sería desencadenada por agentes ambientales, hábitos, o excesos en el estilo de vida. Aparte de los ganglios linfáticos cervicales, podía afectar otros grupos ganglionares, huesos, articulaciones, pulmones y otras visceras, atribuyéndosele diversas formas de presentación que variaban entre las potencialmente curables a las frecuentemente mortales. La afectación multiorgánica, la caseificación y la "tuberculización" de las lesiones originaron la discusión sobre si la escrófula y la tuberculosis eran una sola enfermedad o dos diferentes, y si se desencadenaban sobre una diátesis común o cada una sobre una diátesis específica escrofulosa o tuberculosa. En la mayor parte del siglo XIX, antes del descubrimiento del bacilo de Koch, la noción de contagio como causa de la escrófula y de la tuberculosis pulmonar no parecía predominar en países europeos.

Historia de la escrófula: de la discrasia humoral a la consunción / History of scrofula: from humoral dyscrasia to consumption

The term “scrofula” was used for a long time to designate a chronic swelling of cervical lymph nodes. This paper outlines the prevalent ideas on the nature, pathogenesis and the treatment of this disorder, from classical Greek medicine up to the 18th century. A Hippocratic treatise regarded scrofula as produced by an accumulation of phlegm, with a consequent imbalance or dyscrasia of the body humors. It was believed that it could heal spontaneously; but it could also soften, open through the skin and have an obstinate course. The treatment consisted mainly on local applications, incision to evacuate the soft content, or extirpation of the abnormal mass. In France and England, crowds of scrofulous patients were touched by the kings who were supposed to have a hereditary miraculous power to cure the disease. A Medieval text mentioned that scrofula could also affect other parts of the body. In the 17th century, scrofula was reputed as a frequent condition and was attributed to blood acrimony which coagulated in spongy organs. It was associated to phthisis or consumption due to the lethal outcome in some patients and to a cheese-like appearance of the pulmonary and the scrofulous lesions.