Discordancia entre pruebas de susceptibilidad genotípicas y fenotípicas para tuberculosis en Cali, Colombia: un reto en la práctica clínica / Discordance between genotypic and phenotypic susceptibility tests for tuberculosis in Cali, Colombia: a challenge in the clinical practice

INTRODUCCIÓN: La detección de patrones de resistencia de Mycobacterium tuberculosis se basa en pruebas de susceptibilidad fenotípicas y genotípicas. Los resultados discordantes entre ellas son un desafío clínico para el manejo de pacientes con tuberculosis resistente a fármacos. OBJETIVO: Evaluar la concordancia entre pruebas fenotípicas y moleculares en pacientes con tuberculosis resistente a fármacos atendidos en una institución de Cali, Colombia. MATERIALES Y MÉTODOS: Se realizó un estudio transversal en el que se obtuvo el perfil de sensibilidad fenotípico de cultivos de micobacterias y la susceptibilidad genotípica con las pruebas moleculares Xpert-MTB/ RIF® o Genotype-MDRTBplus ®. Se evaluó el porcentaje de resistencia y porcentaje de acuerdo entre los resultados de las pruebas fenotípicas y genotípicas. Se estimó un coeficiente de kappa de Cohen (κ) para cada tipo de resistencia según la prueba utilizada. RESULTADOS: Se incluyeron 30 casos con resultados de pruebas genotípicas y fenotípicas. Las pruebas fenotípicas detectaron resistencia a fármacos de primera línea en 29/30 casos, mientras que las moleculares detectaron la resistencia en todos los casos evaluados. El porcentaje de resistencia a rifampicina detectado entre la prueba fenotípica y Genotype-MDRTBplus ® &e 61,5% (acuerdo global 41,1%, κ = 0,40, p = 0,96), mientras que el porcentaje de resistencia detectado con Xpert-MTB/RIF® fue 100% (acuerdo global 81,82%, κ: 0,00, p < 0,001) para este mismo medicamento. El porcentaje de resistencia a isoniacida detectado entre la prueba fenotípica y Genotype-MDRTBplus ® fue 94,4% (acuerdo global 89,47%, κ: -0,055 p = 0,59). CONCLUSIONES: La discordancia entre los resultados de las pruebas genotípicas y fenotípicas es posible, por lo que es importante usar e interpretar ambos tipos de pruebas de manera complementaria en el diagnóstico de la resistencia a fármacos de primera línea en la infección por M. tuberculosis.

BACKGROUND: The detection of Mycobacterium tuberculosis resistance patterns is based on phenotypic and genotypic susceptibility tests. The discordant results between them are a clinical challenge for the management of patients with drug-resistant tuberculosis. Aim: To evaluate the concordance between phenotypic and molecular tests in patients with drug-resistant tuberculosis treated in an institution in Cali, Colombia. METHODS: A cross-sectional study was conducted. A phenotypic sensitivity profile was obtained from mycobacterial cultures. The genotypic susceptibility was obtained with Xpert-MTB/ RIF® or Genotype-MDRTBplus ®. The percentage of resistance and percentage of agreement between the results of the phenotypic and genotypic tests were evaluated. A Cohen's kappa coefficient (κ) was estimated for each type of resistance according to the test used. RESULTS: A total of 30 cases with both genotypic and phenotypic testing were included. The phenotypic tests detected resistance to first-line drugs in 29/30 cases, while the molecular tests detected resistance in all the cases evaluated. The percentage of resistance detected between Genotype-MDRTBplus® and the phenotypic test for rifampicin was 61.5% (overall agreement 41.1%, κ = 0.40, p = 0.96), while the percentage of resistance detected with XpertMTB/RIF® was 100% (overall agreement 81.82%, κ: 0.00, p < 0.001) for this same drug. Resistance to isoniazid detected by both types of tests was 94.4% (overall agreement 89.47%, κ: -0.055 p = 0.59). CONCLUSIONS: Discordance between the results of genotypic and phenotypic tests is possible, so it is important to use and interpret both types of tests in a complementary way in the diagnosis of resistance to first-line drugs in M. tuberculosis infection.

A study of clinical profile and treatment outcomes in CNS tuberculoma

Worldwide, around 10 million people fall sick every year because of Tuberculosis (TB). In India, the incidence is 2.69 million cases. Central nervous system Tuberculosis (CNS TB), which is one of the most deadly forms of tuberculosis (TB) mainly manifests as TB Meningitis followed by Tuberculoma, Tubercular abscess and other forms. CNS TB is seen in 5 to 10% of extra-pulmonary TB cases, and accounts for 1% of all TB cases and has the highest mortality. They usually present with symptoms such as headache and seizures. They may have other signs and symptoms based on the size and the location of the lesions. The advent of modern technology such as CT, MRI scans helped to diagnose early. Diagnosis is established by CT/MRI Brain, where a granulomatous lesion with/without perilesional edema is seen. MR Spectroscopy brain is indicated when the diagnosis is doubtful. Presence of lipid peak on MR Spectroscopy is diagnostic of CNS Tuberculomas. Medical management is adequate and there is no role for surgery. A course of ATT for 6 months along with corticosteroids is adequate. Addition of corticosteroids is necessary to reduce the paradoxical response; it also reduces the size of the lesion and perilesional edema. Anti epileptic drugs are not necessary. CNS Tuberculoma is curable if treated properly.

La Tuberculosis Urogenital en Cochabamba, Bolivia: incidencia, seguimiento microbiológico y del tratamiento antituberculoso / Urogenital Tuberculosis in Cochabamba-Bolivia: incidence, microbiological follow-up and monitoring of anti-TB treatment

Objetivo: describir la incidencia de tuberculosis urogenital (TBUG) en los dos centros de referencia diagnóstica del sistema de salud público del departamento de Cochabamba. Métodos: estudio transversal retrospectivo desde enero de 2013 a marzo de 2020; población de estudio: pacientes con sospecha de TBUG con solicitud de cultivo para BK. Recolección de datos: base de datos de los laboratorios y revisión de los expedientes clínicos. Resultados: se identificó a 2266 pacientes con sospecha clínica de TBUG a los que se les realizó cultivos de orina para TB; de los cuales 133 (5,87%) pacientes resultaron con cultivo positivo: 87 de sexo masculino (65,4%) y 46 de sexo femenino (34,6%); De estos, 115 pacientes no cuentan con un seguimiento completo clínico ni microbiológico, de los cuales el 83,3% tenía TB renal, 11,1% genital y 5,6% vesical; el 77,8 % presentaron síntomas del tracto urinario inferior, 33,3 % tenía algún tipo de comorbilidad y 1 requirió cirugía urológica. El tratamiento antituberculoso fue el estándar en el 100%, 1 presentó reacción adversa, pero ninguna resistencia ni defunciones asociadas al tratamiento. Discusión: la incidencia del 5,87% no es despreciable, debido a que se requiere un alto índice de sospecha y contar con el cultivo para el diagnóstico, seguimiento y finalización de la terapia y de este modo disminuir el daño irreversible que afectan la funcionalidad.

Objective: to determine the incidence of urogenital tuberculosis (UGTB) in the 2 diagnostic reference centers of Cochabamba. Methods: retrospective cross-sectional study from January 2013 to March 2020; Study population: patients with suspected UGTB with culture request for BK. Data collection: Laboratory database and review of clinical records. Results: 2266 patients with clinical suspicion of UGTB who had urine cultures for TB were identified; of which 133 (5.87%) patients were culture positive: 87 male (65.4%) and 46 female (34.6%); Of these, 115 patients do not have complete follow-up and only 18 patients were evaluated, of which 83.3% had renal TB, 11.1% genital and 5.6% bladder; 77.8% had lower urinary tract symptoms, 33.3% had some type of comorbidity and 1 required urological surgery. Antituberculosis treatment was standard in 100%, 1 presented adverse reaction, but no resistance or deaths associated with the treatment. Discussion: the incidence of 5.87% is not negligible, due to the fact that a high index of suspicion is required and to have the culture for diagnosis, follow-up and termination of therapy and thus reduce irreversible damage affecting functionality.

Síndrome DRESS asociado a fármacos antituberculosos / DRESS syndrome associated with antituberculous drugs

RESUMEN El síndrome DRESS es una farmacodermia grave, potencialmente fatal, que se caracteriza por eosinofilia periférica y compromiso sistémico. Los fármacos implicados con mayor frecuencia comprenden anticonvulsivantes, alopurinol, sulfasalazina y antivirales. Otros, como antibióticos, AINES y antituberculosos, también se han reportado como agentes causantes. Presentamos el caso clínico de un paciente masculino de 31 años de edad, con diagnóstico de pleuresía tuberculosa, que recibió tratamiento con isoniacida, rifampicina, pirazinamida y etambutol. A los 15 días desarrolló un exantema cutáneo febril, con compromiso hepático, pulmonar y hemodinámico, que requirió cuidados intensivos. Se suspendió el tratamiento y se administraron corticoides, con buena evolución.

ABSTRACT DRESS syndrome is a serious, potentially life-threatening adverse drug reaction, characterized by peripheral eosinophilia, and systemic compromise. The most frequently implicated drugs include anticonvulsants, allopurinol, sulfazalazine and antivirals. Others, such as antibiotics, NSAIDs and antituberculosis agents, have also been reported as causative agents. We present the clinical case of a 31-year-old male patient, diagnosed with pleural tuberculosis, who was treated with isoniazid, rifampicin, pyrazinamide and ethambutol. Fifteen days after he developed a febrile skin rash, with hepatic, pulmonary and hemodynamic involvement, which required intensive care. The treatment was suspended and corticosteroids were administered, with favorable evolution.

Baseline HBV Load Increases the Risk of Anti-tuberculous Drug-induced Hepatitis Flares in Patients with Tuberculosis / 华中科技大学学报（医学）（英德文版）

Hepatitis associated anti-tuberculous treatment (HATT) has been a main obstacle in managing patients co-infected with Mycobacterium tuberculosis and hepatitis B virus (HBV).Therefore,we evaluated the factors related to the severity of adverse effects during HATT,especially those associated with liver failure.A retrospective study was carried out at Tongji Hospital from 2007 to 2012.Increases in serum transaminase levels of＞3,5,and 10 times the upper limit of normal (ULN) were used to define liver damage as mild,moderate,and severe,respectively.Patients with elevated total bilirubin (TBil) levels that were more than 10 times the ULN (＞171 μrnol/L) with or without decreased (＜40％) prothrombin activity (PTA) were diagnosed with liver failure.A cohort of 87 patients was analyzed.The incidence of liver damage and liver failure was 59.8％ (n=52) and 25.3％ (n=22),respectively.The following variables were correlated with the severity of hepatotoxicity:albumin (ALB) levels,PTA,platelet counts (PLT),and the use of antiretroviral therapies (P＜0.05).Hypo-proteinemia and antiretroviral therapy were significantly associated with liver failure,and high viral loads were a significant risk factor with an odds ratio (OR) of 2.066.Judicious follow-up of clinical conditions,liver function tests,and coagulation function,especially in patients with high HBV loads and hypoalbuminemia is recommended.It may be advisable to reconsider the use of antiviral drugs failure during the course of anti-tuberculous treatment of HBV infection patients to avoid the occurrence of furious liver failure.

Breast Tuberculosis - Experience of Cases in a Tertiary Care Institute.

Aim: The study was conducted with an aim to suspect and diagnose “breast tuberculosis (TB)” cases early to avoid unnecessary delay in their treatment. Materials and Methods: For this purpose, the cases of breast complaints presenting in the Department of Surgery were clinically examined, investigated with fine-needle aspiration cytology (FNAC) or biopsy along with other relevant investigations. FNAC or biopsy positive for breast TB cases were further investigated by chest X-ray and/or sputum acid-fast bacilli for any evidence of pulmonary TB. Results: A total of 9 cases of breast TB were collected. Out of these 9 cases, 7 cases were adult females in the age group of 24-40 years. Cases 1, 2, 5, 6, and 9 were non-lactating, while Cases 3 and 7 were lactating. Case 4 was a 12-year-old girl and Case 8 was 25-year-old male. All the cases were involving the right breast except Case 5, which was involving both breasts, and Case 6, which was involving left breast. Case 5 was also having active pulmonary TB. Case 7 was showing Ziehl-Neelsen staining positive for AFB in breast tissue sample. We treated all cases with first-line four drugs (HRZE) for initial 2 months and two drugs (HR) for another 4 months except in Cases 1 and 5 where the continuation phase was extended to 6 months. Conclusion: Histopathological diagnosis is a more reliable and accurate as compared to the bacteriological diagnosis of tubercular mastitis. Four drugs therapy for 6 months is adequate. The majority of the cases will heal without major surgery, and mastectomy should be reserved for extensive breast destruction and unresponsive cases.

Management of severe gastrointestinal tuberculosis with injectable antituberculous drugs

Abdominaltuberculosis (TB) is generally responsive to medical treatment, and earlydiagnosis and management can prevent unnecessary surgical intervention. However, there is a needfor intravenous therapy for severe forms of tuberculosis with extensivegastrointestinal involvement. The authors report an immunocompetent patientwith gastrointestinal TB who was successfully managed with a combination ofsurgical intervention and anti-TB medications, and discuss the importance ofinjectable anti-TB medications in the management of severe gastrointestinal TB.The present case report illustrates a model for assessment and intervention in severeforms of gastrointestinal TB.

Drug sensitivity of thirty-four reference slowly growing mycobacteria to first and second line antituberculous agents / 中国人兽共患病学报

Slowly growing mycobacteria (SGM ) are distributed in the environment ,for example in soil and dirty water . SGM can cause human infections ,especially lung diseases .In this article ,first and second line antituberculous agents were ex‐amined in order to identify the optimum drugs for the treatment of SGM disorders .The fewest SGM in our study (4/34) were susceptible to isoniazid .Rifampicin (13/34) and ethambutol (14/34) were effective against similar numbers of strains .Ofloxa‐cin (23/34) ,kanamycin (26/34 ) , tobramycin (26/34 ) and streptomycin (27/34 ) were active against most of the tested strains .Ciprofloxacin (31/34) ,levofloxacin (31/34) ,amikacin (33/34) and capreomycin (33/34) showed an excellent range of activity .Moxifloxacin (34/34) showed the widest range of activity against the SGM species .Among the tested SGM spe‐cies ,M .simiae and M .af ricanum were resistant to the highest number of drugs .M .szulgai and M .duvalii were susceptible to all the first and second line antituberculous agents tested .Overall ,the second‐line antituberculous agents were good candi‐dates for the treatment of infection by SGM species and can be widely used in the therapy of SGM diseases .

Management of Severe Gastrointestinal Tuberculosis with Injectable Antituberculous Drugs

Abdominal tuberculosis (TB) is generally responsive to medical treatment, and early diagnosis and management can prevent unnecessary surgical intervention. However, intravenous therapy is needed for severe forms of tuberculosis with extensive gastrointestinal involvement. The authors report an immunocompetent patient with gastrointestinal TB who was successfully managed with a combination of surgical intervention and anti-TB medications, and discuss the importance of injectable anti-TB medications in the management of severe gastrointestinal TB. The present case report provides a model for assessment and intervention in severe forms of gastrointestinal TB.

Primary Nasopharyngeal Tuberculosis.

Tuberculous infection of the upper respiratory tract is an uncommon clinical condition and in that nasopharyngeal involvement is struck with rarity per se. This condition is often prevalent in people of low socioeconomic strata living in endemic areas, especially in developing countries. It has a silent and indolent course and most commonly mimicks nasopharyngeal carcinoma in its clinical presentation. In absence of concurrent pulmonary involvement, it is often misdiagnosed or diagnosed only after the biopsy has been taken. Nevertheless, high index of suspicion is required on part of the clinician to diagnose this comparatively rare entity.

Rapidly Progressing Foveal Atrophy with Tuberculous Serpiginous-Like Choroiditis Despite Combined Anti-Tuberculosis and Steroid Treatment

PURPOSE: To report a case of rapidly progressing foveal atrophy with tuberculous serpiginous-like choroiditis. CASE SUMMARY: A 54-year-old female patient had decreased vision of hand motions (os) for 3 days. Fundus examination showed optic disc swelling and yellowish chorioretinal lesions in the posterior pole (os). Optical coherence tomography (OCT) showed intraretinal edema and subretinal fluid in the left macula. Routine laboratory tests, serologic tests, and magnetic resonance imaging results were normal except for erythrocyte sedimentation rate (28 mm/hr). Fluorescein angiography showed the chorioretinal lesions appeared to be early hypofluorescence followed by late hyperfluorescence. Indocyanine green angiography showed hypofluorescence during early and late phases and the result of interferon-gamma release assay was positive. Under diagnosis of tuberculous serpiginous-like choroiditis, anti-tuberculous therapy combined with systemic corticosteroid was started. Despite decreased optic disc swelling, OCT showed a rapid progression of foveal atrophy within 2 weeks. Twelve weeks later, visual acuity was finger count at 10 cm. Six months later, best-corrected visual acuity and foveal atrophy were no interval change. CONCLUSIONS: Tuberculous serpiginous-like choroiditis with foveal involvement can show rapidly progressive foveal atrophy and poor visual prognosis.

Treatment of Periprosthetic Tuberculous Infection of Total Hip Arthroplasty with Long Term Medication without Implant Removal / 대한고관절학회지

Periprosthetic joint infection is one of the most dreaded complications of replacement arthroplasty and the incidence of periprosthetic tuberculous infections is increasing. This report presents a case of extensive periprosthetic tuberculous infections of primary total hip arthroplasty which was treated with debridement and long periods of antituberculous medication without implant removal. The patient completed 18 months of 4 drug antituberculous chemotherapy and the plain radiograph on the last review showed new bony consolidation around the prosthesis without loosening or signs of reactivation.

Disseminated Tuberculosis of Central Nervous System : Spinal Intramedullary and Intracranial Tuberculomas

As a cause of spinal cord compression, intramedullary spinal tuberculoma with central nervous system (CNS) involvement is rare. Aurthors report a 66-year-old female presented with multiple CNS tuberculomas including spinal intramedullary tuberculoma manifesting paraparesis and urinary dysfunction. We review the clinical menifestation and experiences of previous reported literature.

Isolated tubercular splenic abscess: Can we defer splenectomy? Our single experience with anti-tuberculous therapy alone.

Isolated splenic tuberculosis is an exceedingly rare clinical condition. Microbiological confirmation of diagnosis in such cases is quite difficult. We encountered the case of a 35-year-old female, who presented with persistent low-grade fever and weight loss. The CT scan of the abdomen revealed multiple hypodense splenic lesions. No primary focus of infection was detected in any other organs. Fine needle aspiration of splenic lesion revealed acid-fast bacilli on Ziehl-Neelsen stain. With anti-tuberculous therapy, the lesions regressed significantly in size. We stress that splenic tuberculosis should be considered as a diagnostic possibility even in immunocompetent individuals and choose combination antituberculous therapy as the first line treatment with consideration of splenectomy depending on response.

Appropriateness of Adenosine Deaminase-Guided Management for Patients with Pericardial Effusion / 대한내과학회지

BACKGROUND/AIMS: The prognostic impact of empirical anti-tuberculous management according to adenosine deaminase (ADA) levels in patients exhibiting pericardial effusion (PE) has not been established. We evaluated the appropriateness of ADA-guided anti-tuberculous medication for patients with PE. METHODS: From 2001 to 2010, 47 patients with PE and who were diagnosed with either tuberculous pericarditis (TbP) or idiopathic pericarditis (IP) were enrolled. The diagnosis of definite TbP was made by the presence of Tb bacilli or caseous granuloma in pericardial tissue or effusion. The diagnosis of probable TbP was made by the presence of one or more of the following: (1) elevated ADA (> or = 40 IU/L) in pericardial fluid, (2) positive Tb interferon test, or (3) extracardiac presence of Tb. All clinical information was collected by medical record review and telephone contact. RESULTS: Among the 47 patients with PE, 12 were diagnosed with definite TbP; 17, with probable TbP; and 18, with IP. The mean ADA level was significantly higher in patients with definite TbP than in patients with IP (74.97 +/- 36.79 vs. 20.14 +/- 7.39 IU/L; p < 0.001). The optimal ADA cutoff value for diagnosis of definite TbP was 64 IU/L. The median follow-up time was 12.1 months (range, 0.17-100 months). In patients with low levels of ADA (< 40 IU/L), the incidence of death or recurrence did not different between patients who were prescribed anti-tuberculous medication and those who were not. CONCLUSIONS: The ADA level in pericardial fluid was useful for making a rapid diagnosis of tuberculous pericarditis. Even in tuberculosis-endemic areas, patients with ADA < 40 IU/L may have a good prognosis without empirical anti-tuberculous treatment.

Causality assessment of suspected adverse drug reaction with anti-tubercular therapy by WHO probability scale.

The objectives of the study is to monitor and causality assessment of suspected ADRs by WHO Probability Scale in patients of tuberculosis undergoing treatment with anti-tuberculous drugs. An Open, Non- Comparative Study was carried out in the Medicine Department of Majeedia Hospital, Jamia Hamdard, over a period of 6 months. A total of 139 patients, satisfying Inclusion and Exclusion Criteria of the Study were enrolled. Potential study subjects were thoroughly interrogated for history in local dialect along with thorough clinical examination for both Pulmonary and Extra-pulmonary tuberculosis. The patients were followed upon a weekly basis during the period of treatment. Assessment of ADRs was done by formal methods; Timing, Pattern Recognition, Background Frequency and Re-challenge and the same was recorded in ADR Reporting and Documentation Form. All the categorical data was analysed by chi-square test on 120 patients. Causality assessment of ADRs was found to be statistically significant by WHO probability scale. 46.7% of patients reported ADRs to anti-tuberculous drugs. The severity of ADR’s was graded on 3- point scale (Mild-34.2%, Moderate-9.2%, Severe-3.3%). Close clinical monitoring in all tuberculosis patients for ADRs is important. ADRs remain one of the key factors for non-compliance of treatment, a reason for multi-drug resistance tuberculosis.

Nuevos fármacos antituberculosos / New antituberculous drug

La tuberculosis es una enfermedad infectocontagiosa que en pleno siglo XXI continúa siendo un flagelo mundial y que amenza a la humanidad con nuevas formas emergentes de tuberculosis multidrogo resistente (MDR) y la extremadamente resistente a todos los medicamenteos conocidos, la tuberculosis XDR. En este contexto son pocos los nuevos mediamentos antituberculosos desarrollados por la industria farmaceútica, por lo que el esquema terapéutico contra esta antigua enfermedad no ha variado sustancialmente. Hoy todos los seres humanos estamos expuestos y en peligro de contagiarnos de tuberculosis y por ende tener que iniciar prolongados tratamientos o tal vez enfrentar la muerte por falta de acción efectiva de éstos contra el germen productor de la tuberculosis.

Tuberculosis (TB) is a communicable disease that is still a very important health problem in the 21st Century, and it is currently threatening mankind with the emergence of new multidrug resistant (MDR) and extremely resistant (XDR) strains of its causative agent, Mycobacterium tuberculosis. In this scenario, there are very few new antituberculous drugs developed by the pharmaceutical industry, so the therapeutic strategy for this old disease has not undergone substantial changes. Nowadays, every human being is at risk for exposure and for acquiring tuberculosis, so that people acquiring the disease may be exposed to a prolonged therapy schedule, or they may even face death because of lack of effectiveness of antituberculous drugs in MDR or XDR TB cases.

Treatment of latent tuberculous infection in children and adolescent / 소아과

Tuberculosis continues to cause an unacceptably high toll of disease and death among children worldwide. Whereas intense scientific and clinical research efforts into novel diagnostic, therapeutic, and preventive interventions have focused on tuberculosis in adults, childhood tuberculosis has been relatively neglected. However, children are particularly vulnerable to severe disease and death following infection, and those with latent infection become the reservoir for future transmission following disease reactivation in adulthood, fuelling future epidemics. Therefore, it is very important to understand the significance, diagnosis and treatment of latent tuberculous infection to decrease a future disease burden of tuberculosis. Unfortunately, these concept still have not fully implicated in Korean National Tuberculosis Control Program, it should be engaged and enforced as soon as possible.

Treatment of latent tuberculous infection in children and adolescent / 소아과

Tuberculosis continues to cause an unacceptably high toll of disease and death among children worldwide. Whereas intense scientific and clinical research efforts into novel diagnostic, therapeutic, and preventive interventions have focused on tuberculosis in adults, childhood tuberculosis has been relatively neglected. However, children are particularly vulnerable to severe disease and death following infection, and those with latent infection become the reservoir for future transmission following disease reactivation in adulthood, fuelling future epidemics. Therefore, it is very important to understand the significance, diagnosis and treatment of latent tuberculous infection to decrease a future disease burden of tuberculosis. Unfortunately, these concept still have not fully implicated in Korean National Tuberculosis Control Program, it should be engaged and enforced as soon as possible.

Retrospective Study about Medical and Surgical Combination Therapy for Advanced Cervical Tuberculous Lymphadenitis / 결핵및호흡기질환

BACKGROUND: In principle, cervical tuberculous lymphadenitis (CTBL) is a medical disease that may require surgical treatment, particularly in young women who complain of psychosocial and cosmetic problems. We encountered 13 cases of aggravated CTBL treated surgically despite the appropriate course of antituberculous chemotherapy. We report the clinical characteristis of these cases. METHODS: The clinical data of 13 patients with aggravated CTBL requiring surgical treatment from January 2000 to December 2006 at the Department of Chest Medicine, Internal Medicine and Plastic Surgery, National Medical Center was reviewed retrospectively. RESULTS: Twelve of the 13 cases (92%) were female. The most common age was 21~30 years (69%). Multiple nodes were palpated in 11 cases (85%). The supraclavicular lymph nodes were sites the most commonly involved (54%). The other involved sites in the order of decreasing frequency were the jugular chain, posterior cervical, submandibular and infraauricular lymph nodes. A palpable mass was the most commonsymptom. Neck pain was reported in 3 cases (23%). General symptoms such as weight loss, fatigue, anorexia and night sweats were noted in 5 cases (38%). Respiratory symptoms such as cough, sputum, hemoptysis, dyspnea and chest pain were observed in 4 cases (31%). Pulmonary tuberculosis was noted in 11 cases (85%). Other extrapulmonary tuberculosis coexisted in 4 cases (31%). This suggests that surgical CTBLs may be manifestations of a systemic disease and might be difficult to treat. Most cases (92%) were stages 2 and 3 at the initial diagnostic period but all cases fell into stage 4 and 5 when reassesed before surgery. The average duration of anti-TB chemotherapy before and after surgery was 10.2 and 15.2 months, respectively. The 13 patients were followed up until June. 2008. Among them, 2 cases had newly developed CTBL and the other 11cases showed no recurrence. CONCLUSION: In principle, CTBL is the medical disease. However, despite the appropriate course of anti-TB chemotherapy, CTBL can progress to a more advanced stages and grow rapidly to a large-sized or fistulous mass with a persistent abscess. Surgical treatment may be inevitable for patients with psychosocial and cosmetic problems caused by these masses, particularly in young women.