A retrospective analysis of first confirmed tubercular lymphadenitis in 129 cases / 中华传染病杂志

ABSTRACT

Objective@#To analyze and summarize the clinical characteristics of tubercular lymphadenitis, and to improve the ability of diagnosis. @*Methods@#Clinical records of 129 patients first confirmed with tubercular lymphadenitis were collected retrospectively from Nanfang Hospital of Southern Medical University between January 2012 and December 2016. The categorical variables were described with the percentage (%) and compared with the chi-squaue test. Non-normal distribution data were described with M(P25, P75) and compared with rank sum test.@*Results@#The disease courses were different in all cases, mostly of 1-3 months (45.7%). Among the cases, 83 cases (73.6%) complained of lymph node enlargement. The predominant involved lymph node site was cervical (56.6%) with main presentation of single lymph node (61.2%). Only a few cases presented with fever (34.1%). The positive rate of histological examinations was 94.3%, while the positive rate of T cell spot test of tuberculosis infection (T-SPOT.TB) test was 93.3% and purified protein derivative (PPD) test was 69.6%. In the diagnosis of tubercular lymphadenitis, 100 cases (77.5%) were confirmed by histological examinations, 27 cases (20.9%) were given diagnostic treatment, and only 2 case (1.6%) was confirmed by culture. The average period of diagnosis was (10.4±6.5) days. The median age of patients with fever was 50.5 years old with a median disease course of 2.5 months, while the median age of patients fever was 35(24, 49) years old with a median disease course of 1.2(0.5, 6.0) months. The differences between two groups were statistically significant (Z=-3.118 and -2.982, respectively, both P<0.05). Patients with fever had higher proportion of swollen deep lymph nodes (54.5% vs 11.8%), elevated white blood cell counts (34.1% vs 7.1%) and neutrophils (31.8% vs 1.8%), elevated erythrocyte sedimentation rate (97.1% vs 56.1%), elevated C-reactive protein (95.0% vs 40.0%) and received diagnostic treatment (47.7% vs 7.1%) than patients with no fever (χ2=27.337, 15.545, 13.567, 19.347, 25.410 and 28.974, respectively, all P<0.05). @*Conclusions@#Most patients of tubercular lymphadenitis do not present with typical symptoms which might lead to misdiagnose in early stage. The histological examinations and T-SPOT.TB test are especially essential, and histological examinations is the most important diagnostic method. Patients without symptoms of tuberculous poisoning are more common in young people, and the confirmation of diagnosis are mainly based on histological examinations. Patients with symptoms of tuberculous poisoning are more common in middle-aged, with longer duration and deep lymph node involved, which is more serious and nearly half of which are confirmed with diagnostic treatment.