Primary source of infection in tuberculous cervical lymphadenitis: a prospective study

To search for the primary site of infection inpatients with cervical tuberculous lymphadenitis. DESIGN: A prospective study. PLACE and DURATION OF STUDY The study was carried out at the departments of ENT Civil Hospital Karachi, Chest medicine JPMC Karachi and Ojha institute of Chest diseases Karachi, over the period of two years [June 2000 - July 2002] SUBJECT and METHODS: One hundred patients with a clinical suspicion of cervical tuberculous lymphadenitis were included in the study. All Patients had a physical examination of the upper aerodigestive tract. Routine endoscopy and biopsy of the nasopharynx were performed. All of them had excisionallincisional biopsy of the cervical lymph node. Seventy-five patients had histologically confirmed tuberculous cervical lymphadenitis. Culture o f the lymph node specimen showed mycobacterium tuberculosis in 68 [90%]. In 45 [60%] patients with cervical tuberculous lymphadenitis, the primary foci of infection could not be found. Twenty-nine [39%] had radiographic evidence of active or healed pulmonary tuberculosis. Sputum culture from two patients showed mycobacterium tuberculosis. Five patients [6%] had tuberculous nasopharyngitis. In one of them, the tuberculous nasopharyngitis was primary as no other evidence of mycobacterium infection was found. In present study the pulmonary foci are the primary infection site in cervical tuberculous lymphadenitis. The mycobacterial infection of otherparts of the upper aerodigestive tract was not found