T.B. Lymphadenitis

Caustive organism:
T.B bacilli "Mycobacterium tuberculosis".
Initial sites of infection:
1- Cervical L.N. : from T.B. lesions in tonsils or pharynx.
2- Mediastinal L.N.: from pulmonary T.B.
3- Mesenteric L.N.: from Intestinal T.B.

Routes of infection:
1- Lymphatic borne: reach lymph nodes by lymphatics So, affect the cortex.
2- Blood borne: reach the L.N. through blood supply So, affect
the medulla.

Pathology: ® T.B. tubercles. the characteristic tubercle is composed of:
a- Epitheloid cells.
b- Few giant cells.
c- Collagen fibers ® Fibrous tissue
d- Caseous material (pathognomonic).
Pathological types:
(1) Caseous type: low immunity, common in children.
The L.N. is destructed and replaced by caseous material .
(2) Fibrous type: marked fibrosis with minimal caseation or lymphoid hyperplasia.
(3) Lymphadenoid type: Marked lymphoid hyperplasia with no caseation or fibrosis so, the glands become enlarged, discrete, rubbery as Lymphadenoma.
Fate of T.B. Lymphadenitis:
1- Resolution.
2- Calcification ® Silent infection.
3- Caseation ® cold abscess or sinus formation.
4- General dissemination ® Miliary T.B., Urinary T.B. or T.B. of bone. Lower deep cervical T.B. L.N. is more serious than upper one as the former is usually associated with active pulmonary T.B.
Clinical Picture:
Age: common in children ® cervical L.N.
Sex: Both sexes.
Involved L.N.: Cervical, mediastinal, axillary & inguinal. the onset is usually gradual and the course is progressive showing:
(A) Lymphadenopathy: which may be:
1- Caseous type ® Cold abscess which may open to S.C. space ® Collar stud abscess.
2- Fibrocaseous type ® enlarged firm L.Ns. which are matted together, not tender or slightly tender.
3- Lymphadenoid type: enlarged, rubbery L.Ns which are discrete biopsy only can differentiate from Hodgkin disease.
(B) TB. Toxaemia:
1- Not marked as other T.B infection.
2- Only malaise, loss of appetite and sweats.
1- Complete Bl. Picture: to exclude leukaemia.
2- Tuberculine test: Good - ve test.
3- X-ray on chest & abdomen: ® Calcified lymph nodes.
4- Biopsy: = Aspiration from cold abscess
technique: by valvular manner
Culture: on Lewenstein Jensen media.
Staining: By Ziehl Nelson stain.
= Excision biopsy in Lymphadenoid type.
1- Medical treatment.
1- Rest with good nutrition.
2- Anti T.B. drugs for 12:18 months.
3- X-ray for lymphadenoid type but contraindicated in children "CA. thyroid".
2- Surgical treatment.
1- To shorten the time of medical treatment.
2- Presence of complication. 3- For biopsy.
A- Lymph node excision: ® for localized T.B. to one group which shorten the duration of medical treatment to 3 months.
B- Cold abscess:
Repeated aspiration in valvular manner with injection of streptomycin.
Drainage if: ® Impending rupture
® Shows 2ry infection.
Excision with surrounding lymph nodes.
C- T.B Sinus: ® Instillation of streptomycin or P.A.S.
® Excision with the mother lymph nodes.
Although surgical treatment give rapid cure it carry the risk of:-
1- Sinus formation.
2- Injury to important structure of the neck due to marked fibrosis.
3- General dissemination.
4- Keloid formation ® T.B. individuals has keloid tendency.
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