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PubMed2003

[Lymph-node tuberculosis in patients infected or not with HIV: general characteristics, clinical presentation, microbiological diagnosis and treatment].

Lymph node tuberculosis is the most frequent form of extrapulmonary tuberculosis, especially in immunocompromised patients. We have studied patients with proven lymph node tuberculosis in the Department of Infectious Diseases at Pitié-Salpêtrière Hospital, Paris, between January 1997 and January 2002. Clinical presentation, microbiological diagnosis and treatment were analyzed in 13 HIV infected and 19 non-HIV infected patients. A risk factor for tuberculosis was present in all cases (HIV infection, immigration, life in community, poverty, past history of tuberculosis and IVDU). The median duration between the onset of symptoms and diagnosis was longer for HIV infected (2 months) compared with non-HIV infected patients (1 month). At the time of the diagnosis, general symptoms were present in >50% of patients of both groups. In HIV infected patients, abdominal lymph node involvement was more frequent (P < 0.05). All the non-HIV infected and 85% of HIV infected patients had peripheral adenopathies. A pulmonary tuberculosis was noted in more than half of the cases (53% non-HIV and 69% HIV patients). Inflammatory parameters and liver function tests were frequently abnormal in both groups. Hyponatremia was more frequent in HIV patients (P < 0.05). TB skin testing was more frequently positive and phlyctenular in non-HIV infected patients (P < 0.05). In this study, direct examination of the needle aspirate from infected lymph nodes was rarely positive; cultures were more frequently positive after biopsy compared to needle-aspiration. The median duration of treatment was 9 months for the two groups (6-24 months). Three HIV infected patients were infected by mycobacteria resistant to at least one antibiotic (isoniazid, 1; rifampicin, 1; isoniazid, streptomycin, etambutool, 1). All the patients recovered.

AIDS-Related Opportunistic Infections↗
PubMed2002

Assessment of lymph node tuberculosis in northern Germany: a clinical review.

AIM OF STUDY: To evaluate patient profiles, diagnostic approaches, and treatment strategies in patients with lymph node tuberculosis. METHODS: Demographic data, diagnostic findings, and therapies were retrospectively analyzed in 60 patients with lymph node tuberculosis who were hospitalized between 1992 and 1999. RESULTS: Thirty percent (n = 18) of patients were natives, and 70% were immigrants (n = 42). The cervical lymph nodes were most frequently involved (63.3%), followed by the mediastinal lymph nodes (26.7%) and the axillary lymph nodes (8.3%). All patients (except one patient who was HIV-positive) showed a positive response to tuberculin skin testing. Lymph node excision and fine-needle aspiration (FNA) were similarly effective in obtaining sufficient material for histologic and microbiological analysis. Mycobacterium tuberculosis was identified in 43.3% of patients by microbiological testing, and culture methods showed the highest sensitivity. Despite standard treatment, the initial enlargement of the lymph nodes occurred in 20% of patients and local complications occurred in 10%. CONCLUSION: Lymph node tuberculosis is still an important issue in developed countries and has to be considered in differential diagnosis. The best approach appears to be a combination of skin testing and FNA. Negative results in the identification of M tuberculosis do not exclude the diagnosis of lymph node tuberculosis.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[Acquired circinated ichthyosis revealing a lymph node tuberculosis].

BACKGROUND: Acquired ichthyosis usually reveals or is associated with an internal disease. The classical clinical aspect is vulgaris ichthyosis. We report a case of acquired ichthyosis, presenting original clinical features, revealing a lymph node tuberculosis. CASE REPORT: A 63-year-old male patient without past history of skin disease consulted for a generalized eruption. The eruption was composed of multiple erythemato-squamous plaques. The edge of the plaque was raised and circinated. Histologic examination of the edge and the centre of the lesion supported the clinical diagnosis of ichthyosis. The diagnosis of lymph node tuberculosis based on large inguinal nodes was confirmed by the fast acid-bacilli found in the lymph node. Initiation of antituberculosis therapy was followed by the rapid and complete disappearance of the skin lesions. DISCUSSION: We report a case of acquired ichthyosis with original clinical features and we propose to coin the term "acquired circinated ichthyosis". This entity was clinically distinct from ichthyosis vulgaris or pityriasis rotunda. This dermatosis was concomitant to lymph node tuberculosis and healed under antituberculosis therapy.

Antibiotics, Antitubercular↗
PubMed1998

[Computed tomography in the diagnosis of intrathoracic lymph nodes tuberculosis in children].

Computed tomography (CT) was used to examine 48 children aged 3 to 14 years; among them 15 patients were studied for small tuberculosis of intrathoracic lymph nodes (ITLN), 33 for infiltrative and tumorous forms, 19 infected with Mycobacterium tuberculosis with progressive positive hyperergic tuberculin reactions or with its variations. Chest CT study of children with ITLN tuberculosis established the precise site of lymph nodal involvement, evaluated the lymph nodes based on their density, homogeneity, the presence of liquid and solid caseous portions, cavities, calcifications, and the affection of the adjacent mediastinal organs. CT data were used to make a differential diagnosis of bulky mediastinal formations regarded as ITLN tuberculosis. It is recommended to consider CT as the method of choice in the complex X-ray examination of children with ITLN tuberculosis.

Adolescent↗