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PubMedDate not supplied

The management of pulmonary and lymph node tuberculosis notified in England and Wales in 1998.

The management of 1,337 cases of pulmonary tuberculosis and 422 cases of lymph node tuberculosis reported to the 1998 national notification survey was compared with the recommended standards of treatment. Most patients (84%) were under the care of thoracic physicians. Culture confirmation was obtained in 67.5% of pulmonary cases and 52% of lymph node cases. Drug resistance was reported in 7%, ranging from 3.3% in white patients to 7.9-8.2% in other ethnic groups. Only a minority of non-white ethnic patients received the recommended four-drug initial phase of therapy. Non-standard durations of initial and/or continuation therapy were used in 35% of cases on recommended drug combinations. Thirty-nine (2.9%) pulmonary cases were diagnosed only at post-mortem and a further 96 died before the end of the survey period, 55 (4.3%) due to tuberculosis. The outcome for pulmonary disease, with 80% cured or completing treatment, compare favourably with European outcome data. Although overall outcome data were satisfactory, more patients should have received a four-drug initial phase, with more combination tablet use and better compliance monitoring. Outcome monitoring will henceforth be based mainly on the continuous enhanced surveillance system introduced since 1999.

Antitubercular Agents↗
PubMed1989

Six months' chemotherapy for lymph node tuberculosis.

A retrospective report of the experience using the policy of six-month short-course chemotherapy as standard treatment for lymph node tuberculosis is presented. Forty-one patients completed 6 months' treatment as planned. All made a complete recovery, except one who had a 1 cm residual node at the completion of treatment, and one who relapsed four months after treatment, was re-treated and recovered. Nine other patients had changes in treatment because of side-effects (5), drug-resistant organisms (3) and pregnancy (1). Treatment was prolonged in another seven patients, four in error and three because of previous drug treatment. The results suggest that 6 months' treatment of lymph node tuberculosis may be as satisfactory as 9 months', and support the need for a control comparison of these regimens.

Adolescent↗
PubMed1999

Lymph node tuberculosis in the suburbs of Paris: 59 cases in adults not infected by the human immunodeficiency virus.

We report 59 cases of lymph node tuberculosis in adults not infected by the human immunodeficiency virus (HIV), observed over a period of 5 years in the North Eastern suburbs of Paris. There were 31 women and 28 men; 84.7% were aged under 44 years; 69.5% were not French, and 78% had exclusive lymph node tuberculosis. A superficial distribution was found in 52 cases and a deep pattern in 17 cases. Cervical and supraclavicular lymphadenopathies were the most common (64.4%). General symptoms were present in 63% of cases. The diagnosis was established by fine needle aspiration in 10 cases and by biopsy in 36 cases. Three cases of primary resistance to anti-tuberculosis therapy were described. Lymph node tuberculosis is still present in the Paris region, independently of HIV infection, probably due to poor social conditions.

Adolescent↗
PubMed2006

Clinical evaluation of a 16S ribosomal RNA polymerase chain reaction test for the diagnosis of lymph node tuberculosis.

UNLABELLED: Reports on the sensitivity of polymerase chain reaction (PCR) for the diagnosis of lymph node tuberculosis (TB) show divergent results. We evaluated the accuracy of the Roche Amplicor Mycobacterium tuberculosis PCR test with lymph node aspirate and biopsy samples. METHODS: The study was conducted at a public reference hospital in Lima, Peru. From the period of January 2003 to January 2004, we included patients who had lymphadenopathy and in whom the attending physician suspected TB. Aspirate and biopsy samples were submitted for culturing in Lowenstein-Jensen medium, for histopathologic testing, and for PCR. The sensitivity and specificity of PCR were calculated against a reference standard based on histopathologic findings and culture. RESULTS: Our study included 154 patients. Median age was 29 years (interquartile range, 21-40 years); 97 patients (62.9%) were men. Twenty-nine patients (18.8%) had acid fast bacilli-positive histopathologic findings, and 44 (28.6%) had a positive culture result. Using the combination of histopathologic findings and culture as reference standard, 55 patients (35.7%) had a diagnosis of tuberculous lymphadenitis. The sensitivity of the PCR test was 58.2%, and the specificity was 93.9%. For biopsy tissue only, the sensitivity of PCR was 52.7%, and the specificity was 97.0%. For aspirate samples only, the sensitivity of PCR was 47.3%, and the specificity was 96.0%. CONCLUSION: The Amplicor PCR test revealed low sensitivity and high specificity for the diagnosis of lymph node TB. The sensitivity was higher in cases in which the bacillary load was high--in acid fast bacilli-positive samples and among HIV-infected patients. Considering the results of microbiological and PCR tests together, there was still a patient group in whom no final diagnosis could be established.

Adult↗
PubMed1988

Short course chemotherapy for lymph node tuberculosis: final report at 5 years. British Thoracic Society Research Committee.

Seventy-three patients with superficial lymph node tuberculosis, who received either 9 months' or 18 months' treatment with rifampicin and isoniazid, supplemented by ethambutol for the first 8 weeks, were followed up for 5 years. No clinical nor microbiological relapse was recorded. The cosmetic results were good in both groups. Initial surgery or aspiration conferred no advantage or disadvantage. The 9-month regimen can therefore be recommended as effective therapy for superficial lymph node tuberculosis.

Adolescent↗