Abstract
Background: Lymph node tuberculosis is currently a common pathology in Tunisia which generates significant morbidity and socio-economic cost.
Aim: to describe epidemiological, clinical and therapeutic features of lymph node tuberculosis.
Methods: Retrospective study over a period of 12 years carried out from January 2008 to December 2019 at the ENT department of Habib Thameur hospital in Tunis, including 276 patients who were admitted for lymph node tuberculosis.
Results: The mean age of patients was 35±18.3 years, with 36.9% reporting consumption of raw milk. Chronic adenopathy was the main reason for consultation, observed in 11.4% of patients. The most affected lymph node site was the level IIa (65.9%). Tuberculin intradermal reaction (IDR) was >10 mm in 68% of cases. Hypoechoic lymphadenopathy was found in 79.9% cases, while 72.4% cases showed necrotic lymph nodes on ultrasound. Fine needle aspiration (FNA) was performed for cytological and bacteriological purposes. It had a specificity of 100% and a sensitivity of 72.7%. Surgery was indicated for inconclusive cytology or pre-fistulized lymphadenopathy (12 cases). Diagnosis was cytological for 12 patients and histological for others. The search for other sites of infection was systematic. The sites found were: pulmonary in 1 case, tonsillar in 2 cases and nasopharyngeal in one case. Pre-therapeutic evaluation was conducted in all cases. Initial empiric treatment comprised a 4-drug regimen for a median duration of 8.8 months, with an intensive phase of 2 months, followed by a continuation phase of 7 months (isoniazid and rifampicin). Medical treatment was prolonged for patients with drug resistance or poor clinical responses. During treatment, 11.2% of patients had presented side effects related to antitubercular medication. A paradoxical reaction was observed in 8.3% of cases. Drug resistance was observed in 14.8% cases. Univariate analysis identified predictive factors for prolonged treatment (>9 months): history of treated lymph node tuberculosis and bilateral lymphadenopathy. Recurrence rate was 2.5%, with clinical cure achieved in all cases after a mean time of 8.8 months.
Conclusion: Due to the low contribution of bacteriology and the high rate of inconclusive cytology, surgery remains important in the management of lymph node tuberculosis in association with medical treatment.
Keywords: Tuberculosis – Cervical lymphadenopathy – Adenectomy – Lymph node dissection – Antitubercular medications – Paradoxical reaction
