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Tuberculosis has been attracting attention as a re-emerging infection in recent years. Extrapulmonary tuberculosis in the head and neck region usually takes the form of tuberculous cervical lymphadenitis, and salivary gland tuberculosis is rare. Parotid gland tuberculosis is frequently difficult to differentiate from malignant tumors, and definitive diagnosis is often based on postoperative pathology. We report a case in which we reached a definitive diagnosis by appropriate and careful investigation and immediately initiated antimycobacterial therapy while avoiding surgery. The gentleman in his 70s presented with swelling below the left ear. The only local signs were mild tenderness and swelling, with no reddening of the skin or facial paralysis. Results from fine needle aspiration cytology were suggestive of acid-fast bacterial infection. Following puncture, reddening of the skin and necrosis appeared, and a local biopsy was performed. Pathology demonstrated the presence of Langerhans multinucleated giant cells and epithelioid granuloma. As polymerase chain reaction testing of a sample submitted at the same time was positive for Mycobacterium tuberculosis DNA, parotid gland tuberculosis was diagnosed. Outpatient combination therapy was initiated with isoniazid, ethambutol, and rifampicin, to which the infection was sensitive. Since completion of this oral treatment, the patient has shown an uneventful course, with no parotid gland swelling, cervical lymph node swelling, or signs of recurrence. Parotid gland tuberculosis must always be borne in mind as a differential diagnosis for parotid gland tumors.

BACKGROUND Salivary duct carcinoma (SDC) is a rare, extremely aggressive malignancy that arises in the submandibular gland. It can metastasize locally early and therefore is an important differential diagnosis of metastatic disease in cervical lymph nodes or specific lymphadenitis such as tuberculous cervical lymphadenitis. CASE SUMMARY We report a case of SDC in the submandibular gland that presented diagnostic difficulty. The lesion was coincidentally discovered through examination of the radiolucent area of the maxilla. Imaging failed to confirm the possibility of specific inflammation, leading us to execute an open biopsy to verify the diagnosis. The surgical specimen showed that the submandibular gland was primarily replaced with a calcified body. Following histological analysis and confirmation, we performed surgical resection, radiotherapy, and various chemotherapies. CONCLUSION Radiographic imaging characteristics of lymph node metastases of salivary gland cancer, especially of SDC, may resemble other cervical lymphadenitis; calcification at the submandibular gland is the landmark of SDC occurring at the subman-dibular gland.

Aim and Objective: To study incidence of cervical lymphadenopathy between age, sex and disease. Methodology: A review of 100 cases of cervical lymphadenopathy from Shadan Institute of Medical Sciences, Hyderabad were used for analysis and discussion. Results: Tuberculous cervical lymphadenitis is the commonest disease affecting the cervical lymphnodes 50% followed by secondaries from various primaries 39%, non-specific 5%, Hodgkins lymphoma 4% and non Hodgekins lymphoma 2% were diseases commonly found to be effecting cervical lymphonodes in the study conducted above, we had no cases of cat scratch disease or toxoplasma gondi or other in the group. Heigher incidence of tuberculous cervical lymphadenitis in the age group between 11-40 years. The youngest in the series was 11 years, oldest its 66 years. Average age is 35 years. The male: female ratio is 1:1 in present series. Tuberculosis is a disease of the poor still holds good. In the present study 71% of patients belong to socioeconomically low income groups. Hindus were more commonly affected than Muslim which usually vice versa is explained due to the fact that Hindu population is more than Muslim population in the area when this study was conducted. Distribution of disease is more in rural area 67%. According to the present series, this could be due to increase the awareness of the disease and improvement in living condition of the population living in the urban area. Conclusion: There is very high incidence of tubercular cervical lymphadenitis in patients with enlarged neck nodes in developing countries like India. Cervical lymph node adenopathy constitutes the most common presentation of extra pulmonary form of tuberculosis. However, it mimics other pathological conditions like metastasis from other primary sites, reactive lymphadenitis, chronic non-specific lymphadenitis, lymphoma etc. Therefore, it is important that otolaryngologists are aware of tuberculosis in the head and neck region which can aid in early diagnosis with the help of simple investigations and subsequently patients can be managed promptly without delay.

The diagnosis of Tuberculous Cervical lymphadenitis (TCL) is challenging. The present study aimed to assess the performance of GeneXpert ultra (GXu) in the diagnosis of TCL on Formalin Fixed, Paraffin Embedded Tissues (FFPET). This study included 35 TCL cases confirmed by positive microbiology and/or positive GXu on Fresh Tissues (FT). The diagnostic performance parameters of GXu on FFPET were determined with reference to microbiology (positive Ziehl Neelsen and/or positive culture) and with reference to positive microbiology and/or positive GXu on FT. The GXu on FFPET was positive in 26/35 (74%) cases. With reference to positive ZN and or culture, the sensitivity, specificity, positive predictive value, and negative predictive value of GXu on FFPET were 63%, 100%, 100% and 71% respectively. With reference to positive microbiology and/or positive GXu on FT, these rates were 74%, 100%, 100% and 40% respectively. GXu on FFPET is a reliable tool for the detection of Mycobacterium tuberculosis complex particularly for cases where microbiological investigations have not been performed.

Objective This study describes the clinical characteristics and course of conservative treatment using anti-Tb medication and dressing in patients with tuberculous cervical fistula resulting from abscess formation, and to investigate factors prognostic of dressing and treatment duration. Methods The medical records of patients with tuberculous cervical lymphadenitis were reviewed, and 38 of these patients who presented with cutaneous fistula that resulted from abscess formation were included in the study. Results The mean duration of dressing until fistula closure was 3.7 ± 2.0 months (range 0.2–8.5), and the mean duration of treatment with anti-Tb medication was 10.6 ± 2.6 months (range 6.0–16.0). Patients with concomitant Tb, beyond the cervical lymph nodes showed significantly prolonged duration of dressing (4.6 months vs. 3.2 months, p = 0.025) and anti-Tb medication (11.8 months vs. 9.8 months, p = 0.015). Conclusion Our results indicate that about 3.7 months of dressing was required for fistula closure. Tuberculous cervical lymphadenitis patients with fistula who had Tb beyond the cervical lymph nodes could be expected to require dressing for 4.6 months and prolonged and anti-Tb medication treatment.

Objective: This study assesses the role of fine-needle aspiration cytology (FNAC) in the diagnosis of tuberculous lymphadenitis (TL) in comparison with histology and bacteriology findings. Study Design: We undertook a descriptive retrospective study of 937 FNAC specimens from 851 patients with cervical lymph nodes. The FNAC findings were then compared to histopathology and bacteriology. Results: Of the 937 aspirates, the cytopathological diagnoses consisted of 426 (55.9%) TL, 185 (24.3%) reactive lymphoid hyperplasia, 18 (2.3%) suppurative inflammation, 78 (10.2%) malignant metastatic tumor, and 54 (7%) lymphoma. Of the 426 TL cases, 171 were diagnosed by FNAC combined with bacteriological examination. In this group, 22 cases were found to be positive on Ziehl-Neelsen stain and 16 by culture. A histopathology report was available for 62 cases. Compared to histopathology, the overall diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNAC in the diagnosis of cervical TL were, respectively, 96.77, 100, 100, and 96.67%. When comparing bacteriology to histopathology, these values were 97.44, 100, 100, and 91.67%. Conclusion: Our study shows that FNAC is a sensitive and specific tool for the diagnosis of cervical TL.

In the 19th century it was widely believed that both tuberculosis and cervical lymph node swelling, known as scrophula, affected individuals predisposed to an inherited "diathetic constitution". In 1882 Robert Koch proved that human tuberculosis and scrophulous lesions were caused by the bacillus Mycobacterium tuberculosis. In the early twentieth century it was stated that Mycobacterium bovis, the bacillus of cattle tuberculosis, could also cause cervical lymphoadenitis in humans, especially in children, by the intake of milk from sick cows. The incidence of this condition decreased after the infection was controlled in cattle and pasteurization of the milk was introduced. A type of granulomatous necrotizing and suppurative cervico-facial lymphadenitis associated to non-tuberculous mycobacteria was described in 1956. It mainly affects children younger than 5 years old, particularly those born in countries with non-endemic tuberculosis. Tuberculous cervical lymphadenitis is prevalent in young adults from tuberculosis-endemic countries and in HIV-infected subjects. Infectious etiology displaced the importance of a personal disposition in the development of scrophula. Nevertheless, mutations that confer susceptibility to mycobacterial infection are currently investigated.

Objective Lymphadenitis can be treated successfully by empirical antibiotic therapy. However, inflamed lymph nodes can progress into an abscess with local and/or systemic reaction, which requires more complex treatment strategies. The study aim to analyze possible predictors for abscess formation within inflamed nodes that require surgical drainage. Materials and Methods We retrospectively enrolled 241 patients with acute or sub-acute cervical lymphadenitis. Demographic including, lymph node characteristics, management, and final diagnosis were recorded. Predictors for abscess formation within the lymph node that required surgical drainage were evaluated using univariate and multivariate analysis. Patient and lymph node characteristics that differentiated suppurative cervical lymphadenitis (SCL) from other lymphadenitis were also analyzed. Results There were 41 cases of SCL, 173 cases of uncomplicated cervical lymphadenitis, and 27 cases of tuberculous cervical lymphadenitis (TBLN). Abscess was surgically drained in 39 patients, while 2 patients received a needle aspiration. In 9 patients, SCL complications included cellulitis of the neck soft tissue, supraglottic swelling, internal jugular vein thrombosis, and sepsis. Two patients were diagnosed with melioidosis and actinomycosis after drainage. Multivariate analysis showed that an immunocompromised host, male sex, and receiving prior inadequate treatment were predictors for surgical drainage. TBLN patients had similar manifestations as SCL patients. However, affected nodes in SCL patients were singular, painful, and showed fluctuation. Conclusions Following SCL diagnosis, abscess drainage and appropriate antibiotic treatment should be considered. Aspiration or surgical drainage can be effective in certain patients. Pathogen isolation and tissue biopsy should be performed to ensure accurate diagnosis and antibiotic selection. In addition, TBLN and melioidosis should be considered, especially in endemic areas.

With improvement in economic and social conditions and the use of effective anti-tuberculous therapy, the developed nations and most developing nations have enjoyed a decline in tuberculosis (TB) for several decades. However, over ten million cases of TB are reported annually and TB continues to kill nearly two million people each year. Extrapulmonary TB comprises 15–30% of new TB cases, and tuberculous lymphadenitis is an important manifestation. Tuberculous cervical lymphadenitis, or scrofula, accounts for at least 70% of TB cases involving the head and neck. The majority of cases occur without systemic symptoms or concurrent pulmonary TB. In addition to cervical lymphadenitis, tuberculosis can produce isolated disease in the oral cavity, ear, salivary glands, mandible, nose, and larynx. These infections can have various manifestations and it is important for the clinician to recognize and diagnose head and neck TB promptly. This chapter reviews the epidemiology, clinical manifestations, diagnosis, and treatment of various tuberculous infections in the head and neck.

Tuberculous cervical lymphadenitis is not an uncommon entity when it comes to otolaryngology practice in Bangladesh. This study was done in the department of ENT and Head Neck Surgery, Dhaka Medical College Hospital, Dhaka, from January 2012 to January 2013 and was designed to find out chest x-ray abnormalities in apparently chest asymptomatic confirmed tuberculous cervical lymphadenitis without associated diseases. The diagnosis of tuberculous cervical lymphadenitis was confirmed by fine needle aspiration cytology (FNAC) and/or smear for acid-fast bacillus, and chest x-ray (PA view) was done in all confirmed cases (n=183). Normal chest x-ray was found in 132 cases (72.13%) and abnormal chest x-ray in 51 cases (27.87%). Pulmonary infiltration, the commonest radiological finding was detected in 32 cases (17.49%), hilar enlargement in 17 cases (9.29%), right paratracheal opacity in 2 (1.09%), obliteration of costophrenic angles in 3 cases (1.64%) and miliary mottling in one case (0.55%). Upper zonal predominance of lung parenchymal infiltrations was noted in 12.57% and right lung involvement in 16.39%. Single zone was affected in 9.84% cases and multiple zones were involved in 7.65% cases. We observed right hilar enlargement in 6.56%, left hilar lymphadenopathy in 4.37% and bilateral hilar lymphadenopathy in 2.73% cases. We concluded that routine chest x-ray should be done in all tuberculous lymphadenitis before categorization and starting of treatment. DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21521 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 125-128

Making an accurate diagnosis of tuberculous cervical lymphadenitis (TCL) has been a problem to clinicians because it is a versatile masquerader and is often confused with lymphomas or cervical metastases. Ultrasound (US) has advantages over other examination modalities in that it is noninvasive, inexpensive, time-saving, and able to guide procedures such as fine-needle aspiration and core-needle biopsy. It is increasingly being recognized as a primary tool for the evaluation of cervical lymph nodes. In this article, we present six cases with microscopically and/or pathologically confirmed TCL and illustrate the US features. A literature review was also conducted. The key US features of TCL include hypoechogenecity, strong internal echoes, echogenic thin layers, nodal matting, soft tissue changes, and displaced hilar vascularity. US is a reliable and effective tool in assessing cervical lymphadenopathies. When TCL is suspected under US, US-guided procedures such as fine-needle aspiration or core-needle biopsy can be conducted concomitantly to obtain the microscopic or pathological proof.

Summary: Objective: Tuberculous cervical lymphadenitis is the most common presentation of extrapulmonary tuberculosis (TB) in Saudi Arabia and worldwide. Obtaining a tissue biopsy for culture and histopathology is frequently needed to establish the diagnosis. The available diagnostic tools include excisional surgical biopsy, fine needle aspiration (FNA) and ultrasound-guided core lymph node biopsy. We present a single center experience of the use of ultrasound-guided core lymph node biopsy as a diagnostic tool for tuberculous lymphadenitis. Methods: A retrospective review of the interventional radiology database for all of the patients with cervical lymphadenopathy undergoing ultrasound-guided core biopsy at King Abdulaziz Medical City-Riyadh, Saudi Arabia from January 1 2008 to December 30 2011. The data were the patient demographics, clinical characteristics, biopsy method and pathological and clinical diagnoses. Results: Five cases underwent ultrasound-guided cervical lymph node biopsy during the study period. A total of 55 cases underwent excisional cervical lymph node biopsy in the same period. The age of the patients who underwent the core biopsy ranged from 18 to 76 years old. All of the biopsies were performed as one-day surgery, and all of the patients were discharged on the same day with no complications. The final diagnosis was confirmed in all of the cases (100%); with tuberculosis being the diagnosis in four of the five cases (80%), and one case being diagnosed as lymphoma. Conclusion: Ultrasound-guided core biopsy is an underutilized procedure in our hospital and could be a very valuable asset in the diagnostic algorithm of tuberculous lymphadenitis in Saudi Arabia. The widespread use of the procedure would positively affect patient care, providing earlier diagnosis and treatment. Keywords: Ultrasound-guided biopsy, Ultrasound-guided core biopsy, Ultrasound-guided lymph node biopsy

Tuberculous cervical lymphadenitis (TCL) is not very uncommon in our country. A series of 60 cases was studied from 204 non- thyroid neck swelling which were selected from 20,558 patients attending in ENT department in Central Police Hospital and Mitford Hospital, Dhaka in 3 years. The incidence of TCL was 29.41% among the non- thyroid neck swelling and 0.3% from total number of patients attending in ENT department. The most vulnerable ago group was the second decade 38.33% with female preponderance ( Female male ratio was 2: 1). The common presentaions were neck swelling (100%), fever (66.67%), night sweat (50%). 50% cases were associated with pulmonary tuberculosis. Tuberculin test was positive in 73.34%. Maximum number of patients were from low socioeconomic class and BCG vaccination had a significant protective role (31.67% were vaccinated and 68.33% were one- vaccinated). On histopathology of cervical lymph nodes caseation necrosis was found in 85% of cases.DOI: http://dx.doi.org/10.3329/bmj.v41i2.18793 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 9-12

Objectives/Hypothesis The World Health Organization endorsed the Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis (TB), but there is limited information about the utility of this assay for the diagnosis of TB lymphadenitis. Therefore, the objective of this study was to assess the diagnostic accuracy of Xpert MTB/RIF assay in HIV-infected patients with palpable cervical lymph nodes. Study Design Prospective, diagnostic test study. Methods Consecutive patients with cervical lymphadenopathy were prospectively enrolled between January 2011 and March 2013. Lymph node specimens were obtained through fine-needle aspiration or excisional biopsy. Mycobacterial culture was considered as the gold standard. Results Mycobacterium TB was cultured from 15 of 68 specimens (22.05%), and 53 specimens had negative cultures (77.94%). The sensitivity of Xpert MTB/RIF was 100% (95% CI, 74.65%–100%), and the specificity was 100% (95% CI, 91.58%–100%). Smear microscopy had a lower diagnostic performance. Conclusion Although based on a limited sample size, our study indicates that Xpert MTB/RIF is a useful method for the diagnosis of cervical TB lymphadenitis in HIV-infected patients, regardless of the bacillary load in smear-positive samples or the CD4 T cell count. The sensitivity, specificity, positive predictive value, and negative predictive value were similar to gold-standard culture. Level of Evidence N/A. Laryngoscope, 124:1382–1385, 2014

Introduction: Cutaneous tuberculosis (CTB) is a rare presentation of extrapulmonary tuberculosis (TB) with various clinical manifestations. Tuberculids, a type of CTB, are probably the result of hyperergic immune reaction induced by Mycobacterium tuberculosis. Lichen scrofulosorum (LS) is a rare tuberculid mostly seen in children and young adults with or without other manifestations of tuberculosis. Case report: We present a 30 year old patient presented with a papular eruption on his trunk and upper extremities. The patient had recently started on a 4 drug-regimen treatment for a diagnosed tuberculous cervical lymphadenitis and he was under investigation for pulmonary TB. Histopathology of the papular lesions showed epithelioid granulomas strongly indicating lichen scrofulosorum. The eruption responded to antitubercular therapy with complete clearance of the lesions. Discussion: The tuberculids are a form of CTB caused by hypersensitivity reactions to Mycobacterium tuberculosis. The diagnosis of LS is problematic and frequently delayed because of its rarity and clinical similarity to many other more common skin conditions.

Although Excision Biopsy has traditionally been required to diagnose cervical tuberculous lymphadenitis tine needle aspiration cytology (FNAC) has also been found to be useful. This prospective study presents the comparison of FNAC vs Excision Biopsy for suspected tuberculous cervical lymphadenitis in 100 consecutive. The aim and objective of the study was to determine whether FNAC is helpful in diagnosing tuberculous cervical lymphadenopathy thus avoiding Excision Biopsy. Patients between 5-70 years of age with suspected tuberculous lymphadenitis were included. Among these 62% were female and 38% were male 74% belong to poor class and 26% to middle class. 86%, were having history of immunization again tuberculosis with BCG. While 14% had no such history. The neck swelling was present in all 100 patients with some percentage of associated symptoms. The FNAC was positive for tuberculosis in 80 (80%) patients and Excision Biopsy in 94(94%) patients. Excision Biopsy was more sensitive than FNAC (94% vs 80%) in diagnosing tuberculous cervical lymphadenopathy. So it was concluded that FNAC is a safe alternative to Excision Biopsy and it should be recommended as first line and Excision Biopsy as second line investigation only if results of FNAC are negative.

Objective The objective of this study was to investigate the feasibility of computerized segmentation of lymph nodes to evaluate the relationship of treatment outcomes in tuberculous cervical lymphadenitis (TCL). Methods The study included 52 subjects with TCL that had CT before standard medical treatment. The relationship between the medication treatment response, volume and ratio of necrotic area of the largest lymph node in patients with TCL was evaluated. The treatment outcome was defined as the ‘responder’ ( n = 35) and ‘non-responder’ ( n = 17) groups. Seventeen non-responder patients required surgery. Results The average lymph node volumes and ratio of necrotic area were 58.59 cm 3 (range, 4.96–249.48 cm 3 ) and 0.30 (range, 0–0.59), respectively. There was a significant difference in the lymph node volumes (34.91 ± 24.00 cm 3 vs. 107.04 ± 69.12 cm 3 , p p = 0.001) between responders and non-responders. The receiver-operating-characteristic (ROC) curve analysis was used for differentiating responders from non-responders; it showed that the area under the curve for the lymph node volumes and ratio of necrotic area was 0.845 and 0.759, respectively. The cut-off value for the lymph node volumes and ratio of necrotic area was 44.15 cm 3 and 0.36 based on the ROC curve. Conclusions A large lymph node volume and high ratio of necrotic area on the 3D reconstruction of CT images were associated with the response to medical treatment for TB. These findings might be useful for assessing treatment outcomes.

Clinically apparent cervical lymphadenopathy has been found at the initial presentation in 23 to 56 % of cases of papillary thyroid carcinoma. Here we report tuberculous lymphadenitis mimicking metastatic lymph nodes from papillary thyroid carcinoma and suggest that tuberculosis apart from metastasis in papillary thyroid carcinoma should also be considered in the etiology of enlarged lymph nodes in such patients, especially in those with risk factors for tuberculosis. Therefore, the importance of careful pre-operative evaluation of cervical lymph node metastasis cannot be overestimated, so that patients do not undergo unnecessary neck dissection for other benign conditions.

We report two unusual cases of tuberculous lymphadenitis mimicking metastatic lymph nodes from papillary thyroid carcinoma (PTC). Pre-operative ultrasonography of the cervical nodes suggested a metastasis with cystic necrosis and calcification in PTC patients, but permanent pathology revealed tuberculosis lymphadenitis after neck dissection. In cases suspicious for metastatic cervical nodes in patients with PTC, fine-needle aspiration cytology may be indicated for the differential diagnosis of tuberculosis lymphadenitis, especially in those who have experienced tuberculosis in the past.

Mycobacterium interjectum is a rare causative agent of cervical lymphadenitis. We describe a 2-year-old girl with suspected tuberculous cervical lymphadenitis. Sequencing of the 16S rRNA gene allowed the correct identification of Mycobacterium interjectum. As yet, only nine case reports of infections due to M. interjectum in children have been reported in the literature, and in all of them a correct identification could only be obtained using gene sequencing.

We report a case of primary nasopharyngeal tuberculosis in a 27-year-old woman who had immigrated to Japan from Vietnam. She initially complained of right cervical swelling. A red granular mass with ulcer was observed in the nasopharyx. A biopsy from the nasopharynx showed tuberculous changes. Tubercle bacilli were detected in a smear of pharyngeal discharge. Since there were no apparent pulmonary tuberculous lesions, we diagnosed the case as primary nasopharyngeal tuberculosis with tuberculous cervical lymphadenitis.The nasopharyngeal lesion disappeared after three weeks anti-tuberculosis chemotherapy. Tuberculous cervical lymphadenitis increased despite chemotherapy, and required dissection and drainage.Anti-tuberculosis chemotherapy was administered by a short course of carefully monitored treatment.

Background Due to different reports about the value of fine needle aspiration cytology (FNAC) as a simple and minimal invasive diagnostic tool for extra-pulmonary tuberculosis, we attempted to demonstrate the sensitivity of FNAC in patients with cervical tuberculous lymphadenitis in Iran. We wanted to know if fine needle aspiration (FNA) is an accurate method as a first step in diagnosis or not. Methods This study covered a 14 year period identifying 137 patients with a pathological report of granulomatosis in excisional biopsy of lymphadenopathy in two tertiary referral hospitals of Tehran, Iran. The results of fine needle aspiration cytology (FNAC) in 67 patients with tuberculosis cervical lymphadenitis were evaluated. Results The FNA cytology showed granuloma with background necrosis in five patients (7.46 per cent) and granuloma with or without necrosis in 13 patients (19.40 per cent). Patients with positive results of FNAC had a longer duration of lymphadenopathy compared to other patients. Conclusion In this study, sensitivity of FNAC was reported to be low. The sensitivity of this method was 7.46 per cent (including pathology granuloma with background necrosis) and 19.40 per cent (total cases of granuloma with or without necrosis). It seems that the sensitivity of FNAC is significantly lower in patients with early cervical tuberculosis (TB) lymphadenitis. Combining acid-fast bacillus (AFB) staining and non-culture methods like polymerase chain reaction (PCR) could increase FNA sensitivity in these patients.

International audience; The incidence of tuberculous cervical lymphadenitis (TCL) is likely to be on the rise in Tunisia over the last two decades. However, this pathological condition remains poorly characterized, in regard to involved mycobacterial species. Purpose: To study the etiology and treatment outcome of TCL among Tunisian patients; to indicate the myc-obecteria responsible for the majority of TCL cases. This prospective study has involved 114 patients, clinically diagnosed as TCL, presenting to a National referral hospital in Tunis, from November 2011 to January 2014. Results: 69 patients displayed typical cytological signs of TCL, whose mycobacterial etiology was confirmed in 23 cases. 4 cases may be a possible disseminated TB. Mycobacterial species assignment could be established for 15 culture-positive specimens, 11 of which were found to be Mycobacterium bovis, while the remaining were identified as tuberculosis. 6 of M. bovis isolates belonged to the BOVIS1 spoligopattern, and 3 of the M. tuberculosisisolates to the Haarlem3, one of the most prevalent genotype associated with pulmonary tuberculosis in Tunisia. Although all subjects lived in an urban area, the majority declared having consumed raw milk and derived products. The cure rate was low, as among patients that completed an anti-tubercular chemotherapy of at least 8 months, only 55.5% were cured. Conclusion: Our results are consistent with literature since positive cases demonstrated by AFB smear test don't exceed 37.4% and varied by culture between 19 and 71%. This is the first indication that M. bovis is a significant cause of TCL in Tunisia. Consumption of unpasteurized dairy products is the most likely source of transmission. The low cure rates among TCL cases should call health authorities for improved management and therapeutic schemes.

To investigate the distribution of lymph nodes in the neck during the process of development of tuberculous cervical lymphadenitis (TCL) in patients attending an outpatient clinic over a 1-year period.This was a prospective, cross-sectional, observational study which included 100 cases of histopathologically confirmed TCL of6 weeks duration.Lymph nodes in the posterior triangle (PT) were found to be commonest (51%), followed by those in the upper deep cervical (UDC; 48%) and submandibular (SM; 36%) regions. The supra-clavicular (SC; 3%), submental (Sment; 4%) and lower deep cervical (LDC; 9%) regions were found to be the least frequently affected. Uni- and bilateral disease were observed in 83% and 17% of patients, respectively. A single group of lymph nodes was involved in 68% of patients, 2 groups in 29% and2 groups in 13% of patients.These results indicate that if unilateral, painless, enlarged and mated lymph nodes are found in either the PT or the UDC or SM areas, lymphadenitis of tuberculous origin should be suspected rather than lymphadenitis of any other etiology.

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Objectives: The aim of the present study was to identify differences in clinical characteristics between patients with tuberculous cervical lymphadenitis and those with nontuberculous cervical lymphadenitis and to determine the diagnostic accuracy of fine needle aspiration (FNA) cytology. Study Design and Setting: Seventy-two patients with inflammatory cervical lymphadenitis were studied retrospectively. They were divided into 2 groups: group 1 consisted of those with tuberculous lymphadenitis and group 2 consisted of those with non-tuberculous lymphadenitis. The demographic characteristics, clinical parameters, and hematological and cytological results of the 2 groups were compared. Results: Other than there being a significantly higher proportion of foreign-born patients in group 1, there were no differences in clinical characteristics between the 2 groups. The sensitivity and specificity of FNA cytology in the diagnosis of tuberculous lymphadenitis were 88% and 96%, respectively. Conclusion: It is difficult to clinically differentiate tuberculous from nontuberculous lymphadenitis. FNA cytology is useful in the diagnosis of tuberculous lymphadenitis. Significance: In regions where tuberculosis is endemic, treatment can be instituted without the need for excisional biopsy if the FNA results show characteristic caseating granuloma. (Otolaryngol Head Neck Surg 2002;126:176-9.)

Three cases of tuberculous cervical lymphadenitis are presented. All patients presented without positive chest x-ray, fluctuant mass and discharging pus because these cases were all primary and early stage. The diagnoses were very difficult, and histopathological examination was most reliable and only one method.

In this study, we reviewed the medical records of 14 patients who had visited our institution during the past seven years and had been diagnosed as tuberculous cervical lymphadenitis. Three of 14 patients were males and others were females. Only two patients had past histories of pulmonary tuberculosis. The diagnosis was confirmed by biopsy specimens in 13 patients and the method of therapeutic diagnosis was adapted to one patient.Statistical reports by WHO showed that the incidence of tuberculous disease in Japan is relatively higher than those in other countries and the number of patients with tuberculous disease shows a gradual increase. Based on those reports, tuberculous cervical lymphadenitis should be considered when examining neck mass.

Lymphadenitis is the most generic form of extra pulmonary manifestation of tuberculosis. It is both diagnostic and therapeutic challenge because it mimics various other pathologic processes and yields inconsistent physical laboratory findings. Diagnosis is quite difficult often requiring biopsy. It is also important to differentiate tuberculous from non-tuberculous mycobacterial cervical lymphadenitis as their treatment protocols are different. We are presenting a case report of two patients who presented with neck swelling. Elastography is a recent advance in the field of sonography helping in identifying nature of pathology. Sonography, doppler and elastographic findings are discussed.

0196-4399/00 (see frontmatter) © 2010 Elsevier Clinical Microbiology Newsletter 32:19,2010 In 2008, the World Health Organization (1) reported that one-third of the world’s population, or over 2 billion people, are infected withMycobacterium tuberculosis. Most individuals infected with M. tuberculosis have asymptomatic disease, but an estimated 9 million people develop active tuberculosis infections each year resulting in over 2 million deaths. Most cases of tuberculosis are pulmonary in nature, but extrapulmonary infections are not uncommon. Extrapulmonary infections may involve the central nervous and skeletal systems, the kidney, and/or the gastrointestinal tract (2). This case report describes a patient with tuberculous cervical lymphadenitis who presented with no evidence of primary pulmonary infection and a negative tuberculin skin test. This case should serve to remind the reader of the importance of extrapulmonary tuberculous disease in the absence of primary pulmonary infection. Case Report A previously healthy 28-year-old male presented to his primary care physician for evaluation of a mass on the left side of his neck. The neck mass was of sudden onset, and the patient gave no history of febrile episodes, chills, sweats, or sore throat. The patient was employed as a research assistant at a local medical school and, as part of his routine and periodic health assessment, had a tuberculin skin test 5 months previously, which was read as negative. The patient was born in the Philippines, but when he was 6 years old, he moved to the United States with his Mailing Address: Paul A. Granato, Ph.D., Department of Microbiology and Immunology, WH 2204, SUNY Upstate Medical University, 750 East Adams St., Syracuse, NY 13210. Tel.: 315-464-7653. Fax: 315-464-4417. E-mail: granatop@ upstate.edu Case Report

WOS: 000329493900009 PubMed: 24239221 Background: Over the last two to three decades there has been a marked decrease in certain bacterial infections in Turkey. One of them is tuberculosis. Of note, statistics published by the Turkish Ministry of Health (MoH) show decreasing pulmonary tuberculosis (PTB), but on the other hand, increasing extrapulmonary tuberculosis (EPTB). The most common form of EPTB is tuberculous cervical lymphadenitis (TCL). The increase in the number of TCL cases despite the decline in cases of PTB is seen as a paradoxical issue. In contrast there has been an increase in the number of oropharyngeal tularemia cases in the last decade in Turkey. The aim of this study was to draw attention to the importance of differentiating between TCL and tularemia lymphadenitis, because these diseases may have a similar histopathological appearance. Methods: Thirty-two cases diagnosed as TCL were identified from the archives of a pathology laboratory (Patomer Pathology Laboratory, Bursa, Turkey). PCR tests for Francisella tularensis and Mycobacterium tuberculosis were carried out on the paraffin tissue blocks of these cases. At the same time, statistical data on PTB and EPTB for the period 1996-2010 were retrieved from the MoH and reviewed. Statistics related to tularemia, which has been diagnosed since 1988 and has been increasing in the last 10 years, were obtained from the Department of Zoonoses of the MoH. Results: Six out of 32 (19%) cases who had previously been diagnosed with 'casseifying granulomatous lymphadenitis consistent with tuberculosis' were found to be positive for tularemia by PCR test of the cervical lymph nodes. Conclusions: Oropharyngeal tularemia should be kept in mind in the differential diagnosis of cervical lymphadenitis in widespread geographic regions of the Northern Hemisphere, including the Asian continent. In particular, if granulomatous inflammation with necrosis is seen histopathologically, tularemia should be excluded before making the diagnosis of TCL. (C) 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved.

Mycobacterium massiliense is a rapidly growing mycobacterial species. The pathogenicity of this subspecies is not well known. We report here the annotated genome sequence of M. massiliense strain M18, which was isolated from a lymph node biopsy specimen from a Malaysian patient suspected of having tuberculous cervical lymphadenitis.

Summary Three adult patients with tuberculous cervical (submandibular) lymphadenitis were treated in the past year in the Department of Oral and Maxillofacial Surgery, Evangelismos Hospital, University of Athens. None had a history of exposure to tuberculosis. In all, the chest X-rays were clear but the PPD tests were positive. All patients underwent excisional biopsy of grossly involved lymphnodes and histological examination and special stains confirmed the diagnosis. The patients were subsequently treated with triple drug administration. Antituberculosis chemotherapy consisted of isoniazid, rifampin and ethambutol and all are well after a follow-up of 9, 10 and 11 months respectively. Medical approaches often failed to diagnose tuberculous cervical lymphadenitis conclusively, and this disease remains a diagnostic and therapeutic challenge, because it mimics other pathological processes. The treatment of choice seems to be surgical excision and long term antituberculosis chemotherapy. Surgery provides a rapid tissue diagnosis, because the histological examination of the excisional biopsy is the most reliable diagnostic test.

We have treated 8 patients with tuberculosis in the Department of Otorhinolaryngology of Kimitsuchuo Hospital during the past 2 years.The patients ranged in age from 29 to 70 years (average 53.8 years). Anti-tuberculous chemotherapy was administered to all 8 patients. Seven were cured, but one died of pulmonary tuberculosis.Four of the 8 patients, including all of those with tuberculous otitis media, also had pulmonary tuberculosis, but most of those with tuberculous cervical lymphadenitis did not have pulmonary tuberculosis. Their painless cervical swelling made it difficult in some cases to differentiate tuberculosis from malignancy.A carefully taken personal history is important. The diagnosis should be confirmed with X-ray examination, but finally histopathological studies are required.Early diagnosis and treatment are mandatory.

All four patients had neck swelling, but only one had a pulmonary lesion. It is now difficult to diagnose tuberculosis, because it has become rare, but it was never easy to diagnose tuberculous lymphadenitis.Biopsy and histopathologic examination are useful in the diagnosis of tuberculous lymphadenitis.

Cervical lymphadenopathy with packet formation as the sole presentation of tuberculosis is very rarely seen in modern Japan. During the four years from 1987 to 1990, 5 cases of cervical scrofula with packet formation were treated with selective neck dissection followed by antituberculous chemotherapy at the ENT-department of Haibara General Hospital. Clinical evaluation of these cases suggested the following: 1) The physician must keep in mind that cervical scrofula should be included in the differential diagnosis of any neck masses, and malignant neck tumors particularly should be differentiated from cervical scrofula. 2) The treatment of cervical scrofula should be appropriate to the clinical stage diagnosed by CT or MRI. Recommended therapy for cervical scrofula with packet formation is selective neck dissection followed by antituberculous chemotherapy, which can shorten the period of treatment. 3) We present here a 22-year-old female from the Philippines with cervical scrofula and suggest that, in the future in Japan, tuberculosis may frequently be encountered in the immigrant population from the countries with high incidences of tuberculosis.

Objective:We report an extremely rare presentation of concomitant tuberculous cervical lymphadenitis in a patient with carcinoma of the larynx.Case report:A 66-year-old man presented with a nine-month history of hoarseness. He was found to have an exophytic lesion over the posterior half of the right vocal fold. He also had a palpable right jugulodigastric node. Biopsy of the vocal fold lesion revealed invasive squamous cell carcinoma. Histological analysis of an excision biopsy specimen from the lymph node was highly suggestive of tuberculosis. On further assessment of the slides, one acid-fast bacillus was seen. The patient was treated with radiotherapy to the larynx and concomitant anti-tuberculosis chemotherapy. Five months following treatment, there was no sign of laryngeal cancer recurrence; however, the patient continued to have a productive cough and night sweats.Conclusion:To our knowledge, this is the first report of a laryngeal carcinoma with concurrent tuberculous cervical lymphadenitis. In the face of an unhelpful fine needle aspiration cytology examination, an assumption of metastatic neck disease could have been made. Subsequent surgical and/or oncological intervention would have been highly inappropriate, with potentially catastrophic effects. This case highlights the importance of proper diagnosis, and emphasises the fact that tuberculosis should always be borne in mind in the differential diagnosis.

Scrofula, or tuberculous cervical lymphadenitis, though now rare, is more commonly seen in minorities, women and immunosuppressed patients, especially those with HIV. We discuss a patient who presented to the emergency department with an anterior neck abscess and was diagnosed with both advanced HIV and disseminated tuberculosis. A high level of suspicion is necessary to make this diagnosis, but given an increasing degree of global mobility, such patients may present anywhere. Medical management is effective, though difficult. Early diagnosis improves the patient's individual prognosis and may prevent further exposure and transmission to the population.

A case is reported of a 52-year-old lady who presented with a swelling of the submental region of unknown aetiology mimicking a dental abscess. Following an excision biopsy of the lesion, the histopathology report revealed a mass of lymph nodes with granulomatous inflammation strongly suggestive of infective aetiology, most probably of mycobacterial (either tuberculosis or non-tuberculous mycobacteria (NTM)) origin. Cervical lymph node enlargement due to NTM remains a diagnostic challenge because of the inconsistent reliability of clinical and laboratory findings. We discuss the significance of caseating granulomatous inflammation in cervical lymphadenitis and provide a brief overview of tuberculosis and a comparison with NTM.Dental surgeons can play an important role in the diagnosis and early treatment of many systemic conditions and they should be aware of the signs and symptoms of tuberculosis, as this is now an increasingly common condition, particularly amongst the immigrant population.

Objective: To investigate the efficacy of medical antituberculous treatment in patients with tuberculous cervical lymphadenitis (TCL).Methods: In the period 1996–2002, 73 TCL patients were reviewed and the results of clinical and laboratory testing were documented. The efficacy of a four-drug chemotherapy regimen was investigated.Results: Purified protein derivatives (PPD) skin test results were positive in 58 (79 per cent) patients. Chest X-rays revealed changes consistent with tuberculosis in nine (12.3 per cent) patients. The mean duration of medical treatment was 10.04 months. In follow-up evaluation, 14 (20 per cent) patients were considered suspicious for resistant TCL and total excision of all nodes was performed. Histopathology confirmed TB in only 10 of these cases.Conclusion: The high incidence of residual disease in our study indicates that medical treatment (at least nine months of four combined antituberculous drugs) did not seem to be effective. If lymphadenopathy persists, total surgical excision of lymph nodes should be the treatment of choice.