Characteristics of tuberculous lymphadenitis

Abstract

OBJECTIVE: To describe the characteristics of tuberculous lymphadenitis (TBL) cases in Central Chest Clinic, Colombo. METHOD: This descriptive cross-sectional study was conducted in Central Chest Clinic, Colombo (CCC) using a structured format, from 49 consecutive TBL cases registered at CCC during November 2008 - January 2009. Data was analysed using SPSS soft-ware. TBL was diagnosed based on caseating granuloma in histology, TBL culture for AFB or FNA direct smear for acid fast bacilli and supported by Mantoux test and erythrocyte sedimentation rate (ESR). RESULTS: Majority were aged 21 - 40 years (n=29, 59.2%) and 51 % (n^ 25J were males. Four cases (8.2%) had past TBL. Of the tests, histology showed the highest sensitivity (85.7%), followed by Mantoux test (81.6%), smear (45.8%) and culture (13.3%). Although, smear or culture was not positive among seven TBL cases with non-caseating granuloma (14.3%), diagnosis of TBL was made based on higher mantoux tests ranging from 15 to 50 mm. One case had both TBL and PTB. ATT was continued for more than the standard period in 11 cases (22.4%) with surgical interventions (n=7), persistent lymph node (n=3) and drug induced hepatitis (n=l). Oral prednisolone was given to ten cases for persistent lymph node (n=7) or cutaneous reaction (n-1). All the cases (n=10) who received antibiotics had a surgical intervention. Cut-offs for ESR and Mantoux determined by ROC curves. CONCLUSION: At the Chest Clinic, Colombo the diagnosis of TBL is made commonly by histology and Mantoux test rather than a positive culture.