Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-24T18:20:42.868Z Has data issue: false hasContentIssue false
  • English
  • Français

Cervical tuberculous lymphadenitis in the elderly: comparative diagnostic findings

Published online by Cambridge University Press:  18 September 2009

T Kato ,
Y Kimura ,
M Sawabe ,
Y Masuda  and
K Kitamura
T Kato*
Affiliation:
Department of Otolaryngology, Tokyo Metropolitan Geriatric Hospital, Japan
Y Kimura
Affiliation:
Department of Otolaryngology, Tokyo Metropolitan Geriatric Hospital, Japan
M Sawabe
Affiliation:
Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Japan
Y Masuda
Affiliation:
Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital, Japan
K Kitamura
Affiliation:
Department of Otolaryngology, Tokyo Medical and Dental University, Japan
*
Address for correspondence: Dr Tomofumi Kato, Department of Otolaryngology, Tokyo Metropolitan Geriatric Hospital, Sakae-Cho 35-2, Itabashi-ku, Tokyo 173-0015, Japan. Fax: +81 3 3964 1982 E-mail: tomofumi_katou@tmgh.metro.tokyo.jp; kato.oto@tmd.ac.jp
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Patients suspected of having cervical tuberculous lymphadenitis are diagnosed using investigations such as fine needle aspiration cytology and the polymerase chain reaction for Mycobacterium tuberculosis. However, these investigations are intended for primary tuberculosis infection. The majority of cervical tuberculous lymphadenitis cases in the elderly are thought to be caused by reactivation.

Objective:

The aims of this study were (1) to examine the efficacy of fine needle aspiration cytology, polymerase chain reaction and blood tests in the diagnosis of cervical tuberculous lymphadenitis caused by reactivation, and (2) to clarify any differences when compared with primarily infected cervical tuberculous lymphadenitis cases.

Materials and methods:

Thirty-three elderly patients with neck lumps underwent excisional biopsy from 2003 to 2008. The efficacy of fine needle aspiration cytology was examined by comparing the results of excisional biopsy with those of fine needle aspiration cytology performed at the initial medical examination for cases of suspected tuberculous disease. Furthermore, the leucocyte count and C-reactive protein concentration were compared for cases of cervical tuberculous lymphadenitis versus cases of malignant lymphoma.

Results:

Although nine cases were diagnosed with cervical tuberculous lymphadenitis using excisional biopsy, only one of these had been suspected based on fine needle aspiration cytology results. Three cases with tuberculous lymphadenitis were suspected of having malignant lymphoma on initial examination. There was no significant difference in the leucocyte count and C-reactive protein concentration, comparing cases of tuberculous lymphadenitis versus malignant lymphoma.

Conclusion:

Unlike the primary infection often seen in endemic areas, the diagnosis of early stage tuberculous lymphadenitis of the swelling type caused by reactivation in elderly people is difficult to confirm unless excisional biopsy is performed. In elderly patients with neck lumps, cervical tuberculous lymphadenitis should be included in the differential diagnosis.

Keywords

NeckTuberculosisDiagnosisAged
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 12 , December 2009 , pp. 1343 - 1347
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Dawson, DJ, Blacklock, ZM, Hayward, AJ, Walsh, MJ. Differential identification of mycobacteria in smears of sputum. Tubercle 1981;62:257–62CrossRefGoogle ScholarPubMed
2Hopewell, PC, Pai, M, Maher, D, Mukund, U, Raviglione, MC. International standards for tuberculosis care. Lancet Infect Dis 2006;6:710–25CrossRefGoogle ScholarPubMed
3Lee, KC, Tami, TA, Lalwani, AK, Schecter, G. Contemporary management of cervical tuberculosis. Laryngoscope 1992;102:60–4CrossRefGoogle ScholarPubMed
4Castro, DJ, Hoover, L, Castro, DJ, Zuckerbraun, L. Cervical mycobacterial lymphadenitis. Medical vs surgical management. Arch Otolaryngol 1985;111:816–19CrossRefGoogle ScholarPubMed
5Lau, SK, Wei, WI, Hsu, C, Engzell, UCG. Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy. J Laryngol Otol 1990;104:24–7CrossRefGoogle ScholarPubMed
6Beak, CH, Kim, SI, Ko, YH, Chu, KC. Polymerase chain reaction detection of Mycobacterium tuberculosis from fine-needle aspirate for the diagnosis of cervical tuberculous lymphadenitis. Laryngoscope 2000;110:30–4CrossRefGoogle Scholar
7Matsushita, R. The diagnosis and the treatment of lymphadenitis colli tuberculosa [in Japanese]. Geka Chiryo 1966;14:28–35Google Scholar
8Kochi, A. The global tuberculosis situation and the new control strategy of the World Health Organization. Tubercle 1991;72:1–6CrossRefGoogle ScholarPubMed
9Rejagopalan, S, Yoshikawa, TT. Tuberculosis in the elderly. Z Gerontol Geriatr 2000;33:374–80Google Scholar
10Yoshikawa, TT. Tuberculosis in aging adults. J Am Geriatr Soc 1992;40:178–87Google Scholar
11Hernandez-Pando, R, Jeyanathan, M, Mengistu, G, Aguilar, D, Orozco, H, Harboe, M et al. Persistence of DNA from Mycobactrium tuberculosis in superficially normal lung tissue during latent infection. Lancet 2000;356:2133–8CrossRefGoogle Scholar
12Wright, CA, van der Burg, M, Geiger, D. Diagnosing mycobacterial lymphadenitis in children using fine needle aspiration biopsy: cytomorphology, ZN staining and autofluorescence – making more of less. Diagn Cytopathol 2008;36:245–51CrossRefGoogle ScholarPubMed
13Yassin, MA, Olobo, JO, Kidane, D, Negesse, Y, Shimeles, E, Tadesse, A et al. Diagnosis of tuberculous lymphadenitis in Butajira, rural Ethiopia. Scand J Infect Dis 2003;35:240–3CrossRefGoogle ScholarPubMed
14Lau, SK, Wei, WI, Kwan, S, Yew, WW. Combined use of fine-needle aspiration cytologic examination and tuberculin skin test in the diagnosis of cervical tuberculous lymphadenitis. A prospective study. Arch Otolaryngol Head Neck Surg 1991;117:87–90CrossRefGoogle ScholarPubMed
15Purohit, MR, Mustafa, T, Sviland, L. Detection of Mycobacterium tuberculosis by polymerase chain reaction with DNA eluted from aspirate smears of tuberculous lymphadenitis. Diagn Mol Pathol 2008;17:174–8CrossRefGoogle ScholarPubMed
16Yoon, HJ, Song, YG, Park, WI. Clinical manifestations and diagnosis of extrapulmonary tuberculosis. Yonsei Med J 2004;45:453–61CrossRefGoogle ScholarPubMed
17Alleva, M, Guida, RA, Romo, T 3rd, Kimmelman, CP. Mycobacterial cervical lymphadenitis: a persistent diagnostic problem. Laryngoscope 1988;98:855–7CrossRefGoogle ScholarPubMed
18Djoba Siawaya, JF, Bapela, NB, Ronacher, K, Veenstra, H, Kidd, M, Gie, R et al. Immune parameters as markers of tuberculosis extent of disease and early prediction of anti-tuberculosis chemotherapy response. J Infect 2008;56:340–7Google Scholar