Clinical study on tuberculous cervical lymphadenopathy

BACKGROUND: Tuberculosis because of its increasing prevalence continues to be the major burden in our country. Inspite of the advanced studies performed in the field of medicine, it continues to be a major burden. Pulmonary tuberculosis is most common. Among the extra-pulmonary infections, lymph node involvement is the most common. It is the most common cause of lymphadenopathy in the developing countries. Various modes of treatment are available which includes radiation, chemotherapy and antibiotics. AIMS AND OBJECTIVES: 1. To study about the incidence of tuberculous cervical lymphadenopathy. 2. To study about the clinical presentations (signs, symptoms) of tuberculous cervical lymphadenopathy. 3. To correlate clinical diagnosis with the histopathological findings of tuberculous cervical lymphadenopathy and to interpret the results. 4. To study about the clinical work-up and the various management options, their outcome and to follow up the clinical behaviour and improvement in the course of tuberculous cervical lymphadenopathy for a period of not more than 6 months. MATERIALS AND METHODS: The prospective study was conducted on 100 cases presenting to the outpatient department of GOVT.KILPAUK MEDICAL COLLEGE AND HOSPITAL with the signs and symptoms suggestive of tuberculous cervical lymphadenitis out of which 70 cases proved to be positive for tuberculous cervical lymphadenopathy. This study was conducted on patients presenting to the OPD during the period of Aug 2013 to Aug 2014. This study was conducted by collecting data from individual patients in the form of pretested proforma. All the patients were exposed to FNAC/Excision Biopsy and were started on Anti – tuberculous treatment only after confirming the diagnosis based on the clinical findings and the histopathological reports. RESULTS: In our present series, the incidence of tuberculous cervical lymphadenopathy was maximum in the age group of 21-30 years (35 cases-50%). The disease showed an increasing incidence in females as compared to the male patients, with the female to male ratio being 1.5:1. It is more common in the lower socio-economic status people (90%). The disease shows increased incidence among the rural population which accounts for about 70% of the cases. All the 70 cases presented with the complaint of swelling in the neck. 14 cases presented with fever, 7 cases each presented with pain, weight loss and cough respectively. About 70% of the cases presented within 3 months of the start of the symptoms. The left side nodes were most commonly involved (57.1%). The lymph node involvement was discrete in 77.1% and 22.9% presented with matted lymph nodes according to the present study. The lymph nodes were firm in 70% of the cases and soft in the remaining 30%. The upper deep cervical nodes were involved in 60% of the cases, which was the most common lymph node group involved in tuberculous cervical lymphadenopathy in previous studies also. 57.1% % of the cases presented with raised ESR in the present study. 8.6% of the cases had features suggestive of pulmonary tuberculosis on chest x-ray. 82.9% of the cases showed caseating granuloma on FNAC. FNAC was inconclusive in 17.1% of the cases which were then subsequently subjected to Excision Biopsy which proved positive for tuberculous cervical lymphadenopathy. Tuberculin test was positive in 27.1% of the cases. The patients were then categorised as Category I or Category II patients and were put on Anti-tubercular treatment based on the histopathological (FNAC/Excision Biopsy) reports and were followed up for a period of 6 months. 65 cases were symptom free at the end of the study. INTERPRETATION AND CORRELATION: According to the present study, tuberculous cervical lymphadenopathy was more common among the female population with an increasing incidence in the 21-30 years of age. Swelling in the neck was the most common presenting complaint followed by fever, pain, weight loss and cough. Upper deep cervical group of nodes were the most commonly involved and most of the nodes were discrete and firm in consistency. All the patients were subjected to histopathological examination (FNAC/Excision Biopsy) and were started on ATT based on the reports and as per the RNTCP guidelines. All the patients had a 100% cure rate at the end of the study which included the follow up period of 6 months. Surgical treatments are only adjunctive to chemotherapy and not a replacement