Overview of the disease
This is an inflammatory disease of the lymph nodes caused by infection of the lymph nodes by Mycobacterium tuberculosis, which may be characterized by enlargement of the lymph nodes, fever, malaise, night sweats, etc. It is caused by Mycobacterium tuberculosis infection of the lymph nodes and is based on medication, which may be supplemented by surgical intervention.
Definition
Lymph node tuberculosis is a tuberculous lesion caused by Mycobacterium tuberculosis infecting the lymph nodes and is a common type of extrapulmonary tuberculosis.
It can occur in lymph nodes throughout the body, most commonly in the cervical lymph nodes. In addition, it can also occur in the axillary lymph nodes, inguinal lymph nodes, etc. It can also occur in the deep lymph nodes of the body.
Classification
Classification according to pathological manifestations
Nodular type: the lesion lymph nodes are scattered and movable.
Infiltrative type: perilymph node inflammation is more obvious, lymph nodes are enlarged obviously, often adhered to the surrounding tissues, and movement is restricted.
Abscess type: liquefaction occurs in the center of enlarged lymph nodes, forming abscesses, with local fluctuating sensation, no fever and pain, known as cold abscess; if secondary infection occurs, there may be obvious redness, swelling, heat, pain and other symptoms.
Ulcerated fistula type: The subcutaneous abscess at the lesion site breaks down on its own or is cut open, with thin pus flowing out, and a long-lasting fistula (sinus tract) may be formed.
Incidence
The incidence is unknown, but has been on the rise in recent years.
Etiology
Causes
Lymph node tuberculosis is caused by Mycobacterium tuberculosis infection of the lymph nodes. However, Mycobacterium tuberculosis does not normally invade the lymph nodes directly, but rather infects other parts of the body (e.g., the lungs) before invading the lymph nodes.
Risk factors
People with the following risk factors are more likely to develop the disease.
Elderly people, infants and young children.
People who are in close contact with people with active TB.
People with human immunodeficiency virus (HIV) infection, chronic diseases such as diabetes, chemotherapy, and malnutrition.
Smoking.
Alcohol and drug abuse.
Symptoms
Localized symptoms
Lumps in the neck, armpits, groin, and other areas
Lymph node tuberculosis often presents with one or more painless enlarged lymph nodes. Anterior and posterior cervical lymph nodes and supraclavicular lymph nodes are most commonly involved.
If cervical lymph node tuberculosis, it often manifests as a neck mass, which may develop unilaterally or bilaterally, one or more, and the size of the mass varies; initially, the lymph nodes of the disease are scattered and the surface skin is normal. As the disease progresses, the lymph nodes begin to fuse.
The lumps are hard, painless or painful, and can be pushed or moved up and down with swallowing. The lumps are usually not red, and the local skin tends to be free of elevated temperature and tenderness.
Sinus tracts or ulcers
When a lump breaks down, it can form a sinus tract (a hole in the deep tissues of the body that leads to the surface of the body and has only one opening) or an ulcer that fails to heal over a long period of time, which may last for years.
Systemic Symptoms
Some patients may experience systemic symptoms such as low-grade fever, night sweats (sweating after going to sleep, which stops when they wake up), fatigue, weight loss, loss of appetite, and depression.
Other symptoms
Enlarged lymph nodes in the chest may compress the bronchial tubes and cause pulmonary atelectasis, which may lead to lung infection or even bronchiectasis.
Enlarged lymph nodes in the neck can cause upper airway obstruction, but it is very rare.
Involvement of intrathoracic and abdominal lymph nodes may obstruct the thoracic duct and retroperitoneal lymphatic vessels respectively, which may result in celiac disease and ascites.
Medical treatment
Department of Medicine
Department of Infectious Diseases
When symptoms such as enlarged lymph nodes, low-grade fever in the afternoon, night sweats, fatigue and loss of appetite occur, it is recommended to consult a doctor promptly.
General Surgery
When there is a lump in the neck, armpit or groin, etc., it is recommended to consult a doctor promptly.
Preparation for medical treatment
Consultation: Registration, Preparation of documents, Frequently Asked Questions
Tips for the doctor
Wear loose-fitting clothes and avoid wearing clothes made of metal.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Is there a lump in the neck, armpit, groin, etc.?
Is there any pain around the lump?
Are there symptoms such as fever, night sweats, fatigue, weight loss, etc.? How long has it been present?
Medical history checklist
Is there a history of tuberculosis, such as TB, laryngeal tuberculosis, tuberculous peritonitis, etc.?
Any recent contact with TB patients?
Is there a history of blood transfusion, blood donation, injection drug use?
Is there any history of diabetes, hypertension, malnutrition, AIDS, etc.?
Checklist
Test results in the last six months, which can be brought to the doctor’s office.
Laboratory tests: blood count, C-reactive protein, erythrocyte sedimentation rate (sedimentation)
Imaging tests: ultrasound of lymph nodes, CT of lymph nodes
Pathologic examination: lymph node aspiration biopsy
Medication list
Medication use in the last 3 months, if available, bring the box or package to the doctor’s appointment
Anti-tuberculosis drugs: isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin
Antipyretic and analgesic drugs: ibuprofen, acetaminophen
Diagnosis
Diagnosis is based on
Medical history
A history of tuberculosis or close contact with a tuberculosis patient is often present.
Clinical manifestations
The main manifestations are lumps in the neck, armpits, groin and other areas. When the lumps break down, sinus tracts or ulcers may be formed.
It may be accompanied by systemic symptoms such as low-grade fever, night sweats (sweating after going to sleep and stopping after waking up), malaise, weight loss, loss of appetite, and depression.
Laboratory Tests
Blood tests
The white blood cell count may be checked to see if there is a secondary infection.
The white blood cell count is usually normal, but increases in secondary infections.
Erythrocyte Sedimentation Rate (ESR)
Also known as blood sedimentation.
It can be used to see if the lesion is quiescent and if there is a recurrence.
Acceleration suggests active or recurrent lesions.
C-reactive protein (CRP)
Can be used to understand the activity of tuberculosis and to determine the efficacy of treatment.
Elevated levels indicate active lesions.
Tuberculin test (PPD)
The results of the test cannot simply be used to confirm or exclude tuberculosis, but can be used to assist in the diagnosis.
A positive reaction indicates a high probability of tuberculosis infection.
A strong positive reaction indicates the possibility of active TB.
A negative reaction, especially if the test remains negative at higher concentrations, can mostly rule out tuberculosis (note: tuberculosis cannot be ruled out by a negative reaction in cases of advanced age, hormonal or immunosuppressive drugs, or combined immune system disorders).
Mycobacterium tuberculosis antibody test
Detects the presence of antibodies to Mycobacterium tuberculosis in the serum.
A positive test may indicate a previous infection with Mycobacterium tuberculosis, while a negative test may indicate no infection with Mycobacterium tuberculosis (note: this test may have a certain percentage of false positives and false negatives, so it cannot be used directly as a diagnostic or exclusionary evidence).
Imaging
Ultrasound of lymph nodes
Cervical lymph nodes, axillary lymph nodes, and lymph nodes in the inguinal region can be examined to observe the size and nature of the lymph nodes.
CT examination of lymph nodes
It can understand the size and number of lymph nodes as well as their relationship with the surrounding tissue structure.
Tuberculosis pathogenetic examination
Diagnosis of lymph node tuberculosis is confirmed by lymph node biopsy or histologic needle aspiration, and antacid staining, tuberculosis nucleic acid testing (e.g., tuberculosis DNA), and culture of the specimens obtained.
Approximately more than 25% of biopsy specimens are smear-positive for antacid staining, and Mycobacterium tuberculosis is isolated from approximately 50% of biopsy specimens from patients ultimately diagnosed with lymph node tuberculosis.
Pathologic Examination
Lymph node aspiration biopsy reveals typical tuberculous lesions such as caseous necrotizing epithelioid granulomas, which can help to confirm the diagnosis of the disease.
Granulomatous inflammation is seen in most of the biopsy specimens from immunocompetent patients. In contrast, granulomas are atypical in biopsy specimens from immunodeficient patients.
Differential Diagnosis
Lymph node tuberculosis should be differentiated from chronic lymphadenitis, infectious mononucleosis, and malignant lymphoma.
Chronic lymphadenitis
Similarities: Both have enlarged lymph nodes.
Differences: Chronic lymphadenitis often has a history of chronic inflammation, and the enlarged lymph nodes may be painful, and anti-infective treatment is effective. Lymph node tuberculosis often has a history of tuberculosis, the enlarged lymph nodes may not have pressure and pain, after anti-tuberculosis treatment is effective.
Infectious mononucleosis
Similarities: both may have symptoms such as enlarged lymph nodes and fever.
Differences: Infectious mononucleosis patients have an increase in lymphocytes in the peripheral blood and the presence of heterogeneous lymphocytes. Lymph node tuberculosis does not show this in blood tests.
Malignant lymphoma
Similarities: both may have enlarged lymph nodes.
Difference: the biopsy of lymph nodes may be different, the biopsy of lymph node tuberculosis often shows caseous necrosis; the biopsy of malignant lymphoma may show R-S cells (the typical cells of Hodgkin’s lymphoma) and mutated cells, or lymphocytes with different differentiation, which can be used for differentiation.
Treatment
Treatment principle: “early, combined, appropriate amount, regularity, whole course” principle of using anti-tuberculosis drugs, and supplemented by surgery and other treatments.
Treatment goal: Targeted anti-tuberculosis treatment to avoid drug resistance and reduce or prevent recurrence.
Drug treatment
Systemic anti-tuberculosis treatment
Oral anti-tuberculosis drug treatment is required, and the principle is “early, combined, appropriate amount, regularity, and full course”, and the following four kinds of first-line drugs are commonly used.
Generally, the four drugs are used simultaneously for 2 months for intensive treatment of superficial lymph node tuberculosis, followed by isoniazid and rifampicin for 7 months for maintenance and consolidation treatment; the total course of treatment for deep lymph node tuberculosis needs to be up to 1 year; multidrug-resistant lymph node tuberculosis is treated with a drug-resistant tuberculosis regimen, with a course of treatment lasting for 18 to 24 months. The specific drugs and course of anti-tuberculosis treatment need to be defined under the supervision of a doctor.
Isoniazid
It can inhibit the synthesis of Mycobacterium tuberculosis, interfere with the reproduction of Mycobacterium tuberculosis, and has a strong anti-tuberculosis effect.
It is characterized by high safety.
Common adverse reactions are peripheral neuritis, liver function impairment, so take this drug to regularly test liver function index.
Rifampicin
Rifampicin kills Mycobacterium tuberculosis by interfering with the synthesis of DNA and protein of Mycobacterium tuberculosis.
Adverse effects include transient liver function impairment, headache, fever, etc.
Pyrazinamide
Pyrazinamide kills Mycobacterium tuberculosis by interfering with the deamidation of enzymes in Mycobacterium tuberculosis.
Adverse effects are hepatic impairment, hyperuricemia, etc.
Gout, severe hepatic hypoplasia should be used with caution; liver function should be checked regularly during the use of the drug.
Ethambutol
Ethambutol is an antibacterial agent that interferes with the synthesis of RNA of tubercle bacilli.
Common adverse reactions are retrobulbar optic neuritis, rare chills, arthralgias, occasional gastrointestinal discomfort, nausea, vomiting, and hepatic impairment.
It should be used with caution in those who are allergic to the product, in patients with known optic neuritis, in those with ethanol intoxication, and in those <13 years of age.
Localized anti-tuberculosis treatment
If abscess or sinus tract has been formed, it can be treated by local extraction of pus, flushing, and then injecting anti-tuberculosis drugs.
Surgery
Surgical resection may be considered in some cases where anti-tuberculosis treatment is not effective.
Surgery can remove the lesions that cannot subside and liquefy and necrolyze by conservative treatment and prevent recurrence.
Complications such as secondary infection and lymphatic leakage may occur after surgery. Surgery for lymph node tuberculosis may cause injury to adjacent nerves.
Prognosis
Cure
Most patients are cured after prompt and standardized treatment.
Patients with lymph node TB respond much more slowly to standard treatment regimens than patients with pulmonary TB. Even when receiving an effective regimen, some patients may experience lymph node growth, new lymph node involvement, and formation of sinus tracts during the course of treatment, at which point drug resistance and the possibility of comorbidities with other diseases should be ruled out. True bacteriologic relapse after completion of the regimen is rare.
Some patients who are not completely cured and have residual Mycobacterium tuberculosis may relapse.
Hazards
As the disease progresses, untreated individuals may develop necrosis and rupture of the lymph nodes, which can affect quality of life.
Secondary infections may occur, making treatment difficult.
Daily
Daily management
Dietary management
Balanced diet, avoid partiality.
Eat a light diet and avoid fatty, fried and deep-fried foods such as desserts, cakes, ice cream or sugary drinks.
Eat more fresh vegetables and fruits, such as spinach, rape, pumpkin, carrot, yellow peach and tomato.
Increase the intake of foods such as milk and lean meat as appropriate.
Ensure adequate water intake.
Abstain from alcohol.
Life management
If the symptoms are obvious and accompanied by severe TB toxicity symptoms such as high fever, bed rest is required.
If in recovery, take appropriate walks, play Tai Chi and increase outdoor exercise to enhance physical fitness.
Combine work and rest, and ensure sufficient sleep.
It is necessary to develop the habit of taking medication on time.
Psychological support
Treat the disease correctly, reduce mental and psychological pressure, build up confidence in curing the disease, and actively cooperate with the treatment.
Follow-up and review
The treatment of lymph node tuberculosis is a long-term process, and regular follow-ups are needed under the guidance of the doctor, so that the doctor can understand the changes in the condition and adjust the medication.
If your symptoms do not decrease or even worsen during treatment, you need to consult a doctor.
Prevention
Prevention of Mycobacterium tuberculosis infection
Vaccination: The main application is BCG vaccine. Although it cannot completely prevent Mycobacterium tuberculosis infection, it can reduce the probability of the disease and the severity of the disease in children.
Avoid traveling to areas where TB is endemic.
When a family member has tuberculosis, he/she should be isolated.
Enhance your own immunity
Choose the type of exercise that is less active and less likely to overstrain the body.
Eat a healthy and balanced diet.
Get enough sleep and avoid staying up late.
Avoid over-exertion by combining work and rest.
Active treatment of diseases
If you are found to be suffering from tuberculosis in other parts of the body, such as lung tuberculosis, you should actively and thoroughly treat the disease.