Tuberculous cervical lymphadenitis

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Mycobacterial cervical lymphadenitis
Scrofula.jpeg
Scrofula of the neck
Classification and external resources
Specialty infectious disease
ICD-10 A18.4
ICD-9-CM 017.2
DiseasesDB 31259
MedlinePlus 001354
eMedicine ent/524
MeSH D014388

Mycobacterial cervical lymphadenitis, also known as scrofula, scrophula, struma, or the King's evil, refers to a lymphadenitis of the cervical lymph nodes associated with tuberculosis as well as nontuberculous (atypical) mycobacteria.

Tuberculosis infectious disease caused by the bacterium Mycobacterium tuberculosis

Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections do not have symptoms, in which case it is known as latent tuberculosis. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those affected. The classic symptoms of active TB are a chronic cough with blood-containing sputum, fever, night sweats, and weight loss. It was historically called "consumption" due to the weight loss. Infection of other organs can cause a wide range of symptoms.

Nontuberculous mycobacteria (NTM), also known as environmental mycobacteria, atypical mycobacteria and mycobacteria other than tuberculosis (MOTT), are mycobacteria which do not cause tuberculosis or leprosy. NTM do cause pulmonary diseases that resemble tuberculosis. Mycobacteriosis is any of these illnesses, usually meant to exclude tuberculosis. They occur in many animals, including humans.

Contents

Disease

Scrofula is the term used for lymphadenopathy of the neck, usually as a result of an infection in the lymph nodes, known as lymphadenitis. It can be caused by tuberculous or nontuberculous mycobacteria. About 95% of the scrofula cases in adults are caused by Mycobacterium tuberculosis , most often in immunocompromised patients (about 50% of cervical tuberculous lymphadenopathy). In immunocompetent children, scrofula is often caused by atypical mycobacteria ( Mycobacterium scrofulaceum) and other nontuberculous mycobacteria (NTM). Unlike the adult cases, only 8% of cases in children are tuberculous.

Lymphadenopathy disorder of lymph nodes

Lymphadenopathy or adenopathy is disease of the lymph nodes, in which they are abnormal in size, number, or consistency. Lymphadenopathy of an inflammatory type is lymphadenitis, producing swollen or enlarged lymph nodes. In clinical practice, the distinction between lymphadenopathy and lymphadenitis is rarely made and the words are usually treated as synonymous. Inflammation of the lymphatic vessels is known as lymphangitis. Infectious lymphadenitis affecting lymph nodes in the neck is often called scrofula.

<i>Mycobacterium tuberculosis</i> species of bacterium

Mycobacterium tuberculosis is a species of pathogenic bacteria in the family Mycobacteriaceae and the causative agent of tuberculosis. First discovered in 1882 by Robert Koch, M. tuberculosis has an unusual, waxy coating on its cell surface primarily due to the presence of mycolic acid. This coating makes the cells impervious to Gram staining, and as a result, M. tuberculosis can appear either Gram-negative or Gram-positive. Acid-fast stains such as Ziehl-Neelsen, or fluorescent stains such as auramine are used instead to identify M. tuberculosis with a microscope. The physiology of M. tuberculosis is highly aerobic and requires high levels of oxygen. Primarily a pathogen of the mammalian respiratory system, it infects the lungs. The most frequently used diagnostic methods for tuberculosis are the tuberculin skin test, acid-fast stain, culture, and polymerase chain reaction.

Mycobacterium scrofulaceum is a species of Mycobacterium.

With the stark decrease of tuberculosis in the second half of the 20th century, scrofula became a less common disease in adults, but remained common in children. With the appearance of AIDS, however, it has shown a resurgence, and presently affects about 5% of severely immunocompromised patients.[ citation needed ]

Signs and symptoms

The most usual signs and symptoms are the appearance of a chronic, painless mass in the neck, which is persistent and usually grows with time. The mass is referred to as a "cold abscess", because there is no accompanying local color or warmth and the overlying skin acquires a violaceous (bluish-purple) color. NTM infections do not show other notable constitutional symptoms, but scrofula caused by tuberculosis is usually accompanied by other symptoms of the disease, such as fever, chills, malaise and weight loss in about 43% of the patients. As the lesion progresses, skin becomes adhered to the mass and may rupture, forming a sinus and an open wound.

Symptom departure from normal function or feeling which is noticed by a patient, reflecting the presence of an unusual state, or of a disease; subjective, observed by the patient, cannot be measured directly

A symptom is a departure from normal function or feeling which is apparent to a patient, reflecting the presence of an unusual state, or of a disease. A symptom can be subjective or objective. Tiredness is a subjective symptom whereas cough or fever are objective symptoms. In contrast to a symptom, a sign is a clue to a disease elicited by an examiner or a doctor. For example, paresthesia is a symptom, whereas erythema is a sign. Symptoms and signs are often nonspecific, but often combinations of them are at least suggestive of certain diagnoses, helping to narrow down what may be wrong. In other cases they are specific even to the point of being pathognomonic.

Neck part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk

The neck is the part of the body, on many vertebrates, that separates the head from the torso. It contains blood vessels and nerves that supply structures in the head to the body. These in humans include part of the esophagus, the larynx, trachea, and thyroid gland, major blood vessels including the carotid arteries and jugular veins, and the top part of the spinal cord.

Fever common medical sign characterized by elevated body temperature

Fever, also known as pyrexia and febrile response, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using values between 37.5 and 38.3 °C. The increase in set point triggers increased muscle contractions and causes a feeling of cold. This results in greater heat production and efforts to conserve heat. When the set point temperature returns to normal, a person feels hot, becomes flushed, and may begin to sweat. Rarely a fever may trigger a febrile seizure. This is more common in young children. Fevers do not typically go higher than 41 to 42 °C.

Diagnosis

Diagnosis is usually performed by needle aspiration biopsy or excisional biopsy of the mass and the histological demonstration of stainable acid-fast bacteria in the case of infection by M. tuberculosis (Ziehl-Neelsen stain), or the culture of NTM using specific growth and staining techniques.

Medical diagnosis process to determine or identify a disease or disorder

Medical diagnosis is the process of determining which disease or condition explains a person's symptoms and signs. It is most often referred to as diagnosis with the medical context being implicit. The information required for diagnosis is typically collected from a history and physical examination of the person seeking medical care. Often, one or more diagnostic procedures, such as diagnostic tests, are also done during the process. Sometimes posthumous diagnosis is considered a kind of medical diagnosis.

Biopsy medical test involving sampling of cells or tissues for examination

A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist involving extraction of sample cells or tissues for examination to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. An incisional biopsy or core biopsy samples a portion of the abnormal tissue without attempting to remove the entire lesion or tumor. When a sample of tissue or fluid is removed with a needle in such a way that cells are removed without preserving the histological architecture of the tissue cells, the procedure is called a needle aspiration biopsy. Biopsies are most commonly performed for insight into possible cancerous and inflammatory conditions.

Pathology

The classical histologic pattern of scrofula features caseating granulomas with central acellular necrosis (caseous necrosis) surrounded by granulomatous inflammation with multinucleated giant cells. Although tuberculous and nontuberculous lymphadenitis are morphologically identical, the pattern is somewhat distinct from other causes of bacterial lymphadenitis. [1]

Necrosis premature cell death

Necrosis is a form of cell injury which results in the premature death of cells in living tissue by autolysis.

Giant cell Wikimedia disambiguation page

A giant cell is a mass formed by the union of several distinct cells, often forming a granuloma. It can arise in response to an infection, such as from tuberculosis, herpes, or HIV, or foreign body. These multinucleate giant cells (MGCs) are cells of monocyte or macrophage lineage fused together.

Therapy

Treatments are highly dependent on the kind of infection. Surgical excision of the scrofula does not work well for M. tuberculosis infections, and has a high rate of recurrence and formation of fistulae.[ citation needed ] Furthermore, surgery may spread the disease to other organs. The best approach is to use conventional treatment of tuberculosis with antibiotics. The cocktail-drug treatment of tuberculosis (and inactive meningitis) includes rifampicin along with pyrazinamide, isoniazid, ethambutol, and streptomycin ("PIERS"). Scrofula caused by NTM, on the other hand, responds well to surgery, but is usually resistant to antibiotics.[ citation needed ] The affected nodes can be removed either by repeated aspiration, curettage or total excision (with the risk in the latter procedure, however, often causing unsightly scarring, damage to the facial nerve, or both).[ citation needed ]

Prognosis

With adequate treatment, clinical remission is practically 100%. In NTM infections, with adequate surgical treatment, clinical remission is greater than 95%. It is recommended that persons in close contact with the diseased person, such as family members, be tested for tuberculosis.

History

The word comes from the Latin scrofula, meaning brood sow .

In the Middle Ages it was believed that royal touch, the touch of the sovereign of England or France, could cure diseases owing to the divine right of sovereigns. Henry VI of England is alleged to have cured a girl with it. Scrofula was therefore also known as the King's evil. From 1633, the Book of Common Prayer of the Anglican Church contained a ceremony for this, and it was traditional for the monarch (king or queen) to present to the touched person a coin — usually an angel, a gold coin the value of which varied from about 6 shillings to about 10 shillings. In England this practice continued until the early 18th century, and was continued by the Jacobite pretenders until the extinction of the House of Stuart with the death of the pretender Henry IX. King Henry IV of France is reported as often touching and healing as many as 1,500 individuals at a time.

Herbalist Nicholas Culpepper (1616–1654), is claimed to have treated his daughter for scrofula with lesser celandine, and cured her within a week. [2]

Queen Anne touched the infant Samuel Johnson in 1712, [3] but King George I put an end to the practice as being "too Catholic".[ citation needed ] The kings of France continued the custom until Louis XV stopped it in the 18th century, though it was briefly revived by Charles X in 1825.

In the 18th century, Elizabeth Pearson, an Irish herbalist, proposed a treatment for scrofula involving herbs and a poultice and extract of vegetable, and in 1815, Sir Gerard Noel presented a petition to the House of Commons advocating her treatment. [4] In the 19th century in the United States, the patent medicine Swaim's Panacea was advertised to cure scrofula. [5]

In 1768 the Englishman John Morley produced a handbook entitled Essay on the Nature and Cure of Scrophulous Disorders, Commonly Called the King's Evil. The book starts by listing the typical symptoms and indications of how far the disease had progressed. It then goes into detail with a number of case studies, describing the specific case of the patient, the various treatments used and their effectiveness. The forty-second edition was printed in 1824.

In 1924, French historian Marc Bloch wrote a book [6] on the history of the royal touch: The Royal Touch: Sacred Monarchy and Scrofula in England and France (original in French).

See also

Related Research Articles

Kikuchi disease rare disease

Kikuchi disease was described in 1972 in Japan. It is also known as histiocytic necrotizing lymphadenitis, Kikuchi necrotizing lymphadenitis, phagocytic necrotizing lymphadenitis, subacute necrotizing lymphadenitis, and necrotizing lymphadenitis.Kikuchi disease occur sporadically in people with no family history of the condition.

Adenitis is a general term for an inflammation of a gland. Often it is used to refer to lymphadenitis which is the inflammation of a lymph node.

Tuberculous lymphadenitis

Tuberculous lymphadenitis is the most common form of tuberculosis infections that appears outside the lungs. Tuberculous lymphadenitis is a chronic, specific granulomatous inflammation of the lymph node with caseation necrosis, caused by infection with Mycobacterium tuberculosis or related bacteria.

Miliary tuberculosis extrapulmonary tuberculosis that results in formation of tiny lesions in all the organs.

Miliary tuberculosis is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). Its name comes from a distinctive pattern seen on a chest radiograph of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term "miliary" tuberculosis. Miliary TB may infect any number of organs, including the lungs, liver, and spleen. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and accounts for up to 20% of all extra-pulmonary tuberculosis cases.

<i>Mycobacterium avium-intracellulare</i> infection Human disease

Mycobacterium avium-intracellulare infection (MAI) is an atypical mycobacterial infection, i.e. one with nontuberculous mycobacteria or NTM, caused by Mycobacterium avium complex ("MAC"), which is made of two mycobacteria species, M. avium and M. intracellulare. This infection causes respiratory illness in birds, pigs, and humans, especially in immunocompromised people. In the later stages of AIDS it can be very severe. It usually first presents as a persistent cough. It is typically treated with a series of three antibiotics for a period of at least six months.

Bubo Inflammation of the lymph nodes

A bubo is defined as adenitis or inflammation of the lymph nodes and is an example of reactive lymphadenopathy.

Mycobacterium boenickei is a member of the Mycobacterium fortuitum third biovariant complex. They are rapidly growing ubiquitous environmental organisms that normally inhabit soil, dust and water. These organisms frequently are human pathogens that cause a wide spectrum of clinically significant disease. It is important for practitioners to be aware of these organisms as possible etiological agents, as they are resistant to most first-line anti-tuberculous agents.

Mycobacterium bohemicum is a species of the phylum Actinobacteria, belonging to the genus Mycobacterium.

<i>Mycobacterium fortuitum</i> species of bacterium

Mycobacterium fortuitum is a nontuberculous species of the phylum Actinobacteria, belonging to the genus Mycobacterium.

Mycobacterium avium complex is a group of mycobacteria comprising Mycobacterium intracellulare and Mycobacterium avium that are commonly grouped together because they infect humans together; this group, in turn, is part of the group of nontuberculous mycobacteria. These bacteria cause disease in humans called Mycobacterium avium-intracellulare infection or Mycobacterium avium complex infection.

<i>Mycobacterium kansasii</i> species of bacterium

Mycobacterium kansasii is a bacterium in the Mycobacterium family. The genus includes species known to cause serious diseases in mammals, including tuberculosis and leprosy, but this species is generally not dangerous to healthy people.

Rosai–Dorfman disease

Rosai–Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy or sometimes as Destombes–Rosai–Dorfman disease, is a rare disorder of unknown cause that is characterized by abundant histiocytes in the lymph nodes or other locations throughout the body.

History of tuberculosis

Consumption, phthisis and the White Plague are all terms used to refer to tuberculosis throughout history. It is generally accepted that Mycobacterium tuberculosis originated from other, more primitive organisms of the same genus Mycobacterium. In 2014, results of a new DNA study of a tuberculosis genome reconstructed from remains in southern Peru suggest that human tuberculosis is less than 6,000 years old. Even if researchers theorize that humans first acquired it in Africa about 5,000 years ago, there is evidence that the first tuberculosis infection happened about 9,000 years ago. It spread to other humans along trade routes. It also spread to domesticated animals in Africa, such as goats and cows. Seals and sea lions that bred on African beaches are believed to have acquired the disease and carried it across the Atlantic to South America. Hunters would have been the first humans to contract the disease there.

Cervical lymphadenopathy

Cervical lymphadenopathy refers to lymphadenopathy of the cervical lymph nodes. The term lymphadenopathy strictly speaking refers to disease of the lymph nodes, though it is often used to describe the enlargement of the lymph nodes. Similarly, the term lymphadenitis refers to inflammation of a lymph node, but often it is used as a synonym of lymphadenopathy.

Cat-scratch disease Human disease

Cat-scratch disease (CSD) is an infectious disease that results from a scratch or bite of a cat. Symptoms typically include a non-painful bump or blister at the site of injury and painful and swollen lymph nodes. People may feel tired, have a headache, or a fever. Symptoms typically begin within 3-14 days following infection.

The stages of HIV infection are acute infection, latency and AIDS. Acute infection lasts for several weeks and may include symptoms such as fever, swollen lymph nodes, inflammation of the throat, rash, muscle pain, malaise, and mouth and esophageal sores. The latency stage involves few or no symptoms and can last anywhere from two weeks to twenty years or more, depending on the individual. AIDS, the final stage of HIV infection, is defined by low CD4+ T cell counts, various opportunistic infections, cancers and other conditions.

References

  1. ↑ Rosado FG, Stratton CW, Mosse CA Clinicopathologic correlation of epidemiologic and histopathologic features of pediatric bacterial lymphadenitis. Arch Pathol Lab Med. 2011 Nov; 135(11):1490–93. http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2010-0581-OA
  2. ↑ Reader's Digest Field Guide to the Wild Flowers of Britain. Reader's Digest. 1981. p. 26. ISBN   9780276002175.
  3. ↑ Henry Hitchings (2005). Dr Johnson's Dictionary: The Extraordinary Story of the Book that Defined the World. John Murray. p. 11.
  4. ↑ "Petition of Mrs. Pearson Respecting Her Discovery For the Cure of Scrofula, or King's Evil". Hansard . 31: 1086–87. 3 July 1815.
  5. ↑ Young, James Harvey. The Toadstool Millionaires, ch. 5 (1961)
  6. ↑ Bloch, M. (Anderson, J. E., trans), The Royal Touch: Sacred Monarchy and Scrofula in England and France (Les Rois Thaumaturges), Routledge & Kegan Paul, (London), 1973.
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