Tuberculous Lymphadenitis: Clinical Presentation and Symptoms

Tuberculous Lymphadenitis is the most common form of extrapulmonary tuberculosis, affecting the lymph nodes. It is typically caused by Mycobacterium tuberculosis and is commonly seen in immunocompromised individuals.

Clinical Presentation

The condition primarily presents as painless, progressive swelling of lymph nodes, most frequently in the cervical region. Patients may experience:

Persistent enlargement of lymph nodes
Low-grade fever
Night sweats
Weight loss
Fatigue

Symptoms

The symptoms of Tuberculous Lymphadenitis can be classified into systemic and localized manifestations:

Systemic Symptoms:

Fever
Malaise
Loss of appetite
Unintentional weight loss

Localized Symptoms:

Painless swelling in affected lymph nodes
Development of cold abscess
Fluctuant nodules with potential sinus formation

Diagnosis

Diagnosing Tuberculous Lymphadenitis requires a combination of clinical examination and laboratory investigations:

Fine Needle Aspiration Cytology (FNAC) - Used for obtaining lymph node aspirates
Ziehl-Neelsen Staining - Detects acid-fast bacilli (AFB)
Culture & PCR - Confirms presence of Mycobacterium tuberculosis
Chest X-ray - Assesses pulmonary involvement
Interferon Gamma Release Assay (IGRA) - Detects immune response to TB infection

Treatment

The standard treatment for Tuberculous Lymphadenitis involves a multi-drug anti-tuberculosis regimen:

First-line drugs: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
Duration: 6-months regimen (2-months intensive phase, 4-months continuation phase)
Adjunct therapies: Corticosteroids in severe cases
Follow-up: Monitoring for drug resistance and relapse prevention

Prognosis & Prevention

With early diagnosis and appropriate treatment, patients generally recover well. Preventive measures include:

BCG Vaccination
Screening of contacts
Improved hygiene and nutrition