Aggarwal P, Wali J P, Singh S, Handa R, Wig N, Biswas A
Department of Medicine, All India Institute of Medical Sciences, New Delhi.
J Assoc Physicians India. 2001 Aug;49:808-12.
Tuberculous lymphadenitis is the commonest form of extra-pulmonary tuberculosis. It is most often caused by M. tuberculosis though several reports from other countries have shown mycobacteria other than tuberculosis (MOTT) to be responsible for a significant proportion of tuberculous lymphadenitis cases. The present study was conducted to find the prevalence of M. tuberculosis and MOTT as aetiological agents in patients with peripheral tuberculous lymphadenitis.
A total of 138 patients with tuberculous lymphadenitis were included in the study. Diagnosis of tuberculosis was established on the basis of fine needle aspiration cytology, histopathology, presence of mycobacteria on Ziehl Neelson stain or auramine rhodamine stain, or aspiration of pus with negative Gram's stain and pyogenic cultute with radiologic evidence of pulmonary tuberculosis. Mycobacterial cultures were performed on aspirated material and species identified using standard methods.
Of 138 patients, single lymph nodal enlargement was found in 48.6% patients while others had more than one lymph nodes. Lymph nodes were matted in 26.8% cases while fluctuation could be elicited in 12.3% patients. Chest X-ray showed evidence of active pulmonary lesions or mediastinal lymphadenopathy in 28.3% cases. The fine needle aspiration cytology was positive for tuberculous lymphadenitis in 41.3% cases while it revealed granulomas or necrosis in another 13% cases. The Ziehl-Neelson and the auramine-rhodamine staining were positive in 19.6% and 26.8% patients, respectively. On culture, the lymph node aspirate was positive for Mycobacterium species in 40.6% patients. In all but two cases, the culture revealed presence of Mycobacterium tuberculosis. The other two cultures revealed growth of Mycobacterium fortuitum chelonae complex. Of the two HIV-positive patients, M. tuberculosis could be isolated in one case.
Findings of this study suggest that M. tuberculosis is still the most common cause of tuberculous lymphadenitis and MOTT are responsible for very few cases. However, such studies need to be carried out frequently at various centres so as to see any periodic and geographic variations within India.
结核性淋巴结炎是肺外结核病最常见的形式。它最常由结核分枝杆菌引起，不过其他国家的几份报告显示，非结核分枝杆菌（MOTT）导致了相当一部分结核性淋巴结炎病例。本研究旨在确定结核分枝杆菌和MOTT作为外周结核性淋巴结炎病因的患病率。
本研究共纳入138例结核性淋巴结炎患者。结核病的诊断基于细针穿刺细胞学检查、组织病理学检查、萋尼氏染色或金胺 - 罗丹明染色显示分枝杆菌、或吸出物革兰氏染色阴性且化脓培养阴性并有肺结核的放射学证据。对吸出物进行分枝杆菌培养，并使用标准方法鉴定菌种。
138例患者中，48.6%的患者为单个淋巴结肿大，其他患者有多个淋巴结肿大。26.8%的病例中淋巴结相互融合，12.3%的患者可引出波动感。胸部X线检查显示28.3%的病例有活动性肺部病变或纵隔淋巴结肿大的证据。细针穿刺细胞学检查41.3%的病例对结核性淋巴结炎呈阳性，另有13%的病例显示有肉芽肿或坏死。萋尼氏染色和金胺 - 罗丹明染色分别在19.6%和26.8%的患者中呈阳性。培养时，40.6%的患者淋巴结吸出物对分枝杆菌呈阳性。除两例外，所有培养均显示存在结核分枝杆菌。另外两份培养显示偶发龟分枝杆菌复合群生长。在两名HIV阳性患者中，一例可分离出结核分枝杆菌。
本研究结果表明，结核分枝杆菌仍是结核性淋巴结炎最常见的病因，MOTT导致的病例极少。然而，需要在各个中心经常开展此类研究，以便了解印度境内的任何周期性和地理差异。
