Rai Deependra Kumar, Kant Surya, Gupta Vatsal Bhushan
Department of Pulmonary Medicine, All India Institute of Medical Sciences, Patna.
Department of Respiratory Medicine, King George Medical University, Lucknow.
Monaldi Arch Chest Dis. 2023 Oct 3;94(3). doi: 10.4081/monaldi.2023.2625.
The paradoxical reaction (PR) is a transient worsening following tuberculosis treatment, and it is not uncommon in lymph node tuberculosis (LNTB). PR in LNTB may be wrongly considered as treatment failure or relapse. This review was undertaken to address various aspects of PR associated with LNTB prevalence, underlying mechanisms, clinical patterns, predictors, and possible treatment in an immunocompetent individual. A literature review was performed using various databases (PubMed, Scopus, Science Direct, and Google Scholar) to identify relevant articles for review. The prevalence of PR associated with LNTB varies from as low as 13.3% to as high as 35.3%. PR may occur during antitubercular treatment or be reported even after completion of treatment, called post-therapy PR. An onset of PR may occur within a month of therapy to even 12 months from the initiation of an anti-tubercular drug. Delayed hypersensitivity reaction and reduction in immune suppression are believed to be possible mechanisms leading to a PR. PR in LNTB is characterized by either progression of pre-existing nodal enlargement or formation of abscess, sinus formation, or appearance of new nodal enlargement, or rarely extra-nodal involvement. PR is a diagnosis of exclusion and may show granuloma, positive acid-fast bacilli (AFB) smear, or positive GeneXpert, but AFB culture is always negative. Younger age, lymph node size of equal to or more than 3 cm, female gender, unilateral lymphadenopathy, and those with positive AFB on initial examination are predictors for PR in peripheral LNTB. The majority of PR in LNTB have a mild course and are generally self-limited.
矛盾反应（PR）是结核病治疗后出现的短暂病情恶化，在淋巴结结核（LNTB）中并不少见。LNTB中的PR可能被错误地认为是治疗失败或复发。本综述旨在探讨与LNTB相关的PR在免疫功能正常个体中的患病率、潜在机制、临床模式、预测因素及可能的治疗等各个方面。通过使用各种数据库（PubMed、Scopus、Science Direct和谷歌学术）进行文献综述，以确定相关的综述文章。与LNTB相关的PR患病率低至13.3%，高至35.3%。PR可能发生在抗结核治疗期间，甚至在治疗完成后才报告，称为治疗后PR。PR的发作可能在治疗开始后1个月内，甚至在开始使用抗结核药物后12个月内出现。迟发型超敏反应和免疫抑制的减轻被认为是导致PR的可能机制。LNTB中的PR表现为既往存在的淋巴结肿大进展、脓肿形成、窦道形成、新的淋巴结肿大出现，或很少见的结外受累。PR是一种排除性诊断，可能显示肉芽肿、抗酸杆菌（AFB）涂片阳性或GeneXpert阳性，但AFB培养始终为阴性。年龄较小、淋巴结大小等于或大于3 cm、女性、单侧淋巴结病以及初始检查时AFB阳性者是外周LNTB中PR的预测因素。LNTB中大多数PR病程较轻，通常为自限性。
