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结核性颈淋巴结炎患者的临床病理特征及其治疗结果

Clinicopathological Profile in Patients with Tubercular Cervical Lymphadenitis and Its Treatment Outcome.

作者信息

Kaur Jasleen, Jain Avani, Rai Anil Kumar

机构信息

Department of ENT, Employees' State Insurance Corporation Medical College and Hospital, Faridabad, Haryana India.

VMMC and Safdarjung Hospital, New Delhi, India.

出版信息

Indian J Otolaryngol Head Neck Surg. 2024 Oct;76(5):4080-4085. doi: 10.1007/s12070-024-04786-6. Epub 2024 Jun 14.

Abstract

Tuberculosis is a common occurrence in developing countries. Drug resistance, co-morbidities, and limited availability of new rapid tests such as the GeneXpert/MTB Rif assay make diagnosis and treatment of extrapulmonary tuberculosis burdensome. A cross-sectional study was carried out at Employees' State Insurance Corporation Medical College and Hospital, Faridabad, Haryana of patients treated for tubercular cervical lymphadenopathy from December 2021 to March 2023 in the department of ENT. This study included 58 patients. The clinicopathological profile of patients and the outcome of treatment with antitubercular therapy were noted. The majority of patients had level V (39.6%) involvement. Incidental diagnosis of diabetes mellitus was seen in 2 cases (3.4%). Fever was the commonest constitutional symptom observed in 27.5% of cases. FNAC was suggestive of tubercular abscess in 48.2% and the GeneXpert MTB/RIF assay detected Mycobacterial tuberculosis in all the cases with rifampicin resistance in only one case. 56 cases (96.5%) had complete resolution after completion of antitubercular therapy including patients with rifampicin resistance and patients with diabetes mellitus. In the remaining two cases, treatment was prolonged for a few months before the resolution of the disease was observed. Timely diagnosis, patient compliance to antitubercular therapy, and adequate management of comorbidities lead to successful treatment outcomes in tubercular cervical lymphadenitis. Delayed response to treatment in a few cases needs further research into factors like immune status, nutrition, living conditions, and quality of drugs available to the public.

摘要

结核病在发展中国家很常见。耐药性、合并症以及诸如GeneXpert/MTB Rif检测等新型快速检测方法的可及性有限,使得肺外结核病的诊断和治疗变得困难重重。2021年12月至2023年3月期间,在哈里亚纳邦法里达巴德的员工国家保险集团医学院及医院耳鼻喉科,对接受结核性颈淋巴结炎治疗的患者进行了一项横断面研究。该研究纳入了58例患者。记录了患者的临床病理特征以及抗结核治疗的结果。大多数患者(39.6%)为Ⅴ级受累。2例(3.4%)患者偶然诊断出糖尿病。发热是最常见的全身症状,见于27.5%的病例。细针穿刺抽吸活检(FNAC)提示结核性脓肿的占48.2%,GeneXpert MTB/RIF检测在所有病例中均检测到结核分枝杆菌,仅1例对利福平耐药。56例(96.5%)患者在完成抗结核治疗后完全康复,包括对利福平耐药的患者和糖尿病患者。其余2例患者在疾病缓解前治疗延长了几个月。及时诊断、患者对抗结核治疗的依从性以及对合并症的充分管理可使结核性颈淋巴结炎获得成功的治疗结果。少数病例治疗反应延迟,需要进一步研究免疫状态、营养、生活条件和公众可获得药物质量等因素。

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