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Chapter 19 : Tuberculous Lymphadenitis and Parotitis

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Abstract:

The incidence of tuberculosis has increased worldwide, resulting in an increased incidence of tuberculous lymphadenitis. Tuberculous infection in the parotid gland usually develops following infection of intraparotid lymph nodes. As the capsule of the infected lymph tissue breaks down, parotitis may ensue. Historically, lymph node and parotid tuberculosis was caused mainly by , but nearly all tuberculous lymphadenitis is now due to . Symptoms associated with tuberculous lymphadenitis depend largely on the location of involved nodes. Differential diagnosis of tuberculous lymphadenitis or parotitis is extensive. Tuberculin skin testing is the most definitive noninvasive diagnostic procedure, yielding positive results in more than 90% of persons with tuberculous lymphadenitis. When diagnosis of tuberculous lymphadenitis remains in doubt, biopsy material must be submitted for histology, culture, and potentially PCR. Cytologic findings identify granulomatous changes in 50 to 80% of patients with tuberculous lymphadenitis, but acid-fast bacilli are identified in only 30 to 60% and cultures are positive for only 20 to 80%. A recent systematic review found that nucleic acid amplification tests for tuberculous lymphadenitis produce highly variable and inconsistent results, precluding the determination of clinically meaningful results. Management of tuberculous lymphadenitis and parotitis involves appropriate use of antituberculous chemotherapy with the judicious use of surgical excision in a minority of patients. There are no published trials of therapy for parotitis, so guidelines for lymphadenitis should be followed. Treatment involves the use of combination antituberculous chemotherapy, with occasional need for surgical excision.

Citation: Hunt W. 2011. Tuberculous Lymphadenitis and Parotitis, p 293-300. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch19

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Figures

Image of Figure 1.
Figure 1.

Autopsy specimen of endobronchial tuberculosis. A large caseous lymph node is attached to and compresses the right main-stem and right upper-lobe bronchi.

Citation: Hunt W. 2011. Tuberculous Lymphadenitis and Parotitis, p 293-300. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch19
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Image of Figure 2.
Figure 2.

A drawing of the bronchoscopic appearance of childhood endobronchial tuberculosis. (A) Loss of lumen size owing to external compression by a tuberculous peribronchial lymph node; (B) erosion of the lymph node through the bronchial wall with intraluminal granulation tissue. Reprinted from ( ) by permission of Harvard University Press.

Citation: Hunt W. 2011. Tuberculous Lymphadenitis and Parotitis, p 293-300. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch19
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Image of Figure 3.
Figure 3.

A 9-year-old Somali boy with bilateral posterior cervical tuberculous lymphadenitis (one side shown). Photo courtesy of Dwight Powell, M.D.

Citation: Hunt W. 2011. Tuberculous Lymphadenitis and Parotitis, p 293-300. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch19
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Tables

Generic image for table
Table 1.

Racial distribution of tuberculous lymphadenitis and pulmonary tuberculosis in U.S. naval personnel

Citation: Hunt W. 2011. Tuberculous Lymphadenitis and Parotitis, p 293-300. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch19
Generic image for table
Table 2.

Comparative features of tuberculous and nontuberculous mycobacterial cervical lymphadenitis

Citation: Hunt W. 2011. Tuberculous Lymphadenitis and Parotitis, p 293-300. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch19
Generic image for table
Table 3.

Prednisone therapy for children with severe endobronchial tuberculosis

Citation: Hunt W. 2011. Tuberculous Lymphadenitis and Parotitis, p 293-300. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch19

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