Tuberculosis of the lymph nodes - the most common type of extra-pulmonary tuberculosis. This disease is in most cases affects children, young adults and women, but can occur in people of any age and gender.
In most cases (about 70% of cases), tuberculosis of the lymph nodes in the neck develops lymph nodes, more rarely - in the lymph nodes of the mediastinum (in anatomy, this term is used to denote the general central departments of the chest cavity), armpits and groin.
Symptoms of TB of the lymph nodes
The main symptom of this type of TB is a gradual increase in the lymph nodes, which may occur over several weeks or months. When pressed on the enlarged lymph nodes patient may feel weak or moderate pain. In some cases, as a rule - coinfected patients (such as tuberculosis and HIV), or in the later stages of the disease - and there are signs of systemic disease, such as fever, weight loss, fatigue, profuse sweating at night. A strong cough is often a symptom of TB mediastinal lymph nodes.
In the initial stages of the disease lymph nodes solid and mobile; the skin on them looks perfectly normal. Later, the lymph nodes are formed between the spikes and the skin over them inflammatory processes begin. In more advanced stages of lymph node begins cheesy necrosis, they are soft to the touch, form abscesses. Greatly enlarged lymph nodes may compress adjacent structures, and this can complicate the course of the disease.
Enlarged lymph nodes in the chest can press on the bronchi, resulting in atelectasis can become, chylothorax and lung infection - a condition in which the accumulation of lymph notes in the pleural cavity, and which, if left untreated can lead to death of the patient. Tuberculosis of peripheral lymph nodes in the neck and the chest cavity and can cause complications such as dysphagia, traheoezofagealny fistula, cardiac tamponade. Complications of other types of tuberculosis of the lymphatic system can be chyloperitoneum, chyluria and, in rare cases, renovascular hypertension.
Tuberculosis of the lymphatic system and HIV infection
If, among the people who are not infected with HIV, tuberculosis, lymphatic system is most common in children, young people and women, in HIV-infected patients, the disease is most common in men of middle-aged and elderly. In addition, they most often struck lymph nodes anterior and posterior mediastinum. Typically, in these patients, along with enlarged lymph nodes, there are symptoms such as high fever and sudden weight loss.
Diagnostics
In the differential diagnosis of tuberculosis of the lymph nodes is necessary to rule out other possible causes of lymphadenopathy, such as reactive hyperplasia lymph node, lymphoma, sarcoidosis
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, Secondary carcinoma
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, Generalized lymphadenopathy HIV, Kaposi's sarcoma, toxoplasmosis.
Mantoux test in most patients with tuberculosis of the lymph nodes gives a positive result. The probability of false-negative result is less than 10%. However, the tuberculin skin test does not help to determine what type of TB ill patient; in most cases it uses chest X-ray. If you suspect a tuberculosis of the lymph nodes may also be performed abdominal ultrasound and computed tomography of the chest. These diagnostic procedures can both detect enlarged lymph nodes (usually they look like a very dense areas with clear boundaries), and set the stage of development of tuberculous lymphadenitis and assess how an increase in lymph nodes affected the surrounding structures.
Often, in order to diagnose TB
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lymph nodes, in addition to the above procedures also requires a biopsy. Traditionally, the diagnosis of this disease is used excisional biopsy, but now experts are increasingly preferred by fine-needle aspiration biopsy - This procedure is less invasive and painful, and is considered more secure. In addition, fine-needle biopsy is performed on an outpatient basis - that is, the patient can go home the same day, when the procedure is performed.
Treatment of tuberculosis of the lymph nodes
As a rule, tuberculosis of the lymph nodes is only used medication. Application of surgical treatment in combination with anti-tuberculosis drugs usually leads to less favorable results than using only drug therapy.
Treatment regimens that are effective in pulmonary tuberculosis, and are usually effective in tuberculous lymphadenitis. In most cases, the following regimens:
- The nine-month course of treatment: isoniazid, rifampicin and ethambutol for the first two months, then - isoniazid and rifampicin for a further seven months;
- The six-month course of treatment: two months - isoniazid, rifampicin and pyrazinamide, and four months - isoniazid and rifampicin.
Because patients who are taking ethambutol, in addition to medical treatment often require aspiration of lymph nodes than those who are appointed to pyrazinamide, usually doctors prefer to prescribe a second scheme of therapy.
Shortly after the start of treatment, some lymph nodes may increase even more, and sometimes the lymph nodes are enlarged and that once looked normal. As a rule, it is - a temporary phenomenon, and the vast majority of cases, these glands begin to gradually decrease. However, any aggravation of the symptoms of tuberculosis of the lymph nodes in eight or more weeks after the start of therapy is worrisome sign; in such cases usually require surgical intervention.
To minimize the risk of possible complications of tuberculosis of the lymph nodes, it is also necessary to diagnose and treat co-infections, if any. Patients should be sure to follow the instructions of your doctor about taking drugs; If the patient misses a regular medication or interrupt treatment prematurely, this may lead to the development of drug resistance, and increase the likelihood of serious complications of tuberculous lymphadenitis.
Another important condition for the successful treatment of tuberculosis of the lymph nodes is good nutrition and avoiding alcohol and smoking. If the patient does not have enough nutrients he smoke or abuse alcohol, his body will be more difficult to cope with the disease, and the likelihood of relapse is increased.
Patients who are experiencing any residual changes after treatment of tuberculosis lymph nodes need to undergo regular medical examinations. If the lymph nodes
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again begin to increase, and requires a biopsy, usually one course of drug therapy. For most patients, the treatment regimen, previously used, is an effective and relapse TB lymph nodes.
