Mycobacterial cervical lymphadenitis

Mycobacterial cervical lymphadenitis, also known as scrofula or King's Evil, is a type of lymphadenitis that involves the cervical lymph nodes. It is primarily caused by infection with Mycobacterium tuberculosis or Mycobacterium scrofulaceum. This condition is characterized by the swelling of the neck lymph nodes due to the infection. It is more common in children and immunocompromised individuals, such as those with HIV/AIDS.

Etiology

Mycobacterial cervical lymphadenitis is caused by two main types of bacteria: Mycobacterium tuberculosis, the bacterium responsible for tuberculosis, and Mycobacterium scrofulaceum, a non-tuberculous mycobacterium. Infection with Mycobacterium avium complex (MAC) can also lead to this condition, especially in immunocompromised patients.

Symptoms

The primary symptom of mycobacterial cervical lymphadenitis is the enlargement of one or more cervical lymph nodes. These swollen nodes may be painless or tender. Over time, the affected lymph nodes may become fluctuant and may suppurate, leading to the formation of a sinus tract that drains to the skin surface. Other symptoms may include fever, night sweats, weight loss, and general malaise, especially if the infection is due to Mycobacterium tuberculosis.

Diagnosis

Diagnosis of mycobacterial cervical lymphadenitis involves a combination of clinical examination, imaging studies, and laboratory tests. Imaging studies such as ultrasound or computed tomography (CT) scan of the neck can help assess the extent of lymph node involvement. The definitive diagnosis is made by isolating the causative organism from the lymph node material, which can be obtained through fine-needle aspiration or lymph node biopsy. Polymerase chain reaction (PCR) tests and cultures are used to identify the specific mycobacterial species.

Treatment

Treatment depends on the causative organism. For lymphadenitis caused by Mycobacterium tuberculosis, a combination of anti-tuberculosis medications is used, typically for a duration of 6 to 9 months. In cases caused by non-tuberculous mycobacteria, treatment may involve surgical excision of the affected lymph nodes in addition to or instead of antibiotics. The choice of antibiotics and the duration of treatment vary depending on the specific mycobacterial species and the patient's response to therapy.

Prevention

Prevention of mycobacterial cervical lymphadenitis primarily involves measures to prevent tuberculosis, such as vaccination with the BCG vaccine in countries where tuberculosis is common, and prompt treatment of individuals with active tuberculosis to reduce transmission. For non-tuberculous mycobacterial infections, avoiding exposure to environmental sources of these organisms, such as soil and contaminated water, may reduce risk.

See Also

• Tuberculosis
• Lymphadenitis
• Mycobacterium tuberculosis
• Mycobacterium scrofulaceum
• HIV/AIDS