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Features of tuberculous lymphadenitis – Experience of a single tertiary centre in Greece

Abstract number: R2496

Yiakoumis X., Pangalis G.A., Andreopoulos A., Diamantopoulos P., Bouros S., Siakantaris M., Sachanas S., Vassilakopoulos T.P.

Objectives: Tuberculous lymphadenitis (TBL) is considered the most prevalent form of extrapulmonary tuberculosis. Incidence and clinical features of various forms of tuberculosis have changed during the last 40 years, mainly due to introduction of new drugs, admixture of populations and increased number of immunosupressed individuals.

We conducted a retrospective study to determine the clinical and laboratory features of TBL in an adult population evaluated for peripheral lymphadenopathy in a tertiary centre in Greece, where published data on tuberculosis are sparse.

Patients and Methods: Among 516 adult patients, who presented with peripheral lymphadenopathy between 1990 and 1995, 27 (5.2%) were diagnosed with TBL, following an excisional biopsy. TBL was the 3rd leading benign cause of lymphadenopathy in this population, following infectious mononucleosis and toxoplasmosis. Patients were evaluated by physical examination, complete blood counts, erythrocyte sedimentation rate (ESR), chest X-rays and PPD skin test.

Results: All patients were native Greeks with median age of 47 years (18–70); 70% were females. All presented with cervical/supraclavicular lymphadenopathy. A single patient was diagnosed by axillary lymph node biopsy, but small axillary and inguinal lymph nodes were found in 42% and 4% of patients respectively. Notably preauricular, postauricular and suboccipital nodes were not palpable in any case. Only 19% had concomitant fever, 15% weight loss and 7% sweats. The median size of the nodes was 2.5cm2 (0.5–25.0) and none had fistulas, while hard texture was present in 46% and tenderness in only 8% of the patients. Splenomegaly was noted in 4% and hepatomegaly in 15% of the patients. All patients had positive PPD test. Hemoglobin and platelet count were within normal limits, while, lymphocytopenia was observed in 29% of the patients. Median ESR was 34 mm (range 4–85). Chest X-rays did not reveal abnormal findings in any case. All patients were successfully treated with isoniazide and rifampicin for 9 months and ethambutol for 3 months.

Conclusion: TBL is a major cause of lymphadenopathy in adult patients in Greece. It should be considered especially in patients >40 years old with clinically significant, non-tender, cervical/supraclavicular lymphadenopathy and positive PPD. The expansion of immigrant population in Greece during the last decade should prompt for a further increase in the level of suspicion for this curable disease.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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