Tuberculous lesion of peripheral lymph nodes

According to well-known literary data, extrapulmonary forms of tuberculosis in children, as a rule, are a manifestation of lymphogenous or hematogenic dissemination. To create a severe disseminated process in childhood, it is necessary to create certain conditions that weaken the child's body. This is primarily the massiveness of the infection against a background of poor vaccination of BCG or its absence, unfavorable socio-economic conditions and various concomitant diseases. The most characteristic for childhood is tuberculosis of peripheral lymph nodes, meningitis and damage to the bone system.

Lesion of peripheral lymph nodes

The defeat of peripheral lymph nodes is more often caused by bovine mycobacteria. This must be taken into account when diagnosing in certain regions of Russia, especially in rural areas. The development of a specific process in the lymph nodes is attributed by many authors to the lymphotropic capacity of the MVT and the barrier function of lymph nodes rich in elements of the mononuclear phagocyte system, in which the initial reactive (and then specific) changes occur most often. There are several points of view on the development of the disease. Through the mucous membranes of the oral cavity, the eye, the skin, by contact or alimentary pathways, MW penetrate into the body with subsequent involvement in the inflammatory process of lymph nodes of various locations - cervical, axillary, submandibular, etc.

According to our clinic, in 83.3% of cases lymph nodes of the cervical group suffered, in 11,2% - underarm. Only in 5,5% of cases the process was localized in the inguinal lymph nodes.

This confirms the lymphohematogenous pathway of infection from fresh foci of inflammation or reactivated old foci in the lungs or intrathoracic lymph nodes.

According to clinical manifestations and the nature of tissue reactions, there are three main forms of tuberculosis of peripheral lymph nodes:

• infiltrative - densely-elastic consistency enlarged lymph nodes with phenomena of periadenitis;
• caseous (with or without fistula) - often involve the involvement of several groups of lymph nodes in the inflammation;
• Inductive (fibrous or fibrous-caseous - as an outcome of the previous two forms).

Inflammation develops mainly against the background of intrathoracic tuberculosis, which together and causes the severity of clinical symptoms, the severity of the intoxication syndrome. In isolated cases, isolated forms of the disease are recorded. Attention is low, and in some cases, negative sensitivity to tuberculin. The first symptoms of the disease are swelling, an increase in the size of any one group of lymph nodes (from small to 1.5-2 cm in diameter). Less often, two or three groups of lymph nodes are involved. Characteristic symptoms are painlessness, mobility, absence of external signs of inflammation, phenomena of periadenitis. In the absence of specific treatment, new groups of lymph nodes that form whole conglomerates are involved in the process. Progression of the process leads to the appearance of symptoms of inflammation - hyperemia, swelling, tenderness. Against this background, fluctuations occur in the center of the conglomerate, followed by fistula formation, which is extremely unfavorable both for the child and for his environment in the epidemiological sense.

When diagnosing, it is important to assess the epidemiological situation, the features of clinical manifestations of the disease, a decrease in sensitivity to tuberculin, a low titer of specific antibodies (only one in every third child has positive ELISA results, which is typical for this inflammation). In peripheral blood moderately increased ESR, lymphocytosis, monocytosis. Moderate leukocytosis.

If you suspect a disease, you need to carefully collect an anamnesis taking into account the phthisiopaediatric aspects:

• premorbid background (frequency of colds, childhood infections - epidemic parotitis, scarlet fever, measles, chicken pox, smallpox);
• contact with pets, especially cats;
• injuries, bruises, carious teeth;
• dynamics of sensitivity to tuberculin with the establishment of the fact and timing of infection with MW;
• contact with the patient with tuberculosis (family, industrial) and its duration, chemoprophylaxis on contact (her regimen, the number of drugs).

To clarify the activity and nature of inflammation it is desirable to use biochemical, immunological methods, including the ELISA method, a clinical blood test. Examine the tissue of the lymph node for MW (puncture biopsy or surgical material). The final stage of diagnostics of tuberculosis of peripheral lymph nodes is the detection of MW by bacterioscopy, sowing of fistula contents, postoperative material, biopsy material.

Differential diagnostics

Nonspecific lymphadenitis. The disease develops on the background of exacerbation of chronic pathology of ENT organs or a regionally located infected wound, furuncle, etc. It is characterized by a pronounced clinical picture with an increase in body temperature, changes in the general blood test (increased ESR, leukocytosis, shift of the leukocyte formula to the left). Locally in the area of the lymph node - hyperemia of the skin, tenderness, swelling of surrounding tissues and other classic signs of nonspecific inflammation. Against the backdrop of nonspecific antibacterial therapy, a marked positive dynamics is observed within 5-7 days, which allows excluding the tuberculous process.

Felinosis - benign lymphoreticulosis (a disease of cat scratch).

The causative agent of the disease are chlamydia, the carrier is the cat. Infection occurs when the skin, mucous membranes are damaged. The incubation period is from 1 to 3 weeks. The disease often develops sharply, with a sharp rise in body temperature, an increase in regional lymph nodes, a reaction from the liver, spleen, peripheral blood. With the appointment of tetracycline antibiotics, a rapid positive dynamics is noted.

Malformations - middle and lateral cysts of the neck (met much less frequently than BCG lymphadenitis and felinosis). Median cysts exist for a long time in the form of a soft-elastic formation located above the thyroid cartilage in the hyoid bone. The size of education is from 1 to 4 cm, the skin under them is not changed, mobile. The danger is infection of the cyst. At the same time, it grows rapidly in size, painful. A fistula is formed. Lateral cysts are much less common, they are localized between the larynx and the anterior edge of the sternocleidomastoid muscle. Of great importance in diagnosis is puncture followed by examination of the material - a fluid with a large number of cells of the cylindrical or ciliated epithelium.

Toxoplasmosis. The disease is widespread among wild and domestic animals, birds. Pathogen - intracellular parasite, attributed to the simplest. Suffer peripheral lymph nodes, often cervical, axillary or inguinal groups. The disease can occur both acute and latent. In contrast to tuberculous lymphadenitis, there is no abscessing in toxoplasmosis. In the inflammatory process, the central nervous system, the eyes, the skin, the lungs, the myocardium can be involved. There are observations and combined lesions. Diagnosis of toxoplasmosis is complex, taking into account clinical, epidemiological and laboratory data: detection of antibodies in the blood serum in reaction with Feldman's dye, in RPC, RIGA, RIF, intradermal test with toxoplasmin, as well as studies that detect a pathogen in a punctate or biopsy of the lymph node with a straight line microscopy or by bioassay when infecting experimental animals.