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PubMed1999

Surgical treatment of atypical mycobacterial cervicofacial adenitis in children.

BACKGROUND: Atypical mycobacteria have long been recognized as a cause of cervicofacial adenitis in otherwise healthy children. The disease is nearly always localized but if left untreated the involved lymph nodes caseate and discharge. The management of this condition has been considered to be surgical with techniques including aspiration, incision and drainage, curettage and excision. METHODS: Cases of atypical mycobacterial cervicofacial adenitis treated by curettage at the Canberra Hospital, ACT, Australia, are reviewed. RESULTS: Ten cases successfully treated with curettage are reported. Two patients experienced delayed healing of their wounds and one required a second curettage 7 months after primary excision for recurrent disease. CONCLUSION: Curettage is a safe and effective means of treating atypical mycobacterial cervicofacial adenitis in children. The primary cure rate of 70% is less than that for excision of the involved nodes (92% cure rate), which is the standard treatment for this disease.

Child↗
PubMed2005

[Four cases of the tuberculous adenitis].

We report four cases of tuberuculosis with the lymph nodes swelling in the porta hepatis. Case 1 is 52 years-old man, who was admitted to our hospital because of anorexia. The chest X-ray film showed abnormal shadow and he was diagnosed as tuberculosis by sputum examination. At the time of hospitalization, patient's conjunctiva is icteric on physical examination. The serum T-Bil was 3.21 mg/dL and D-Bil was 2.54 mg/dL. The enhanced CT showed compression of the extrahepatic common bile duct which was caused by enlarged lymph nodes secondary to tuberculous adenitis. Case 2 is 25 years-old man, who was admitted to our hospital because of low grade fever and lower abdominal pain. The chest X-ray film showed abnormal shadow and he was diagnosed as tuberculosis by sputum examination. An enhanced CT showed the swelling of the lymph nodes in the porta hepatis. Case 3 is 21 years-old woman, who visited the outpatient clinic bacause of neck lymph node swelling. And she was diagnosed as tuberculous adenitis of the cervical lymph-nodes by the neck lymph node biopsy. The patient complained of upper abdominal pain during the clinical course. The enhanced CT showed the swelling of the lymph nodes in the porta hepatis. A Case 4 is 31 years-old man, who visited to outpatient clinic bacause of fever. The chest X-ray film showed mediastinal lymphadenopathy, and he was diagnosed as tuberculosis by the thoracoscopic biopsy. The enhanced abdominal CT showed lymph nodes swelling in the porta hepatis. All of lymph nodes swelling found in our four cases markedly reduced in size on abdominal enhanced CT or ultrasonography after the initiation of anti-tuberculous standard chemotherapy. Symptom of all cases got better as well. In these clinical circumstances, it was clinically important to rule out malignant lymphoma and lymphadenopathy caused by cancer. The enhanced abdominal CT were useful for diagnosis and follow-up as tuberculous adenitis.

Adult↗
PubMed1985

Cervical tuberculous adenitis: CT manifestations.

Cervical tuberculous adenitis is being seen with increasing frequency in the United States; in the appropriate clinical setting it should be included in the differential diagnosis of an asymptomatic neck mass. Patients are typically young adults who are recent arrivals from Southeast Asia. A history of tuberculosis is not always elicited nor is the chest radiograph always abnormal. All of these patients have positive purified protein derivative tests unless they are anergic. The CT findings may lead to the diagnosis. Several CT patterns of nodal disease can be seen in tuberculous adenitis; some may mimic benign and neoplastic disease. The presence of a multiloculated or multichambered (conglomerate nodal) mass with central lucency and thick rims of enhancement and minimally effaced fascial planes is highly suggestive of tuberculous adenitis, especially if the patient has a strongly positive tuberculosis skin test.

Adult↗
PubMed1994

Determination of humoral immunoglobulins M and G directed against mycobacterial antigen 60 failed to diagnose primary tuberculosis and mycobacterial adenitis in children.

The serodiagnosis of primary tuberculosis (TB) and mycobacterial adenitis in children was tried using the Anda-Tb tests (Anda Biologicals, France) that measure immunoglobulins (Ig) M and G directed against mycobacterial antigen 60 (A60) by enzyme-linked immunosorbent assay. The 188 cases studied included 81 healthy or mycobacteria-unrelated diseased children with no reaction to tuberculin skin test (STN); 9 recent BCG vaccination (BCG); 35 asymptomatic (AsTB), 29 symptomatic (STB) primary TB and 11 adenitis caused by atypical mycobacteria from the group avium-intracellulare-scrofulaceum (MAIS) tested before treatment; and 23 past primary TB tested at different times after completion of specific treatment (past TB). The individual IgM and IgG levels largely overlapped whatever the clinical status of the children. Setting the normal upper limit at the 95th percentile of the STN values, which by definition gives 95% specificity, the highest IgM sensitivity was found in past TB (35%), AsTB showing 23%, STB 17%, and MAIS 18% sensitivity. IgG sensitivity was also the highest in past TB (26%) and was equal to 6, 14, and 9% in AsTB, STB, and MAIS, respectively. Positive and negative predictive values and the test efficiency (63 and 62% for IgM and IgG, respectively) were far too low. Combining positivity for IgM and/or IgG did not improve the results. In our study, the anti-A60 IgM and IgG measurements using the Anda-Tb tests in primary TB and mycobacterial adenitis in children did not prove of any diagnostic help.

Antibodies, Bacterial↗
PubMed1989

Mycobacterium tuberculosis cervical adenitis. Diagnosis and management.

Cervical adenopathy as the sole presentation of tuberculosis is seen infrequently in the pediatric age group. Despite modern treatment and public health measures, tuberculous cervical adenitis persists, and its prompt diagnosis and treatment are important from both a clinical and preventive health perspective. The authors report five cases of children with ages ranging from 8 to 17 years, in whom cervical adenitis was the only presentation of infection with Mycobacterium tuberculosis. The clinical presentation and methods of diagnosis and treatment are described, and the difficulty of differentiation between infections with M. tuberculosis and non-tuberculous mycobacterial infections is stressed. Tuberculous cervical adenitis should be considered in cases of an elusive diagnosis of a cervical mass in the pediatric patient.

Adolescent↗
PubMed2005

Effects of cyclosporine A on clinical and histologic abnormalities in dogs with sebaceous adenitis.

OBJECTIVE: To evaluate the effects of cyclosporine A in the treatment of sebaceous adenitis in dogs. DESIGN: Open-label clinical trial. ANIMALS: 12 dogs with sebaceous adenitis. PROCEDURE: Dogs were treated with cyclosporine A at a dosage of 5 mg/kg/d (2.3 mg/lb/d), PO, for 12 months and reevaluated every 4 months. A clinical score was calculated by grading the extent of alopecia and severity of follicular casts as absent, mild, moderate, or severe in each of 17 body regions. Biopsy specimens were obtained and examined histologically and by means of immunohistochemical staining. RESULTS: Mean clinical score was significantly decreased, compared with baseline score, after 4 months of treatment and remained low after 8 and 12 months. Histologically, the severity of inflammation was significantly decreased, as were numbers of macrophages, CD3+ T cells, and major histocompatibility complex class II-expressing cells. The percentage of hair follicles with sebaceous glands increased, suggesting regeneration of sebaceous glands. Clinical signs recurred when cyclosporine administration was discontinued. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that administration of cyclosporine A at a dosage of 5 mg/kg/d may reduce the inflammation associated with sebaceous adenitis in dogs. Long-term treatment appears to be neccessary to control the disease.

Administration, Oral↗
PubMed1997

The etiology and clinical characteristics of mesenteric adenitis in Korean adults.

This study is aimed at investigating the etiology and clinical characteristics of mesenteric adenitis in Korean adults, prospectively. Clinical manifestations of fifteen patients who presented with the acute onset of right lower quadrant pain and sonographically enlarged mesenteric lymph nodes and normal appendix were evaluated. For etiologic diagnosis, stool culture, serologic test for Epstein-Barr virus, and Widal test were performed. Colonoscopy with mucosal biopsies and microbial tissue cultures were performed in 12 of 15 patients. Of fifteen patients 6 were male and the average age was 29.9 (17 approximately 41) years. Associated symptoms were diarrhea (80%), fever (73%), nausea and vomiting (27%). Right lower quadrant tenderness was observed in all cases but rebound tenderness was observed only in 26.7% of the cases. Etiology was identified in 7 cases (47%): 2 Yersinia enterocolitica infection, 2 non-typhoidal Salmonella infection, 2 tuberculosis, and 1 typhoid fever. In colonoscopic examination, signs of active inflammation were observed in 9 cases (75%) and inactive or normal findings in 3 cases (25%). All of our patients, except for the patients with tuberculosis and typhoid fever who needed specific antibiotic therapy, improved spontaneously without using antibiotics. In conclusion, the etiology of mesenteric adenitis in Korean adults seems to be different from that of western countries. Furthermore, mesenteric adenitis in Korean adults is a clinical syndrome, frequently found in a relatively young age group, which improves spontaneously unless specific anti-microbial agents are indicated by microbiological tests, such as tuberculosis or typhoid fever.

Adolescent↗
PubMed1991

A possible role of crows in the spread of diarrhoeal diseases in Aden.

The Indian House Crow (Corvus splendens) has increased dramatically in number in Aden. These birds pollute the environment by dropping their faecal material all over the city. They may accordingly be related to important public health problems. The present work aimed at investigating the possibility that they play a role in the spread of diarrheal diseases. One hundred and fifty crows were collected and their liver, intestine and cloaca examined bacteriologically for Enterobacteriaceae and Vibrionaceas as well as for parasites. Different members of Enterobacteriaceae including Salmonella, and Shigella serotypes and Proteus strains as well as members of Vibrionaceae and Pseudomonads were isolated from a great proportion of crows. Some of them were found identical to the strains previously isolated from patients suffering from diarrhea in Aden. Giardia lamblia cysts and Hymenolepis nana ova were also recovered from crows. It was concluded that crows may participate in the spread of diarrheal diseases in Aden.

Animals↗
PubMed1988

Atypical mycobacteria-induced cervical adenitis. Treatment by needle aspiration.

Atypical mycobacteria are among the most frequent causes of cervical adenitis. These unilateral nodes seldom present a treatment problem since surgical excision is curative. Occasionally, however, the affected cervical node lies adjacent to the facial nerve and/or its marginal mandibular branch. There can be a substantial risk of damage to the facial nerve and its branches in excision of such an infected mass with surrounding edema and cellulitis. An alternative and safe method of treatment in these cases is needle aspiration of the contents of mass. Of 17 cases of atypical mycobacteria-induced cervical adenitis seen at UCLA from 1975 to 1985, nine were treated by aspiration alone. None of these required further surgery. All were treated with one or more antituberculous agents during and after aspiration. This method of needle decompression of cervical nodes provides a safe and effective way to treat atypical mycobacteria infection that overlies the facial nerve and its branches.

Adult↗
PubMed1988

Nontuberculous mycobacterial adenitis of childhood. The ten-year experience at a community hospital.

An increased occurrence of nontuberculous mycobacterial adenitis was observed in children admitted to the Tucson Medical Center for adenitis between 1979 and 1983. All infections were due to Mycobacterium avium-intracellulare complex (MAI). All isolates were obtained from children less than 3 years old and with symptoms of two months or less. Children with negative cultures tended to be older, had a longer interval of lymphadenopathy, and had larger glands. Factors that may have caused the separation of our two groups and the high prevalence of MAI are addressed herein. Only earlier suspected diagnosis and application of tuberculosis screening studies can define the true prevalence of MAI disease in childhood.

Arizona↗
PubMed1991

Chronic bilateral dacryo-adenitis in identical twins: a possible incomplete form of Sjögren syndrome.

We report an unusual case of chronic bilateral dacryo-adenitis in 10-year-old identical twin sisters. Both girls presented with bilateral lacrimal gland enlargement and developed moderate xerophthalmia and keratitis. Both the lacrimal and minor salivary gland biopsies showed a non-granulomatous inflammatory infiltration of mono-nuclear cells. All granulomatous diseases and neoplasms could therefore be ruled out and only Sjögren syndrome and very few other forms of chronic dacryo-adenitis remained as possible diagnoses. Both patients and their parents were evaluated for auto-antibodies. Very low titres of smooth muscle antibodies were found in one, antinuclear antibodies in two and anti-dsDNA antibodies in all four members of the family. Even though the titres of antinuclear and anti-dsDNA antibodies increased in one of the sisters, both patients did not develop any sign or symptom of a systemic connective tissue disease. During the 6 years' follow up, both patients showed persistent tarsal gland enlargement but no other symptoms apart from a moderate xerophthalmia and occasional mild keratitis.

Biopsy↗
PubMed1999

PFAPA syndrome (Periodic Fever, Aphthous stomatitis, Pharyngitis, Adenitis).

This paper aims to remind paediatric clinicians to suspect and confirm 'PFAPA' syndrome (Periodic Fever, Aphthous stomatitis, Pharyngitis and cervical Adenitis syndrome). We report two cases of PFAPA syndrome: a 3-year-old healthy boy with atopic rhinitis and a boy aged 8 years 5 months who simultaneously had lymphocytic vasculitis syndrome treated with immunosuppressive drugs. Both met Marshall's criteria. The literature regarding PFAPA syndrome was complied using a Medline search for articles published between 1963 and 1998 and we then reviewed the reference lists of the articles. The Medline search revealed 28 cases with available clinical manifestations, management and prognosis. Our study describes two additional cases. We divided the cases into typical (28 cases) and atypical (two cases) PFAPA syndrome. In typical PFAPA, the age of onset was less than 5 years in most cases and the patients presented 4.9 +/- 1.4 days of fever (100%), pharyngitis (89.3%), cervical adenitis (72.1%), stomatitis (71.4%), malaise (64.3%), headache (60.7%), abdominal pain (53.6%) and nausea/vomiting (17.9%). Afebrile intervals were 3.2 +/- 2.4 months and increased with age. The time from initial onset to final episode was 3 years 7 months +/- 3 years 6 months. The total number of episodes was 8.3 +/- 2.5 (range 6-14). Effective treatment included steroids, tonsillectomy/adenoidectomy and cimetidine. The general outcome was good. In atypical PFAPF, the clinical manifestations were similar to those of typical PFAPA except that the age of onset was more than 5 years, and life-threatening intestinal perforation happened once in a patient with underlying Fanconi's anaemia. It was concluded that typical PFAPA syndrome is benign and can be diagnosed by detailed history-taking and from physical findings during repeated febrile episodes with tests to rule out other periodic fever syndromes. A review of the literatures since the first report in 1987 has shown that typical PFAPA syndrome is not associated with significant long-term sequelae and has a good response to steroids. One patient with atypical PFAPA, who received low-dose steroids for over 1 year, developed intestinal perforation after an increment of the 7-day steroid dose. If an underlying problem requires long-term immunosuppressive medication, it is wiser to choose cimetidine rather than increasing the steroid dosage to resolve atypical PFAPA.

Azathioprine↗
PubMed1987

Neonatal BCG vaccination and mycobacterial cervical adenitis in childhood.

Mycobacterial cervical adenitis is an uncommon disease in children in Finland. During 10 years, from 1977-1986, its incidence was of the order of 0.3/year/100,000 children. Of the 12 bacteriologically verified cases, M. avium-intracellulare was isolated in nine, M. malmoense in two and M. tuberculosis in only one case. Neonatal BCG vaccination seemed to protect children against non-tuberculous mycobacterial infection, especially at 1-4 years of age. In Sweden, where neonatal BCG vaccination has been discontinued, the incidence of non-tuberculous mycobacterial adenitis is at least 30 times greater.

Adolescent↗
PubMed2005

Tumor necrosis factor receptor-associated periodic syndrome in a young adult who had features of periodic fever, aphthous stomatitis, pharyngitis, and adenitis as a child.

Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) was diagnosed in a 22-year-old man after a 1-year history of periodic fever, myalgia, conjunctivitis, cervical lymphadenopathy, and oral ulcers. As a child he had signs and symptoms suggestive of periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. This report indicates the importance of considering TRAPS as a cause of periodic fever in older children and adults and that TRAPS may present with signs and symptoms suggestive of periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome in young children.

Adult↗
PubMed1995

The application of ultrasound criteria for malignancy in differentiating tuberculous cervical adenitis from metastatic nasopharyngeal carcinoma.

Tuberculous adenitis and metastatic nodes from Nasopharyngeal carcinoma may have a similar clinical presentation. Clinical examination and laboratory tests alone are unable to differentiate the two. However, ultrasound is a useful initial investigation in differentiating these two conditions. We present ultrasound appearances in 33 patients with proven tuberculous cervical adenitis and 32 patients with proven metastatic nasopharyngeal carcinoma. The ultrasound features we found useful were the distribution of the nodes, cystic change, matting and surrounding soft tissue oedema. The size, shape and internal architecture of the nodes, previously described criteria in differentiating benign from malignant nodes, did not help.

Adolescent↗
PubMed1999

Distribution and relationships of selected trace metals in molluscs and associated sediments from the Gulf of Aden, Yemen.

Concentrations of Cd, Pb, Zn, Cu, Ni, Co, Cr, Mn and Fe in the soft tissue of Turbo coronatus, Acanthopleura haddoni, Ostrea cucullata and Pitar sp., as well as in associated surface sediments (bulk and bioavailable metal concentrations) from the Gulf of Aden, Yemen, were determined by atomic absorption spectrophotometry method. Large differences between size-classes of molluscs in metal concentrations were recorded. Significant spatial differences in metal concentrations in both the soft tissue of the molluscs and associated sediments studied were mostly identified. Statistically significant correlations (p<0.01) between concentrations of selected metals were observed. A slope of the linear regression is significantly higher than unity for Fe (9.91) and Cd (3.45) in A. haddoni and for Ni (4.15) in T. coronatus, suggesting that the bioavailability of these metals is disproportionally increased with a degree of enrichment of the sediments in Fe, Cd and Ni, respectively. A slope constant approximating to unity (1.14) for Cu in A. haddoni relative to its concentration in sediment extract implies that bioavailability of this metal proportionally increased with growing concentrations of its labile forms in the associated sediment. The degree of contamination of Gulf of Aden waters by the metals studied is discussed and the potential ability of molluscs, especially A. haddoni and T. coronatus, as biomonitors of metallic pollutants is postulated.

Journal Article↗
PubMed1979

Mechanism of Lactobacillus leichmannii ribonucleotide reductase studied with Coalpha-[alpha-(Aden-9-yl)]-Cobeta-adenosylcobamide (Pseudocoenzyme B12) as coenzyme.

Coalpha-[alpha-(Aden-9-yl)]-Cobeta-adenosylcobamide (pseudocoenzyme B12) purified from Clostridium tetanomorphum has been reacted with ribonucleotide reductase purified from Lactobacillus leichmannii under various conditions, and the properties of the products obtained have been compared by electron paramagnetic resonance (EPR) with those previously reported for products formed from the normal coenzyme (adenosylcobalamin). The rapidly formed intermediate and the slowly formed "doublet" species from the pseudocoenzyme have EPR spectra identical with those formed from the normal coenzyme. This and other considerations make it less likely that the unusual magnetic properties of the rapidly formed intermediate are due to strongly distorted octahedral symmetry about Co(II) as previously postulated. Instead it is probable that the EPR spectrum is due to interaction of the radical pair by both exchange coupling and magnetic dipole--dipole coupling. Although Coalpha-[alpha-(aden-9-YL)]cob(II)amide in solution does not show superhyperfine splitting in the EPR spectrum because of its base-off configuration, the cob(II)amide formed by degradation of the pseudocoenzyme within the catalytic site of the enzyme did show triplets due to a nitrogen axially coordinated to cobalt. This suggests that binding of the cob(II)amide to the reductase catalytic site causes a shift to the base-on form.

Electron Spin Resonance Spectroscopy↗