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PubMedDate not supplied

Nontuberculous mycobacterial adenitis in children: diagnostic and therapeutic management.

We reviewed a series of 45 patients affected by nontuberculous mycobacterial adenitis of the neck observed in the Ear, Nose, and Throat Institute of S. Orsola-Malpighi Hospital-Bologna over a 20-year period between 1981 and 2001. The mean age was 5.5 years. Patients were tested by using the differential Mantoux test, which was the principal diagnostic tool in the case of atypical mycobacterial infections. Forty-two patients were surgically treated by total excision of infected nodes, whereas parotidectomy with sparing of facial nerve was performed in those 3 cases with intraparotid nodes involvement. In all cases, the histopathological diagnosis was tubercular granulomatous lymphadenitis. The culture growth of nontuberculous mycobacteria was positive in 13 cases with a marked prevalence of the avium-intracellular germs. The disease was eradicated in all patients. The diagnostic and therapeutic management of nontuberculous mycobacterial adenitis is discussed in this retrospective study.

Anti-Bacterial Agents↗
PubMed1990

Periportal-peripancreatic tuberculous adenitis. US and CT findings.

We present ultrasound (US) and computed tomography (CT) findings in 7 patients with periportal and peripancreatic tuberculous adenitis. In US scans, hypoechoic adenopathies were found in 6 patients while in the other one a hypoechoic, poorly marginated mass was seen. CT studies showed hypodense (25-35 HU) enlarged lymph nodes with immediate postcontrast peripheral rim enhancement in 3 patients. An infiltrating inhomogeneous mass was present in other patient and soft tissue density lobulated masses were found in delayed postcontrast scans of 2 patients. The US findings are of no help in distinguishing tuberculosis from other causes of adenitis. The CT appearance has been variable and only the hypodense nodes with peripheral enhancement in postcontrast scans are suggestive of this entity.

Adult↗
PubMed1997

Mesenteric adenitis caused by Yersinia pseudotuberculosis presenting as an abdominal mass.

Infection by Yersinia pseudotuberculosis has become of increasing pathological importance. Patients normally present with symptoms similar to those of appendicitis, due to mesenteric adenitis. We present the case of 3 patients infected by Yersinia pseudotuberculosis who in addition to fever and abdominal pain had a palpable abdominal mass, so great was the enlargement of the mesenteric nodes. In 2 patients a laparotomy was carried out, followed by biopsy of a mesenteric lymph node. The diagnosis of Yersinia infection was confirmed by bacterial culture of the biopsied material and also by serology. In the third patient, serological studies and ultrasonic imaging of the abdomen led to early diagnosis and surgery was avoided. We suggest that a diagnosis of mesenteric adenitis due to Yersinia pseudotuberculosis should now be considered in all patients presenting with an abdominal mass, and in whom there is an appropriate clinical and epidemiological history. The diagnosis should be confirmed by abdominal ultrasound (alternatively Computerised Axial Tomography or Magnetic Resonance Imaging) and serological studies. In this way, unnecessary surgery can be avoided.

Adolescent↗
PubMed2001

Treatment of Calmette-Guérin bacillus adenitis: a metaanalysis.

Various treatments have been used to decrease the risk of suppuration; the most troublesome complication of Calmette-Guerin bacillus adenitis, but results are controversial. Metaanalysis of four randomized controlled trials revealed no significant difference in the frequency of suppuration between the treatment and control groups for all treatments [relative risk (RR), 1.10; 95% confidence interval (CI), 0.88 to 1.38], erythromycin (RR 1.04; 95% CI 0.79 to 1.37) and isoniazid (RR 1.35; 95% CI 0.84 to 2.18). Therefore medical treatment does not reduce the frequency of suppuration in Calmette-Guerin bacillus adenitis.

BCG Vaccine↗
PubMed2000

Periodic fever, aphthous stomatitis, pharyngitis, adenitis: a clinical review of a new syndrome.

Periodic fevers (fevers that occur predictably at fixed intervals) are unusual in infants and children. The classic periodic fever syndrome is cyclic neutropenia (neutropenia followed by infections and fever that recur every 21 days). A new periodic fever syndrome PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) has been characterized over the past decade. PFAPA is defined clinically, because specific laboratory abnormalities have not been found. The clinical characteristic of PFAPA is high fevers (usually 40.0 degrees C to 40.6 degrees C) recurring at fixed intervals every 2 to 8 weeks. The fevers last for about 4 days, then resolve spontaneously. Associated with the fevers are aphthous stomatitis in 70% of patients, pharyngitis in 72% of patients, and cervical adenitis in 88% of patients. PFAPA is not familial and begins before the age of 5 years. An episode of PFAPA can be aborted with one or two small doses of prednisone. The episodes of PFAPA may last for years and the patient is well between episodes. The cause of PFAPA is unknown and there are no reported sequelae.

Child↗
PubMed1986

Immunohistochemical observations on carbonic anhydrase I and II in human salivary glands and submandibular obstructive adenitis.

Immunohistochemical identification of carbonic anhydrase I and II (CA-I, CA-II) was made in human major salivary glands and obstructive adenitis in submandibular glands. Normal salivary glands stained the strongest for CA-II in serious acinar cells and were negative in mucous cells. Moderate to strong staining for CA-I and CA-II was found in ductal segments. Submandibular glands with obstructive adenitis exhibited reduced CA-I activity in atrophic acinar cells, but not in ductal elements in the early and intermediate stages of the disorder. In the late stage of the obstructive lesion, CA staining in duct-like structures was moderate; however, almost degenerate ductal cells were negative for CA. During the progression of the degeneration in the obstructive lesion, the CA staining decreased dependent on acinar atrophy. Even after longstanding obstruction of the salivary gland, altered ductal epithelia may retain some of their functions.

Adult↗
PubMed1986

Periportal tuberculous adenitis: CT features.

The computed tomographic (CT) findings in six patients with periportal tuberculous adenitis were reviewed retrospectively to analyze the main morphologic features of the disease. In all patients, hypodense lymph nodes were observed close to the porta hepatis, with peripheral enhancement seen after administration of contrast material. In one patient, this hypodense adenopathy was associated with homogeneous, normally enhancing lymph nodes. These different features on the CT scans could signify the evolving pathologic stages of the disease, with early noncaseating granulomas and subsequent caseation necrosis. Recognition of these hypodense lymph nodes, especially in patients at risk, should help optimize the correct diagnosis of periportal tuberculous adenitis.

Adult↗
PubMed2005

[Usefulness of chemotherapy associated with surgery in the management of nontuberculous mycobacterial adenitis].

BACKGROUND: In recent years, lymphadenitis caused by atypical mycobacteria (also called nontuberculous mycobacteria [NTMB] or, more recently, environmental) have played a significant role in the differential diagnosis of adenitis in non-immunocompromised children. OBJECTIVES: To describe the clinical and pathological findings in childhood NTMB adenitis and study the possible usefulness of antimicrobial therapy in addition to surgery. METHODS: We present eight cases of neck lymphadenitis occurring over a 5-year period. All of the children received combined chemotherapy, and six also underwent surgery. Of the two remaining patients, the parents of one child refused surgery and a watchful approach was adopted in the other. RESULTS: Complete clinical recovery was achieved in all patients except one who did not undergo surgery. CONCLUSIONS: Prolonged administration of two antibiotics (of which one must be clarithromycin) in addition to surgery was well-tolerated and could be useful in patients with NTMB neck lymphadenitis.

Child, Preschool↗
PubMed1995

Surgical treatment of cervicofacial nontuberculous mycobacterial adenitis in children.

Fifteen children with nontuberculous mycobacterial adenitis of the head and neck underwent surgical treatment between July 1991 and July 1994. Fine-needle aspiration for biopsy and culture allowed early diagnosis in nine children. Positive cultures grew Mycobacterium avium-intracellulare complex in 12 children and M. chelonei in one child. Total excision was performed in 10 cases with combinations of lymphadenectomy and salivary gland excision. Curettage was used to successfully treat five children. One patient required local flap coverage for primary wound repair. Two patients required more than one surgical procedure. Our approach to early diagnosis and surgical treatment of cervicofacial nontuberculous mycobacterial adenitis is presented.

Biopsy, Needle↗
PubMed2005

Patient knowledge, practices and challenges to health care system in early diagnosis of mycobacterial adenitis.

OBJECTIVE: To assess diagnostic delay, knowledge and practices related to tuberculosis among patients with mycobacterial adenitis. DESIGN: A cross sectional study involving comparison analysis of high-risk groups. SETTING: Seven hospitals in rural and semi-rural districts of Arusha. SUBJECTS: Four hundred and twenty six clinically diagnosed adenitis patients. INTERVENTIONS: Biopsy specimens were processed for culture, histology, and sera for HIV testing. A questionnaire was used to assess knowledge, practice, and diagnostic time. MAIN OUTCOME MEASURES: Tribal comparisons were made using proportions and means. RESULTS: About 90% (387/423) of patients first visited medical facilities within a mean time of 10.1(SD, 15.7) weeks after becoming aware of their illness, and a diagnosis was made at a mean of 27 (SD, 25) weeks. Non-Iraqw patients, especially the Datoga, practised drinking raw milk (35.2% 43/122), eating raw animal products (18.8% 24/128) and living in houses with poor ventilation (33.6% 44/131), more than Iraqw patients. Of the investigations done, 14.5% (60/415) were culture positive, 11.3% (16/142) were HIV positive, and 73.6% (128/174) had histological features consistent with tuberculosis. The knowledge of TB spread by air droplets was poorer in Iraqw (74.1%, 203/274) than in non-lraqw (61.1%, 77/126) patients. About 35.0% (45/129) of non-lraqw and 27.3% (79/289) of Iraqw patients were not aware that TB could be transmitted from animals to humans. CONCLUSIONS: The health system diagnostic delay is about twice the patient delay. The knowledge and practices related to both human and bovine TB transmission were poor in all patients, especially in the patients from nomadic tribes.

Adolescent↗
PubMed1993

Syndrome of Rochalimaea henselae adenitis suggesting cat scratch disease.

OBJECTIVE: To describe a clinical syndrome of cat scratch disease caused by Rochalimaea henselae, including methods for isolation of the organism from tissue and for identification. DESIGN: Case series. SETTING: U.S. Air Force referral hospital infectious diseases clinic. PATIENTS: Two previously healthy patients. MAIN MEASUREMENTS AND RESULTS: Two immunocompetent patients who had handled cats developed unilateral upper-extremity adenitis associated with a distal papular lesion and fever. The adenitis and distal lesions persisted and progressively worsened. Cultures of the involved lymph nodes from both patients grew R. henselae, a recently described organism associated with bacillary angiomatosis and peliosis hepatis in human immunodeficiency virus-infected patients and with bacteremia in immunocompromised and immunocompetent hosts. The organism was characterized as oxidase negative and X-factor dependent and had a characteristic pattern in analysis of whole-cell fatty acids differing from Afipia felis, a bacterium that has been associated with cat scratch disease. The identity of the isolate was confirmed by analysis of whole-cell fatty acids using gas chromatography and by amplification of the citrate synthetase gene sequence and analysis of the polymerase chain reaction-amplified product. The organisms were broadly susceptible to a variety of antimicrobials by broth microdilution; however in-vitro resistance to first-generation cephalosporins correlated with clinical failure of therapy. CONCLUSION: Rochalimaea henselae can be a cause of cat scratch disease in immunocompetent patients.

Adult↗
PubMedDate not supplied

Diagnosis and management of biliary obstruction due to periportal tuberculous adenitis.

Biliary obstruction due to periportal tuberculous adenitis is a rare condition which is difficult to diagnose and treat. We describe two patients presenting with obstructive jaundice due to periportal tuberculous adenitis managed by two different approaches. In one patient the diagnosis was made after laparotomy and lymph node biopsy, and segment III biliary enteric bypass was performed with good relief of obstruction. In another patient the diagnosis was established by laparoscopy and the patient was successfully managed conservatively with percutaneous biliary drainage and antituberculous treatment. The different approaches of diagnosis and management of this rare condition are discussed.

Adult↗
PubMed1991

Cyclosporine-responsive granulomatous sebaceous adenitis in a dog.

Granulomatous sebaceous adenitis was diagnosed in a 2 year old spayed Miniature Pinscher. Initial treatment with isotretinoin for 3 weeks resulted in little response and decreased tear production. Immunosuppressive doses of prednisone for 3 weeks resulted in mild response of the dermatitis; however, the dog developed transient diabetes mellitus secondary to this treatment. Cyclosporine (5 mg/kg of body weight, po, q 12 h) resulted in good clinical response for 12 months, but histologically, the sebaceous glands remained absent. Although cyclosporine has immunosuppressive properties, this drug also has inhibitory effects of keratinocyte proliferation. These mechanisms may explain the beneficial response of cyclosporine in the treatment of granulomatous sebaceous adenitis in this dog.

Animals↗
PubMed1990

[Our experience in the treatment of cervico-facial adenitis caused by non-tuberculous mycobacteria (atypical mycobacteria)].

The authors believe that the greater part of chronic cervicofacial adenitis actually observed in our hospitals, are not caused by M. tuberculosis or M. bovis but by scrofulaceum mycobacterium, M. avium, M. fortuitum and M. Kansasii, and above all, by the first two of these. They present their experience with 16 cases of cervico-facial adenitis due to atypical mycobacterium (CAAM) treated in our centre during the last years, in which period no case of cervical tuberculosis (CT) was observed. It is important to establish an early differential diagnosis between both etiologies, seeing as treatment is different. Whilst tuberculostatics can solve the phymic infection, surgical extirpation is the only solution for CAAM. The diagnosis of these types of infection is achieved by means of a very characteristic clinical procedure and by cutaneous tests specific for each bacteria. Faced with the clinical suspicion, the total extirpation should be effected of the adenopathic block affected. The exact diagnosis can only be made by the culture of the operatory mass.

Child↗
PubMed1994

Vesicular adenitis syndrome in beef bulls.

Vesicular adenitis syndrome was diagnosed in 69.3% (52/75) of a group of yearling bulls on breeding soundness examination. Association of Haemophilus somnus infection with vesicular adenitis syndrome was confirmed in these bulls by microbial culture of vesicular gland fluid or semen samples and serologic testing.

Animals↗
PubMed1975

Treatment of atypical mycobacterial cervical adenitis with rifampin.

The clinical response of atypical mycobacterial cervical adenitis to standard antituberculous therapy has been disappointing. Surgical procedures in the anterior cervical triangle are difficult and often complete excision is impossible. In each of four children with atypical mycobacterial cervical adenitis in this study, the institution of rifampin therapy was followed by complete resolution. Previously rifampin, a well-tolerated, orally administered drug, had been used effectively with Mycobacterium tuberculosis. The place of this drug as a major alternative to surgical excision in cases of atypical mycobacterial cervical adentis is reviewed.

Antigens↗
PubMedDate not supplied

Alcohol-induced pain in tuberculous adenitis.

Since its first description in Hodgkin's disease, alcohol-induced pain has subsequently been described both in other neoplasms and in various non-malignant conditions. There seems little doubt that ethyl alcohol itself is responsible, although the mechanism for producing pain remains elusive. We report a case of alcohol-induced pain in a patient with enlarged lymph nodes on the right side of the neck. This symptom led us to make a preliminary diagnosis of Hodgkin's disease, which was subsequently disproved by biopsy, and tuberculous adenitis was established. We have been able to find only one other record of alcohol-induced pain and tuberculous adenitis in a patient reported by Bastin in 1957.

Adult↗
PubMed2003

Utility of tonsillectomy in 2 patients with the syndrome of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis.

OBJECTIVES: To review the various causes of period fever in childhood, including the syndrome of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA), and to examine the value of tonsillectomy in the treatment of PFAPA syndrome. DESIGN: Retrospective case series. SETTING: Urban and tertiary care referral children's hospital. PATIENTS: Two patients who underwent tonsillectomy for presumed recurrent adenotonsillitis were later diagnosed as having PFAPA syndrome. Intervention Tonsillectomy. MAIN OUTCOME MEASURE: Frequency of PFAPA symptoms before and after tonsillectomy. RESULTS: No difference was found in the frequency of PFAPA symptoms after tonsillectomy. CONCLUSION: Although a larger series of patients is required, our initial experience suggests that tonsillectomy is not always beneficial for patients with PFAPA syndrome.

Adolescent↗