Tubercular lymphadenopathy for postgraduates – A minireview

Abstract

Extrapulmonary tuberculosis (EPTB) remains often ignored by both medical community and authorities. This review attempts to summarize the pathogenesis, clinical presentation, investigations, diagnosis, treatment, and complication of lymph node TB (LNTB) in India. LNTB refers to Mycobacterium tuberculosis infection of the lymph nodes and is the most common form of EPTB in India. Classical symptoms include low-grade fever, weight loss, loss of appetite, night sweats, and painless enlarged lymph nodes in the neck or axilla or groin. Mediastinal lymphadenopathy presents with cough and chest discomfort and uncommonly even with shortness of breath; wherever possible, a pathological and microbiological diagnosis must be attempted by fine-needle aspiration for cytology, histopathology, acid-fast bacilli smear, and molecular tests such as cartridge-based nucleic acid amplification test and culture. For deep nodes, ultrasound/computed tomography/endobronchial ultrasound-guided aspiration can be done. LNTB is primarily requires medical management, and adjunct surgical excision is generally associated with worse outcomes. Six-month antitubercular therapy standard first-line regimen is recommended for peripheral LNTB and can be provided at the nearest local directly observed treatment short-course chemotherapy center in India.