Tuberculosis of cervical lymph nodes

 Prevention: hygiene education, cultivate the habit of not spitting phlegm anywhere, BCG vaccination for children, care of oral hygiene, early treatment of dental caries and resect pathological tonsils.
  

   Diagnosis: based on the history of contact with tuberculous patients and regional symptoms especially formations of  cold abcess or fistula and ulcers. If there is enlargement of cervical lymph nodes but without cold abcess, it will be difficult to diagnose, therefore, it must be differentiated from chronic lymphadenitis, lymphosarcoma, tumor metastases to neck and so on. If the differential diagnosis is difficult, biopsy may be necessary.   

Clinical manifestations: unilateral or bilateral enlargement of cervical lymph nodes, frequent in supraclavicular region, namely, anterior and posterior of sternocleidomastoid muscle under the lower jaw. In early stage or initial period, the swollen lymph nodes are harden, painless and moveable. It will then progress to inflammation around lymph nodes, causing adhesion of lymph nodes and surrounding skin, lymph nodes may chained and merged together forming immovable clusters. In late stage, the lymph nodes will undergo caseous necrosis, liquefication and form cold abcess. The decomposition of cold abcess will yield white granulated pus which later develops into unhealed fistula or chronic ulcer; skin of ulcer s edge is dark red and slink while granulation tissues are pale (white) and have edema. The different stages of pathological changes mentioned above may appear in each lymph node of a patient simultaneously. After increase of patient s immunity and proper treatment, those pathological changes of lymph nodes will stop and undergo calcification. Some patients may have subfebrile temperature, excessive sweating, loss of appetite, cachexia and other general intoxication symptoms.  

Tuberculosis of the cervical lymph nodes or tuberculous lymphadenitis is a type of chronic specific infection caused by Mycobacterium tuberculosis. One must prevent the habit of spitting phlegm everywhere to prevent tuberculous lymphadenitis. In traditional chinese medicine (TCM), this disease is categorized as luo li (scrofula), its causes are emotional depressed with heating and accumulation of liver Qi , spleen loses its transportation ability and formed phlegm, thus heat and phlegm struggle and store at neck s route and finally caused disease; or external bad substances struggles with internal moist phlegm and caused disease; or general body weakness with Yin insufficient of lung and kidney which later heats fluid into phlegm and formation of disease from the accumulation of phlegm s heat. It is mostly seen in children and youth. Usually, mycobacteria enters to the body by tonsils and dental caries, in some cases--complications of lung or bronchus tuberculosis. But it can only induce disease when one s immunity resistance is low.

Treatment:

Rules of treatment of western medicine:

(1) Regional treatment:

1. Resection operation for less limitation, bid and movable lymph nodes. Need to be cautious while operation not to damage the nerves.

2. Puncture for cold abcesses that are not ruptured. Enter the needle at normal skin near abcess. Clear the pus as possible and introduce 5% isoniazid solution or 10% streptomycin solution to clean the abcess cavity, twice a week.
3. Necretomy (removing of dead tissue) for ulcers and fistulas formed after ruptured of cold abcess e.g non-significant continuous infections. Carefully remove the dead or pathological tissues. Wounds are not stitched, care of the wound with streptomycin solution.

4. If there is spreading of cold abcess, incision and drainage is needed; after infection is controlled, necretomy is done necessarily.

(2) General treatment: Rational diet and rest. Introduction of isoniazid orally for 1-2 years, those accompanied by general intoxication syndrome or other tuberculous patients must additionally introduce sodium-para-aminisalicylate or rifampin or intramuscular injection of streptomycin.