Lymph Node Tuberculosis is an extrapulmonary form of tuberculosis that is quite common in our country, and lymph node tuberculosis in children is showing a significant upward trend. Peripheral lymph node tuberculosis is the most frequently encountered form, with common locations including cervical, axillary, and inguinal lymph nodes. Additionally, lymph node tuberculosis can occur in lymph nodes located in internal organs such as the mediastinal and mesenteric lymph nodes.
What is Lymph Node Tuberculosis?
Before exploring whether lymph node tuberculosis is contagious and whether it is dangerous, it is essential to affirm that this disease is not very dangerous, does not cause death, can be cured, but is quite common and can lead to prolonged symptoms. However, lymph node tuberculosis can cause significant difficulties in daily life, often leaving behind many complications and disfiguring scars that affect aesthetics, so patients should not be complacent.
Currently, there are two common forms of lymph node tuberculosis: bronchial lymph node tuberculosis, which occurs only in children, and peripheral lymph node tuberculosis, which is prevalent in all age groups. This disease often appears in adolescents, with females being twice as likely to be affected as males. Worldwide, the incidence of lymph node tuberculosis is also relatively high and affects all demographics, similar to Vietnam.
Commonly found in the neck, especially in children.
Causes of Lymph Node Tuberculosis
The causative agent of lymph node tuberculosis is the tuberculosis bacillus, most commonly Mycobacterium tuberculosis. Peripheral lymph nodes are locations where the tuberculosis bacteria can easily invade, settle, and lead to lymph node tuberculosis. The bacillus can directly enter the lymphatic system through lesions in the oral mucosa or due to trauma, infection, or can be a result of systemic tuberculosis infection (such as in pulmonary tuberculosis), causing inflammation in multiple lymph nodes.
Symptoms of Lymph Node Tuberculosis
Patients with lymph node tuberculosis primarily exhibit swelling of one or more lymph nodes. The lymph nodes gradually increase in size, so patients often do not notice exactly when the nodes appeared. The nodes enlarge without pain, have a firm consistency, a smooth surface, and the skin over the swollen nodes is not hot or red. It is common to see multiple nodes swollen together, forming a chain, although sometimes only a solitary node in the neck may be enlarged.
Lymph node tuberculosis develops through three stages:
- Initial Stage: The lymph nodes begin to swell, are irregular in shape, and are still mobile as they are not yet adhered to each other or to the skin. The disease may remain at this stage or progress to lymphadenitis and perinodal inflammation.
- Later Stage: This stage is characterized by lymphadenitis and perinodal inflammation. The nodes become larger, and due to inflammation of the surrounding tissues, they may stick together forming a mass or chain, or adhere to the skin and surrounding tissues, limiting their mobility.
- Softening Stage: The lymph nodes gradually become soft, feel boggy upon palpation, the skin over the swollen nodes becomes red and swollen, but is not hot or painful, and a fluctuating apex may be visible. Once the nodes have formed pus, they can easily rupture, creating long-lasting fistulas, with the mouth of the fistula appearing dark purple and resulting in lumpy, raised scars that affect aesthetics. The pus that drains is often light green, non-sticky, and contains clumps of caseous material.
During the course of lymph node tuberculosis, the overall health is not significantly affected, sometimes there may be mild fever or fatigue. However, if there is a superinfection or accompanying damage from tuberculosis in other organs such as the lungs or bones, systemic symptoms may become more pronounced.
In the tumor form of lymph node tuberculosis, also known as hypertrophic lymphadenitis, the symptoms often include: the appearance of a tumor in the neck, with one or several enlarged nodes that may merge into a mass, which is painless, not red, mobile, and firm. The tumor gradually enlarges, occupying almost the entire neck area, leading to a deformity of the patient’s neck. Lymph nodes in other areas such as under the jaw or near the ear may also be enlarged. Hypertrophic lymphadenitis is often very difficult to treat completely. This form of the disease is quite rare.
Transmission of Lymph Node Tuberculosis
Unlike pulmonary tuberculosis, in lymph node tuberculosis, the tuberculosis bacteria are localized in the inflamed lymph nodes and do not leak outside, so lymph node tuberculosis is not directly transmissible from person to person, especially for those who directly care for a person with lymph node tuberculosis. Thus, lymph node tuberculosis is not considered an infectious disease.
However, the treatment for lymph node tuberculosis is similar to that for pulmonary tuberculosis, primarily using medical methods such as administering various anti-tuberculosis medications in stages to inhibit and eventually eliminate the tuberculosis bacteria. Generally, individuals with lymph node tuberculosis should seek medical consultation and follow the prescribed treatment guidelines, which do not affect those around them.
One of the signs of lymph node tuberculosis.
Prevention of Lymph Node Tuberculosis
To prevent lymph node tuberculosis, it is essential to adhere to the following:
- Enhance immunity, maintain a nutritious diet, and ensure proper rest, especially for children,
- Practice oral hygiene, and extract or treat decayed teeth.
- Once diagnosed with lymph node tuberculosis, it is crucial to follow the treatment prescribed by a tuberculosis specialist to ensure complete recovery and prevent the bacteria from invading and causing disease in other organs.
Diagnosis of Lymph Node Tuberculosis
Confirmatory Diagnosis
Diagnosis is based on clinical manifestations and several tests such as:
- Needle aspiration for cytological examination
- Lymph node biopsy for histopathological diagnosis
- Culture for tuberculosis bacillus
- Chest X-ray
Differential Diagnosis
- Acute or chronic lymphadenitis caused by bacteria or viruses is the primary differential diagnosis. If the lymph nodes are swollen, hot, red, painful, soft, and responsive to antibiotic treatment, it indicates bacterial lymphadenitis.
- Hodgkin and Non-Hodgkin Lymphoma: lymph node biopsy and bone marrow examination can help differentiate.
- Metastatic cancer lymph nodes: biopsy and clinical manifestations of primary cancer.
- Benign tumors: lipomas, fibromas, neurofibromas, lymphatic cysts, etc.
Treatment Methods for Lymph Node Tuberculosis
Can Lymph Node Tuberculosis Be Cured?
In general, lymph node tuberculosis is easier to treat than other forms of tuberculosis. Treatment methods for lymph node tuberculosis include:
Medical Treatment
The principles are similar to those for treating tuberculosis in general. It is necessary to combine anti-tuberculosis medications, using at least three drugs or more. The treatment duration for lymph node tuberculosis can range from 4 to 12 months depending on the form of the disease and the individual patient’s response. Lymph node tuberculosis in children often responds well when medication is combined with maintaining hygiene in daily activities, such as oral hygiene and treating decayed teeth. In cases with purulent lymph nodes nearing rupture, active aspiration of pus may be performed to avoid creating fistulas or unsightly scars, and antibiotics should be used while continuing to administer anti-tuberculosis medication for several months even after symptoms have resolved. Most anti-tuberculosis medications can cause liver damage; therefore, it is advisable to combine them with liver-protective medications or products that lower liver enzymes.
Surgical Treatment
Complete Lymph Node Excision: indicated when the lymph nodes are purulent but do not respond to aspiration and antibiotic treatment, or in cases of lymphatic tuberculosis where there is no pus and the infection is localized. It is best to treat tuberculosis before surgery to prevent the spread of bacteria.
Surgery and thorough cleaning of pus and caseous material, followed by the application of anti-tuberculosis antibiotics is also an effective treatment method.
Early removal of lymph nodes in children should be avoided because lymph nodes play a protective role against the invasion of tuberculosis bacteria.
Regarding treatment, it is essential to pay attention to health care, especially for children, to prevent chronic lymphadenitis.
