How the process develops
Mycobacteria penetrate the lymph node and cause specific inflammation: granulomas form around the pathogen, in the center of which the tissue is gradually destroyed, turning into a cheesy mass. The node enlarges, loses mobility, and fuses with neighboring nodes and skin. Over time, the contents can melt, and a cold abscess forms - a collection without pronounced redness and heat, which distinguishes it from an ordinary abscess. When it breaks out, a fistula is formed, which does not heal for a long time and leaves a retracted scar.
- Formation of granulomas in the tissue of the node
- Curdled melting in the center
- Soldering nodes into a package
- Cold abscess without significant skin inflammation
- Formation of fistula and retracted scar
- The cervical and supraclavicular nodes are most often affected
Causes and risk factors
The causative agent is Mycobacterium tuberculosis, which is transmitted by airborne droplets from a patient with a pulmonary form. It enters the lymph nodes with the lymph flow, often years after the initial infection, when the protective forces weaken. This is why the disease more often develops in people with HIV infection, diabetes mellitus, chronic kidney disease, exhaustion, or taking glucocorticosteroids and drugs that suppress the immune system. Children and adolescents are also a vulnerable group, especially in family contact.
- Contact with a patient with active tuberculosis
- HIV infection
- Diabetes mellitus
- Wasting and nutritional deficiency
- Taking immunosuppressive drugs
- Chronic kidney disease
- Overcrowding and poor living conditions
Symptoms
The main symptom is a gradually enlarging lymph node or group of nodes, usually on the side of the neck or above the collarbone. At the beginning they are dense, mobile and almost painless, the skin over them is not changed. Over time, the nodes become inactive, the skin over them turns red and thins. General manifestations are less pronounced than with pulmonary tuberculosis, but low temperature in the evenings, night sweats, weakness, decreased appetite and gradual weight loss are common.
- Slowly growing lymph nodes in the neck
- Firmness and mild pain
- Soldering nodes together
- Redness and thinning of the skin over the node
- Fistula with discharge
- Low-grade fever and night sweats
- Weakness and weight loss
Diagnostics
The examination begins with an ultrasound of the lymph nodes, which shows their structure, size and the presence of fusion. Obtaining the material is of decisive importance: a puncture is performed or, more reliably, the node is removed with histological examination, culture and a molecular genetic test for mycobacteria, which also determines drug resistance. A chest x-ray is required to find a possible pulmonary lesion. Additionally, immunological tests and HIV testing are used.
- Ultrasound of lymph nodes
- Puncture or biopsy of the node with histology
- Culture and molecular genetic test for mycobacteria
- Determination of drug resistance
- X-ray of the chest organs
- Immunological tests for tuberculosis
- Screening for HIV and diabetes
Treatment and prevention
Treatment is carried out by a phthisiatrician according to standard regimens: several anti-tuberculosis drugs are prescribed simultaneously, the course lasts at least six months, and if the pathogen is resistant, much longer. It is impossible to interrupt treatment when improvement occurs: this is the main reason for the formation of stable forms. Surgical removal of the node or opening of the abscess is additionally used for large bags, fistulas and doubts about the diagnosis, but the operation does not replace drug therapy. Prevention includes examination of contact persons and vaccination of children according to the calendar.
- Combined anti-tuberculosis therapy
- A course of at least six months under the supervision of a TB specialist
- Determination of pathogen resistance before treatment
- Surgical removal of a node or opening of an abscess according to indications
- Adequate nutrition and treatment of associated diseases
- Examination of family members and contact persons
- Vaccination of children according to the national calendar