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Tuberculosis continues to be the biggest health problem in developing countries with enormous social and economic implications. Even in the developed countries, where the disease was controlled to a large extent, it is again posing a new health challenge. This is due to the migration of people from developing areas with a high prevalence of tuberculosis and the increasing high incidence of HIV infection in these countries. This has resulted in a worldwide resurgence of tuberculosis. During the past decade the clinical pattern and presentation of tuberculosis has changed dramatically. Much of the traditional learning about this disease is no longer true and tuberculosis has become a new entity. 1
Tuberculous lymphadenitis is the commonest form of extrapulmonary tuberculosis. Cervical lymph nodes are the most common lymph nodes affected by this disease-classically termed as "scrofula". We studied the recent clinical pattern of the disease because we come across many patients with cervical tuberculous lymphadenopathy in our outpatient department. Although literature is available on various aspects of this disease, not many recent studies have been done on the clinical pattern of the disease. We treated our patients with short course chemotherapy with very few patients requiring surgery. Our experience with this treatment modality is presented here.
Patients and methods
The present study involved 56 patients with tuberculous cervical lymphadenopathy, out of the total 94 patients with cervical lymphadenopathy, who attended the ear, nose, and throat outpatient department of the Government Medical College Hospital, Chandigarh, India from June 1997 to May 1998. This institution caters to a population of 900000.
After a detailed history and clinical examination, fine needle aspiration cytology of involved nodes was performed in all these patients. Biopsy of the lymph nodes was performed on the two occasions when fine needle aspiration cytology was either negative or doubtful and clinical suspicion was high for tuberculosis. Routine tests including erythrocyte sedimentation rate (ESR), Mantoux test, chest radiography, and sputum examination for acid-fast bacilli were also done in all the patients. HIV screening was not performed in any of the patients as there was no clinical suspicion regarding AIDS.
After confirmation of diagnosis all patients were treated with short term intensive chemotherapy for six months. In the first two months isoniazid, rifampicin, pyrazinamide, and ethambutol or...