Disease Description (Causes and Symptoms)
- Definition and cause: Infection of the lymph nodes by Mycobacterium tuberculosis, occurring mainly in the cervical lymph nodes but also possible in the axillary, mediastinal, abdominal, and groin lymph nodes. It develops when M. tuberculosis enters the lungs and spreads to nearby lymph nodes or through the bloodstream or lymphatic system. If pulmonary tuberculosis is also present, the risk of transmission is the same as that of pulmonary tuberculosis.
- Pathophysiology: Granulomatous inflammation caused by M. tuberculosis progresses within the lymph nodes and, as it advances, may lead to central necrosis (caseation), abscess formation, and skin sinus tracts or ulcers.
- Main symptoms: Slowly enlarging lumps around the neck (especially on one or both sides of the neck), usually for 1–2 months or longer; low-grade fever, loss of appetite, weight loss, night sweats, fatigue, and localized pain or tenderness. As the condition progresses, lymph-node abscesses and pus discharge, skin ulcers, and sinus-tract formation may occur.
Treatment Methods
- Standard drug treatment (general recommendation)
- Initial 2 months: Isoniazid (INH) + rifampin (RIF) + pyrazinamide (PZA) + ethambutol (EMB) (HRZE)
- Continuation 4 months: Isoniazid + rifampin (HR)
- Total treatment duration is generally 6 months. Extension of treatment (e.g., to 9–12 months) may be considered depending on the clinical course, complications (abscess, sinus tract, persistent disease), or suspected drug resistance.
- Drug-related precautions and supportive measures
- Vitamin B6 (pyridoxine) is recommended to prevent peripheral neuropathy when taking INH, especially for people with risk factors such as pregnancy, diabetes, alcohol use, or renal failure.
- Monitor liver function (ALT/AST) before and during treatment, and monitor vision (visual fields and visual acuity) when using EMB.
- Multiple drug interactions with rifampin (including anticoagulants and antiretroviral drugs) must be checked.
- Procedures/Surgery
- When an abscess has formed and contains a large amount of pus, drainage by needle aspiration may be performed (often recommended).
- Excision (lymph-node removal) may be considered in cases of extensive necrosis, persistent sinus tracts, or functional or cosmetic problems.
- Early surgical excision (immediately after starting antituberculosis drugs) may instead worsen sinus-tract formation, so the decision should be made cautiously.
- Infection control and public health
- Check whether pulmonary tuberculosis is also present (chest X-ray, sputum smear and culture, or NAAT). If pulmonary tuberculosis is present, airborne-infection precautions (masks, isolation, etc.), notification of health authorities, and contact investigation are necessary.
- Lifestyle management
- Take the medication regularly as prescribed (do not stop it on your own). Limit alcohol because it increases the risk of hepatotoxicity.
- Report medication side effects (jaundice, severe rash, visual disturbances, abnormal sensations, etc.) to a healthcare professional immediately.
Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)
- Materials/items to bring
- A list of all medications currently being taken (including prescription drugs, OTC medications, and herbal medicines)
- A history of tuberculosis and previous treatment (whether it was cured and whether drug resistance was present)
- Copies of recent test results (chest X-ray, sputum tests, blood tests, etc.), if available
- A record of when symptoms began and how they have progressed (changes in lump size, pain, fever, weight changes, etc.)
- Information about allergies and chronic diseases (liver disease, kidney disease, diabetes, HIV, etc.)
- Situations to tell the healthcare professional about in advance
- Whether you currently have a cough, sputum, hemoptysis (coughing up blood), or respiratory symptoms
- Possibility of pregnancy or whether you are breastfeeding
- Alcohol-use habits and a history of liver disease
- Examples of medical-history questions (questions for the patient to prepare)
- The date symptoms began and how they have progressed, and whether fever/night sweats/weight loss are present
- Whether anyone among recent contacts has had pulmonary tuberculosis
General Sample Questions to Ask the Doctor
- What are the main side effects of this medication (the prescribed antituberculosis drugs), and what should I do if they occur?
- How long is the treatment expected to last, and what tests will I need during treatment and how often?
- Are there any restrictions on daily activities (exercise, work, food, or alcohol) while taking the medication?
- Do my family members or people living with me need testing or preventive measures?
- Do I need to change any medications I am currently taking because of drug interactions?
Disease-Specific Sample Questions
- Based on the condition of my lymph nodes (size, abscess, sinus tract, etc.), is treatment with antituberculosis drugs alone sufficient, or might drainage or surgery be necessary?
- What tests should be prioritized to determine whether pulmonary tuberculosis is also present (chest X-ray, sputum test, NAAT, etc.)? Depending on the test results, are isolation or public-health measures necessary?
(Note: This is general information about tuberculous lymphadenitis. Testing and treatment plans may vary depending on the individual’s condition, so detailed consultation with the treating healthcare professional is necessary.)