Tuberculosis: a surgical viewpoint

Over the past 15 years, 32 cases of tuberculosis have been seen and diagnosed in the surgical and gynaecological departments of the Northern General Hospital, Sheffield. The average age of patients was 42.8 years. Of the sites affected, 17 had head, neck or axillary swellings, 6 affected the female genital tract, 3 had intra-abdominal tuberculosis, 2 presented with soft tissue swellings on the trunk or limbs, 2 affected the male genitourinary system, whilst the remaining cases presented with an ischiorectal and psoas abscess. The time delay between initial consultation and diagnosis being established was between 1 and 8 months. In only 7 (21.8%) cases was a correct preoperative diagnosis made, with only 8 patients being clinically unwell at presentation. Twenty-three received antituberculous chemotherapy and there was one death. Tuberculosis will not be diagnosed or correctly treated unless it is considered in the differential diagnosis and appropriate specimens sent for bacteriology and histology. We conclude that tuberculosis is still prevalent in the surgical departments and both general surgeons and gynaecologists should consider the diagnosis more frequently than is currently the case.

Cervical mycobacterial lymphadenitis. Medical vs surgical management

After years in its decrease, cervical mycobacterial adenitis is once again an increasing problem in Los Angeles County. We reviewed 54 cases of cervical lymphadenopathies treated over ten years. Twenty-five (46%) of these patients were found to have mycobacterial cervical lymphadenitis. Medical approaches often failed to conclusively diagnose this disease. In our series, none of the patients with cervical adenopathies (36%) treated only medically regressed, even after an average time of 18 months of antituberculosis drug treatment. The treatment of choice seems to be surgical excision and long-term antituberculosis drugs. Surgery provides a rapid tissue diagnosis and confirms the bacterial type, including atypical mycobacterium. This approach is simple, shortens hospitalization, is cost-effective, and carries a low morbidity.

Chronic lymphadenopathy due to mycobacterial infection. Clinical features, diagnosis, histopathology, and management

This report provides clinical information, diagnostic criteria, management, and outcome of 153 cases of mycobacterial lymphadenitis; 22 patients (14%) had Mycobacterium tuberculosis (TB) and 131 patients (86%) had nontuberculous mycobacterial (NTM) disease. Correct diagnosis of TB v NTM disease is essential, since antituberculous chemotherapy was effective for TB adenitis, while excisional biopsy was the treatment of choice for NTM adenopathy. Dual (PPD-NTM, PPD-T) Mantoux tests discriminated between TB and NTM adenitis in 151 (99%) of 153 patients, while dual (PPD-Battey [B], PPD-T) tests differentiated between NTM and TB adenitis in 135 (88%) of 153 cases. A PPD-T reaction of 1 to 14 mm suggested either an NTM or TB infection, whereas a PPD-T of 15 mm or greater was strongly associated with TB disease. We recommend the use of PPD-B and PPD-T antigens as reliable diagnostic discriminators between TB and NTM adenitis.

[Surgical treatment of tuberculosis of non-pulmonary localization]

Experiments in 86 rabbits and observation of 360 patients have shown the antibacterial therapy to be of limited use for the treatment of non-pulmonary tuberculosis. It was found that the antibacterial therapy failed to result in healing the caseous-destructive foci and to cure turebculosis of kidneys, bones, joints, female genitals and lymph nodes. It is considered to be a reason for surgical procedures according to principles of the focal surgery on non-pulmonary tuberculosis elaborated by P. G. Kornev and his school.

Tuberculous lymphadenopathy: a review of results of surgical treatment

Eighty consecutive cases of tuberculous lymphadenopathy confirmed by histological examination were reviewed. Fifty-five cases (69%) were followed up for more than two years. Excluding twelve cases with incomplete chemotherapy, the results of treatment by combined surgery and chemotherapy in the remaining 43 cases were analysed. Twelve cases had complete excision of all grossly involved lymph nodes; all did well. Twenty-one cases had only representative lymph nodes biopsied for diagnosis, five of them (24%) required a second operation--three for abscess formation and two for progressive enlargement of the residual lymph nodes. Seven cases of tuberculous abscesses were treated by a simple drainage procedure, and despite chemotherapy, all had persistent wound discharge for over one month which required a second operation to remove the underlying caseating lymph nodes. Results suggest that all easily accessible tuberculous lymph nodes should be removed and that persistent discharging sinuses should also be treated by surgery.

Mycobacterium cervical lymphadenopathy: 1981 update

Scrofula or tuberculous cervical lymphadenopathy is a well known disease dating back thousands of years. In spite of antituberculous chemotherapy and public health measures, scrofula persists and is seen not infrequently among the recent immigrants to the United States from Southeast Asia and Mexico. Cervical lymphadenopathy may arise from infections with mycobacteria other than Mycobacterium tuberculosis. These infections may resemble one another, but it is important to make a distinction between them, for their clinical courses and treatments are different. A tuberculous infection usually responds very well to antituberculous chemotherapy, but a nontuberculous mycobacterial one may require surgical intervention for resolution of the problem. We would like to reawaken an awareness of this distinction and hope this paper will aid the reader in understanding the diagnosis and treatment of scrofula and nontuberculous mycobacterial cervical lymphadenopathy. The subject is reviewed, and illustrative cases are presented.