cervical lymph node tuberculosis
Introduction
Introduction to cervical lymph node tuberculosis The traditional Chinese medicine of tuberculosis of lymph nodes is called , and the tubercle bacilli are mostly invaded by the oral cavity (caries) or tonsils, and there are many no tuberculosis lesions in the invasive site. A small number of tuberculosis lesions secondary to the lungs or bronchi. Clinically, local lymph node cold abscess is the main manifestation, less systemic poisoning such as low fever, night sweats, weight loss, etc., late stage lymph node cheese-like changes, sinus tract after long-term rupture after rupture, and there is a bean poma-like thin pus discharge, the disease must be Take comprehensive treatment measures, while standardizing anti-tuberculosis treatment, properly remove the infected lymph nodes or scrape the sinus, which can promote recovery. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: through the respiratory tract, blood transmission Complications: traumatic ulcer
Cause
Causes of cervical lymph node tuberculosis
(1) Causes of the disease
The pathogenic bacteria are mainly human tuberculosis. Bovine tuberculosis infection is caused by drinking unsterilized diseased milk. It is rare in China and there are two infection routes:
Pathogen infection (35%):
Tuberculosis can form primary lesions through the upper respiratory tract or with food in the tonsils, caries, etc., through its submucosal rich lymphatic network, infect the shallow layer of the neck, deep lymph nodes, any lymph nodes in the neck can be affected, but those Lymph nodes below the mandible are the most common site of location, and most of the primary tumors are difficult to detect.
Pulmonary infection (25%):
It can also be caused by lymphatic or hematogenous dissemination of primary pulmonary tuberculosis in the lungs; it can also be caused by lymphatic vessel infection due to mediastinal lymph node tuberculosis, which mainly involves deep lymph nodes in the lower part of the supraclavicular or sternocleidomastoid muscle.
(two) pathogenesis
Lymph nodes are one of the surrounding immune organs of the body. They have a filtering effect and produce lymphocytes. Tuberculosis invades the body for the first time, especially after entering the lymph nodes, which can sensitize the lymphocytes which are immunologically active, so that they proliferate and multiply, and cellular immunity occurs. Humoral immunity and secretion of lymphokines, antibodies and other active substances can also activate macrophages to enhance their phagocytosis and bactericidal ability. Thus, through enhanced body specificity and non-specific immunity, the amount of tuberculosis in the lesion is small. In the case of small tissue damage, the tuberculosis is eliminated, the lesions are basically dissipated, or only a small amount of fibrous tissue remains.
In areas where tuberculosis is concentrated, tissue necrosis can occur, and necrotic tissue can be absorbed when there is little tissue; when there are many necrotic tissues, fibrous envelope can be formed around, and some calcification can be formed later.
In the case of low resistance and large amount of pathological bacteria, the lesions continue to develop, and the cheese-like tissue can be liquefied, form an abscess, penetrate the lymph node cyst, infect the surrounding tissue, or collapse to the surface skin, and the lesion can be prolonged. Better, the process of deterioration is repeated alternately, forming a keloid tube, often draining pus.
Prevention
Cervical lymph node tuberculosis prevention
1. Inoculate BCG vaccine according to the immunization plan to improve the body's ability to resist Mycobacterium tuberculosis.
2. Actively do a good job in physical exercise and improve physical fitness.
3. Strengthen nutrition, pay attention to work and rest, and ensure adequate sleep.
4. Strengthen personal protection and avoid direct contact with tuberculosis patients.
5. Pay attention to oral hygiene, early treatment of dental caries, tonsillitis and so on.
Complication
Cervical lymph node tuberculosis complications Complications, traumatic ulcers
1. Secondary infection of cervical lymph nodes: The ulcerated lymph nodes are prone to secondary infection, causing acute inflammation symptoms.
2. Blood dissemination: The cheese-like lymph nodes can rupture and invade the jugular vein, resulting in serious complications caused by the spread of Mycobacterium tuberculosis to the distant parts of the body (joints, bones).
Symptom
Cervical lymph node tuberculosis symptoms Common symptoms Abscess lymph node enlargement Acute non-suppurative one...
There are a number of enlarged lymph nodes of different sizes on one side or both sides of the neck. They are usually located in the anterior, posterior or deep side of the submandibular and sternocleidomastoid muscles. In the initial stage, the enlarged lymph nodes are separated from each other and can be moved. Hard, no pain; lesions continue to develop, inflammation around the lymph nodes, lymph nodes and adhesion to the skin and surrounding tissues, each lymph node can also adhere to each other, fuse into a mass, forming a nodular mass that is difficult to push; late, lymph node cheese-like change Liquefaction into a cold abscess, followed by rupture, forming a sinus or ulcer that is not easy to heal, draining a thin pus mixed with bean dregs-like debris, sinus or ulcer surface with dark red, sneak skin edges and withered, Pale granulation tissue, lymph nodes with different stages of tuberculosis at the same time.
Examine
Examination of cervical lymph node tuberculosis
1. Tuberculin test: It is helpful for the diagnosis of pediatric patients. The positive reaction indicates that there is a tuberculosis infection, or the immunity has been established; the strong positive reaction indicates that there is active tuberculosis in the body.
2. Smear microscopy: take sinus discharge pus or cheese-like necrosis directly smear, find tuberculosis.
3. Histopathological examination: If the diagnosis is difficult, it is feasible to perform lymph node puncture or resection of one or several lymph nodes for pathological examination.
4. X-ray or chest X-ray: can rule out the possibility of tuberculosis.
Diagnosis
Diagnosis and diagnosis of cervical lymph node tuberculosis
Patients have no significant systemic symptoms, and a small number of patients may have low-heat, night sweats, loss of appetite, weight loss and other systemic poisoning. According to the history of tuberculosis exposure and local signs, especially when a cold abscess has been formed, or a sinus or ulcer that has been formed for a long time has been broken, a clear diagnosis can be made. If necessary, chest fluoroscopy can be performed to determine whether there is tuberculosis or not. For pediatric patients, the tuberculin test can help diagnose.
Differential diagnosis
If only cervical lymph nodes are enlarged, and no cold abscess or ulcer formation, the diagnosis is often difficult, and it must be differentiated from acute and chronic lymphadenitis, malignant lymphoma, and cervical metastases.
1. Acute and chronic lymphadenitis: more common in children, often have high fever, discomfort, white blood cell count and neutrophilia in the acute phase, redness, fever, tenderness in the local lymph nodes, usually caused by tonsillitis, oral caries infection, etc. Caused, quickly resolved after treatment with antibiotics.
2. Malignant lymphoma (Hodgkin's disease, lymphosarcoma, reticulocyte sarcoma, etc.): It is a primary malignant tumor of the lymphatic system. In the initial stage, 35% to 80% of patients have one or more painless necks. Sexual enlarged lymph nodes, hard and active, and then gradually enlarged lymph nodes in the neck, fused together into a mass, nodular, reduced activity, or even fixed, with systemic lymphadenopathy Large, especially underarm, groin and mediastinal lymph nodes are often involved, and often have chest, back or abdominal pain, spleen, liver, abdominal mass, and fever, anemia, loss of appetite, weight loss, weakness, night sweats Waiting for systemic symptoms.
3. Metastatic cancer of the neck: Metastatic cancer accounts for 3/4 of the malignant tumors of the neck. It is more common in adults. The main feature is that the neck area or the supraclavicular fossa has hard enlarged lymph nodes. It is single-shot and painless at first. Can be promoted; later progressively grow up, and soon there are multiple swollen lymph nodes, invading the surrounding tissue, the mass is nodular, fixed, may have local or radioactive pain, late tumor can occur necrosis, ulceration, infection , bleeding, appearance of cauliflower, secretions are bloody or pus and have stench.
4. Actinomycosis: often secondary to dental infections or oral trauma, a single, hard, irregular mass on the lower jaw or close to the lower jaw, may have varying degrees of pain, tenderness or painlessness, and venous congestion on the surface of the skin. It is purple-red, with or without adhesion to the mass. The center of the mass is necrotic and liquefied to form an abscess. It can fluctuate and collapse to form multiple sinuses. After a long time, the sinus discharges a small amount of thick or thin sticky sulphur particles. ", the pressure is brittle, adjacent lymph nodes can be swollen and tender.
