Asunto(s)
Síndrome de Hipersensibilidad a Medicamentos , Herpesvirus Humano 6 , Linfadenitis , Linfoma , Infecciones por Roseolovirus , Humanos , Herpesvirus Humano 6/aislamiento & purificación , Linfadenitis/virología , Linfadenitis/diagnóstico , Linfadenitis/etiología , Infecciones por Roseolovirus/complicaciones , Infecciones por Roseolovirus/diagnóstico , Síndrome de Hipersensibilidad a Medicamentos/diagnóstico , Síndrome de Hipersensibilidad a Medicamentos/etiología , Síndrome de Hipersensibilidad a Medicamentos/patología , Linfoma/complicaciones , Diagnóstico Diferencial , Masculino , Femenino , Persona de Mediana EdadRESUMEN
CONTEXT: Bacillus Calmette-Guérin (BCG) vaccine has been used to prevent tuberculosis and/or its severe complications for long. BCG lymphadenitis is a common complication of the vaccine, which is sometimes subjected to cytological examination. The aim of the study is to describe the cytological findings of BCG lymphadenitis. SETTINGS: The study was conducted in a tertiary care hospital in the western part of India from January 2021 to December 2022. DESIGN: The study was performed on archived material of all patients who were referred to the fine needle aspiration clinic for cytology examination. Clinical and pathological data of cases were retrieved, and cases of BCG lymphadenitis were selected in the study based on these data. Slides of cases were retrieved, and cytological findings were studied. MATERIALS AND METHODS: Papanicolaou, Giemsa, and Hematoxylin & eosin-stained smears, as well as Ziehl-Neelson stain (Z.N. stain) smears of all BCG lymphadenitis cases, were retrieved. Cases were reviewed for individual cytological features and overall cytological diagnostic categories. Z.N. stain smears were evaluated for acid-fast bacilli. RESULTS AND CONCLUSIONS: Diagnostic categories observed in BCG lymphadenitis include suppurative lymphadenitis/abscess (15 %), necrotizing lymphadenitis (23 %), necrotizing granulomatous lymphadenitis (46 %), suppurative granulomatous lymphadenitis (8 %), non-necrotizing granulomatous lymphadenitis (8 %). Acid-fast bacilli were detected by Z.N. stain in 8 cases (62 %). The cytological findings of BCG lymphadenitis closely overlap with those of tuberculous lymphadenitis. So, clinical context is very important while reporting isolated axillary lymphadenopathy, specifically in recently vaccinated infants, to avoid misdiagnosis as tuberculous lymphadenitis.
Asunto(s)
Vacuna BCG , Linfadenitis , Tuberculosis Ganglionar , Humanos , Lactante , Vacuna BCG/efectos adversos , Biopsia con Aguja Fina , Citodiagnóstico , Granuloma , Linfadenitis/etiología , Linfadenitis/patología , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/complicaciones , Tuberculosis Ganglionar/patologíaRESUMEN
Non-tuberculous mycobacterial (NTM) lymphadenitis typically presents as a unilateral, non-tender, slowly enlarging cervical, submandibular, or pre-auricular lymph node in children. Disseminated NTM infection is most often seen in immunocompromised children. Here, we present an unusual case of extensive bilateral cervical and retropharyngeal lymphadenitis caused by Mycobacterium Avium Complex (MAC) in an ostensibly immunocompetent pediatric patient.
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Linfadenitis , Infecciones por Mycobacterium no Tuberculosas , Niño , Humanos , Micobacterias no Tuberculosas , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Linfadenitis/etiología , Linfadenitis/microbiología , Complejo Mycobacterium avium , Huésped InmunocomprometidoRESUMEN
INTRODUCTION: Bacillus Calmette-Guerin (BCG) vaccination is given as a part of the national immunization schedule in India and its most common complication is BCG lymphadenitis. The reported incidence of BCG lymphadenitis ranges from 0.1 to 9.9% in various studies. In our country, though most babies get BCG vaccination during the neonatal period, the incidence of BCG lymphadenitis is not studied well. AIMS: To study the incidence of lymphadenitis following BCG vaccination at tertiary care hospital in North India. METHODS: It was a prospective longitudinal observational study. All newborns weighing ≥1.5 kg at birth without any significant illness who received BCG vaccination at our institute were enrolled and followed up for 16 weeks after vaccination. Babies were examined at 6, 10 and 14 weeks for the development of lymphadenopathy. Meta-analysis of studies evaluating incidence of BCG adenitis in children was also performed. RESULTS: Out of 817 babies vaccinated during the enrolment period, 605 babies could be followed up till 16.2 ± 0.9 weeks post BCG vaccination. One case of BCG lymphadenitis was detected at 14 weeks. Thus, the observed incidence of BCG lymphadenitis was 0.16% (95% CI of 0.004%-0.92%). Meta-analysis of 21 studies showed mean incidence estimate of 0.336% (95% CI: 0.315%-0.358%) using fixed effect model whereas random effect model showed mean incidence of 4.45% (95% CI: 3.02%-6.15%). CONCLUSION: The lower incidence of lymphadenitis in our study can probably be attributed to a less immunogenic vaccine (Danish 1331), proper technique, experience of the vaccinator and good storage facilities available at our institute.
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Vacuna BCG , Linfadenitis , Humanos , Lactante , Recién Nacido , Vacuna BCG/efectos adversos , Incidencia , Linfadenitis/epidemiología , Linfadenitis/etiología , Estudios Observacionales como Asunto , Estudios Prospectivos , Vacunación/efectos adversosRESUMEN
BACKGROUND: Bacille Calmette-Guérin (BCG) adenitis is an uncommon complication following BCG vaccination. In rare cases, infants can develop other complications. Controversy exists regarding the diagnosis and management of these cases. Not much information is available in literature regarding their microbiological and immunological characteristics. METHODS: Electronic medical records of children presenting to the Pediatric Infectious Diseases clinic in a tertiary care hospital from January 2011-December 2020 with a diagnosis of BCG adenitis were retrospectively reviewed. Their clinical, microbiological, treatment and follow-up data were noted and analyzed. FINDINGS: During the study period, 40 infants presented with a probable diagnosis of BCG adenitis with or without disseminated BCG. Median age at symptom onset was 4(2.5-5.9) months. Nine infants had disseminated disease at presentation. Fifteen infants were suspected to have underlying immune deficiency of whom 12 had proven defects in immune function. On multivariable logistic regression analysis, presence of disseminated disease was the only factor predictive of underlying immunodeficiency. Isoniazid monoresistance was seen in seven cases (32%) of the 22 samples sent for TB cultures. CONCLUSIONS: Though BCG adenitis runs a benign course, it could rarely be the first manifestation of an underlying immune defect. There is sizable isoniazid monoresistance, hence sending tissue samples for microbiologic evaluation is necessary to guide anti-tubercular therapy.
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Linfadenitis , Mycobacterium bovis , Tuberculosis , Lactante , Niño , Humanos , Estudios Retrospectivos , Tuberculosis/diagnóstico , Vacuna BCG/efectos adversos , Isoniazida , Linfadenitis/diagnóstico , Linfadenitis/tratamiento farmacológico , Linfadenitis/etiología , Resultado del TratamientoAsunto(s)
Herpes Simple , Leucemia Linfocítica Crónica de Células B , Linfadenitis , Linfoma de Células B Grandes Difuso , Humanos , Leucemia Linfocítica Crónica de Células B/complicaciones , Leucemia Linfocítica Crónica de Células B/diagnóstico , Leucemia Linfocítica Crónica de Células B/patología , Herpes Simple/diagnóstico , Herpes Simple/patología , Linfoma de Células B Grandes Difuso/patología , Linfadenitis/diagnóstico , Linfadenitis/etiología , Linfadenitis/patologíaAsunto(s)
Linfadenitis , Mycobacterium tuberculosis , Cardiopatía Reumática , Tuberculosis Ganglionar , Niño , Humanos , Ganglios Linfáticos , Linfadenitis/diagnóstico , Linfadenitis/etiología , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/diagnóstico , Tuberculosis Ganglionar/complicaciones , Tuberculosis Ganglionar/diagnósticoRESUMEN
BACKGROUND: There is no consensus on managing common adverse reactions to Bacille Calmette-Guérin (BCG) vaccination. We systematically reviewed the management of BCG-associated regional lymphadenitis and injection site abscess in immunocompetent individuals. METHODS: Searches of Medline, Embase and PubMed were done until November 2020. Randomized controlled trials (RCTs) and cohort studies that compared management strategies for complications of intradermal BCG vaccination were included. RESULTS: Of 1338 individual articles, 15 met inclusion criteria. Six RCTs, 4 prospective and 4 retrospective cohort studies compared management in 1022 children with BCG-associated lymphadenitis. For nonsuppurative lymphadenitis, no antimicrobial was found to significantly impact on time to resolution or prevention of suppuration. For suppurative lymphadenitis, there was some evidence that needle aspiration shortens time to resolution and prevents sinus tract formation. Surgical excision (mainly offered for persistent suppurative lymphadenitis) generally had favorable outcome. Two cohort studies (including 1 aforementioned) compared management strategies in up to 36 children with BCG injection site abscess; one showed no difference in outcome in children treated with antibiotics and the other reported complete resolution without treatment. CONCLUSIONS: Evidence does not support a role for antimicrobial therapy in the management of localized reactions to BCG vaccination in immunocompetent children. Needle aspiration may shorten the recovery period for BCG-associated suppurative lymphadenitis. BCG injection site abscess usually heals without treatment. However, studies are limited and cases are not well defined. Growing research into novel BCG applications provides opportunities to investigate optimal management strategies for adverse reactions in a prospective manner using active safety surveillance.
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Absceso/etiología , Vacuna BCG/efectos adversos , Manejo de la Enfermedad , Inmunocompetencia , Linfadenitis/etiología , Humanos , Linfadenitis/fisiopatología , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Severe fever with thrombocytopenia syndrome (SFTS), also known as fever, thrombocytopenia, and leukopenia syndrome, is an emerging tick-borne infectious disease in Asian countries. SFTS should be suspected in patients presenting with fever, thrombocytopenia, and leukopenia and have a history of tick exposure in an endemic area. Since SFTS can be accompanied by lymphadenopathy, particularly generalized lymphadenopathy, it can be confused with a primary malignancy, such as lymphoma. The study reports a case of SFTS accompanied by multiple lymphadenopathies, which mimicked malignant lymphoma on F-18 fluorodeoxyglucose positron emission tomography/computed tomography.
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Linfadenitis , Phlebovirus , Síndrome de Trombocitopenia Febril Grave , Fluorodesoxiglucosa F18 , Humanos , Linfadenitis/diagnóstico por imagen , Linfadenitis/etiología , Tomografía Computarizada por Tomografía de Emisión de PositronesRESUMEN
BACKGROUND: Tuberculosis and human immunodeficiency virus (HIV) are among the major health problems in Ethiopia. This study assessed the proportion of tuberculosis lymphadenitis (TBLN), HIV infection and their co-infection among TBLN presumptive individuals at the selected hospitals in Northwest Ethiopia. METHODS: Institution based cross sectional study was carried out. Data on demographic and clinical variables were collected with standardized questionnaire. Microbiological culture was done on specimen obtained by fine needle aspirates. The HIV status was determined by rapid anti-HIV antibody test. Data was entered and scrutinized using SPSS version 20 statistical packages. A stepwise logistic regression model was used. The result was considered as statistically significant at P<0. 05. RESULTS: A total of 381 lymphadenitis patients were included in the study. The overall prevalence of TBLN and HIV were at 250(65.6%) and 9(2.4%), respectively and their co-infection was at 6(2.4%). Based on the cytological examination, 301(79.0%) of them were diagnosed as TBLN. The age group, (P=0.01) and residency, (P=0.01) were found significantly associated with TBLN. Similarly, unsafe sex was also statistically significant for HIV infection (P=0.007). CONCLUSION: Tuberculosis lymphadenitis is the leading cause of TB and lymphadenitis in the region. However, TBLN-HIV coinfection was promisingly low. High rate of discrepancy was noticed between cytological and culture results. Hence, the TBLN diagnostic criteria shall pursue revision.
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Coinfección , Infecciones por VIH , Linfadenitis , Mycobacterium tuberculosis , Tuberculosis Ganglionar , Coinfección/epidemiología , Estudios Transversales , Etiopía/epidemiología , VIH , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Linfadenitis/epidemiología , Linfadenitis/etiología , Tuberculosis Ganglionar/epidemiologíaRESUMEN
Adenopathy in pediatrics can have many different causes: infectious, tumoral, and inflammatory. We report the case of an 8-year-old patient with a febrile popliteal ulceration associated with an inflammatory satellite inguinal lymph node adenitis. Serological tests and polymerase chain reaction analyses confirmed the diagnosis of ulceroglandular tularemia. An appropriate antimicrobial therapy led to a full recovery. This case reminds us to consider tularemia as a potential emergent disease in children presenting with subacute to chronic lymphadenopathy and thereby to choose the correct diagnostic tool and appropriate antimicrobial therapy.
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Linfadenitis/etiología , Tularemia/complicaciones , Antibacterianos/uso terapéutico , Niño , Femenino , Humanos , Ganglios Linfáticos/anomalías , Ganglios Linfáticos/fisiopatología , Linfadenitis/fisiopatología , Tularemia/fisiopatologíaRESUMEN
A previously healthy 49-year-old Japanese woman presented with cervical lymph node swelling and tenderness. Lymph node biopsy revealed reactive lymphadenitis without granulomas. No malignant cells were found, and no acid-fast positive bacilli were identified by Ziehl-Neelsen staining. She was treated unsuccessfully with various antibiotics, and it was very challenging to reach a diagnosis. 18F-Fluorodeoxyglucose (18F-FDG) uptake in bones was evaluated using positron emission tomography-computed tomography (PET-CT), and disseminated mycobacterial infection was suspected. The interferon-gamma (IFN-γ) release assays QuantiFERON (QFT) and T-SPOT were used to diagnose tuberculosis infection. On testing, a difference in mitogen response was found between these assays. The response was low for QFT but adequate for T-SPOT, suggesting the presence of anti-IFN-γ antibodies. This difference depended on whether the patient's plasma (including anti-IFN-γ antibodies) was used within the assay system. Mycobacterium abscessus was isolated from lymph node cultures, and plasma anti-IFN-γ antibodies were confirmed. The patient was diagnosed with disseminated M. abscessus infection with underlying adult-onset immunodeficiency caused by anti-IFN-γ antibodies. Granulomas are a pathological hallmark of mycobacterial infection, but may not fully form in immunodeficient patients. Clinicians should be aware of the possibility of mycobacterial infection without granuloma formation due to anti-IFN-γ antibodies.
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Anticuerpos/inmunología , Granuloma/diagnóstico , Granuloma/etiología , Interferón gamma/inmunología , Linfadenitis/diagnóstico , Linfadenitis/etiología , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/microbiología , Anticuerpos/sangre , Manejo de la Enfermedad , Susceptibilidad a Enfermedades , Femenino , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Evaluación de SíntomasRESUMEN
Here we present the case of a 37-year-old previously healthy man who developed fever, headache and a unilateral, painful neck swelling while working offshore. He had no known contact with anyone with COVID-19; however, due to the ongoing pandemic, a nasopharyngeal swab was performed, which was positive for the virus. After transfer to hospital for assessment his condition rapidly deteriorated, requiring admission to intensive care for COVID-19 myocarditis. One week after discharge he re-presented with unilateral facial nerve palsy. Our case highlights an atypical presentation of COVID-19 and the multifaceted clinical course of this still poorly understood disease.
Asunto(s)
Alcalosis Respiratoria/sangre , Parálisis de Bell/fisiopatología , COVID-19/fisiopatología , Miocarditis/fisiopatología , Adulto , Alcalosis Respiratoria/etiología , Análisis de los Gases de la Sangre , Proteína C-Reactiva/metabolismo , COVID-19/sangre , COVID-19/terapia , Ecocardiografía , Edema/etiología , Electrocardiografía , Humanos , Hipotensión/etiología , Hipotensión/fisiopatología , Linfadenitis/etiología , Linfadenitis/fisiopatología , Imagen por Resonancia Magnética , Masculino , Miocarditis/sangre , Miocarditis/diagnóstico por imagen , Miocarditis/terapia , Péptido Natriurético Encefálico/sangre , Cuello , Terapia por Inhalación de Oxígeno , Fragmentos de Péptidos/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Recuperación de la Función , SARS-CoV-2 , Troponina T/sangre , Vasoconstrictores/uso terapéuticoRESUMEN
OBJECTIVE: PFAPA syndrome is derived from the initials of the English words of the findings that make up the syndrome ("Periodic Fever", "Aphthous Stomatitis", "Pharyngitis", "Adenitis"). This study aims to evaluate the vestibular system in patients with PFAPA syndrome by the cVEMP test and to give a general review of PFAPA syndrome in light of current literature. METHODS: In this prospective study, 30 patients aged 4-6 who were diagnosed with PFAPA in a tertiary pediatrics clinic, between January 2016 and February 2020 and 30 children of the same age group who applied to a tertiary otorhinolaryngology clinic for other reasons and proven to have no hearing or vestibular problems were included and in addition to routine physical examination, electromyographic activity of the sternocleidomastoid muscle surface was measured. RESULTS: We found that the amplitude difference between cVEMP p1-n1 in patients with PFAPA syndrome in both ears decreased compared to the healthy control group. CONCLUSION: Our study proves there is a vestibular system involvement of PFAPA syndrome. This study is the first in the literature to search the relationship between PFAPA and the vestibular system.
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Fiebre/etiología , Linfadenitis/etiología , Periodicidad , Faringitis/etiología , Estomatitis Aftosa/etiología , Enfermedades Vestibulares/complicaciones , Enfermedades Vestibulares/diagnóstico , Pruebas de Función Vestibular/métodos , Vestíbulo del Laberinto/fisiopatología , Factores de Edad , Niño , Preescolar , Electromiografía , Femenino , Fiebre/fisiopatología , Humanos , Linfadenitis/fisiopatología , Masculino , Faringitis/fisiopatología , Estudios Prospectivos , Estomatitis Aftosa/fisiopatología , Síndrome , Enfermedades Vestibulares/fisiopatologíaRESUMEN
Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome and familial Mediterranean fever (FMF) are considered as inflammasome disorders associated with uncontrolled interleukin (IL)-1ß production. Anti-IL1 agents are used in colchicine-resistant cases of FMF. Increase in pro-inflammatory mediators even between febrile attacks in PFAPA suggests that anti-IL1 treatment might be beneficial in these patients. We describe a child presenting with recurrent, self-limited febrile attacks at 1 year of age who was diagnosed as FMF being heterozygous for M694 V mutation. Her clinical findings were only controlled by the addition of canakinumab (2 mg/kg/8 week) to colchicine treatment. However, she developed typical PFAPA attacks during this treatment at 3 years of age. We conducted a literature search focusing on English articles with keywords including PFAPA, anakinra, canakinumab, and rilonacept. Five children and one adult patient with PFAPA were found and evaluated. Anakinra was reported to abort PFAPA attacks in children, while the adult patient first responded and then became resistant to anakinra. Canakinumab was effective in preventing febrile attacks in this patient. Failure of canakinumab to prevent PFAPA attacks in our case may arise from the differences in the pathophysiology of PFAPA and FMF. Thus, further experience with higher doses or shorter intervals of canakinumab is needed in children with PFAPA.
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Anticuerpos Monoclonales Humanizados/uso terapéutico , Fiebre/tratamiento farmacológico , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Linfadenitis/tratamiento farmacológico , Faringitis/tratamiento farmacológico , Estomatitis/tratamiento farmacológico , Femenino , Fiebre/etiología , Humanos , Lactante , Mediadores de Inflamación , Interleucina-1beta/antagonistas & inhibidores , Linfadenitis/etiología , Faringitis/etiología , Estomatitis/etiología , SíndromeRESUMEN
Hypermucoid Klebsiella pneumoniae, known for its association with multiple-organ infection, has gradually increased in prevalence beyond where it was first characterized in East Asia. Here we describe a unique presentation of suppurative lymphadenitis due to hypermucoid Klebsiella in a patient from Tonga, a country with few reported cases.
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Infecciones por Klebsiella/complicaciones , Klebsiella pneumoniae/patogenicidad , Linfadenitis/etiología , Femenino , Humanos , Venas Yugulares/diagnóstico por imagen , Infecciones por Klebsiella/diagnóstico , Klebsiella pneumoniae/aislamiento & purificación , Linfadenitis/diagnóstico , Persona de Mediana Edad , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiologíaRESUMEN
We described a case of a 30-year-old Filipino woman who presented with fevers, night sweats, left hip pain, painful scalp lesions, and a neck mass. Symptoms began 6 months earlier, with nasal drainage, fever, cough, and occasional hemoptysis, which did not resolve with outpatient antibiotics. A further workup revealed lymphadenopathy and several lytic bone lesions. Her hospital course was later further complicated by the development of a tracheoesophageal fistula secondary to an esophageal mass and, then later, aseptic meningitis. Extensive diagnostic workup and immunologic tests were performed and finally led to the diagnosis. Here, we discussed the diagnostic workup and pathophysiology of the underlying condition. This case illustrated the importance of appropriate immunologic workup to make the diagnosis of a rare condition that proves to be clinically significant and presents challenges in management.