Clinico-demographic profile of patients treated for Tuberculous Lymphadenitis at the Central Chest Clinic, Colombo, Sri Lanka

Background: Tuberculous lymphadenitis (TBLN) is the commonest form of extra-pulmonary tuberculosis in Sri Lanka. The management of TBLN faces many challenges due to difficulty in achieving microbiological confirmation as well as slow or paradoxical clinical response during the treatment. Objective: To describe the demographic features and the characteristics associated with clinical presentation, diagnostic modalities and treatment outcome of patients with TBLN. Method: An audit was carried out revising clinical records of patients treated for peripheral lymph node enlargement due to tuberculosis at the Central Chest Clinic, Colombo.   Results: A total of 126 clinical records were analysed. The male:female ratio was 1:1.6 with a mean age of 36 years (SD=17.6). The most affected site were the cervical lymph nodes (94%). Mantoux test positivity (>10mm) was detected in 87.5%.  Evidence of granulomatous inflammation in primary investigations was seen in 122 (97%) of patients. Out of all only 12 (9.5%) were microbiologically confirmed including 5 culture positives. The rest of the patients (90.5%) were diagnosed based on supportive primary and ancillary diagnostic tests. Paradoxical reactions were identified in 4% of patients.   Adverse drug reactions including skin reactions and drug induce hepatitis were noted in 17%. Eighty-two patients achieved complete clinical resolution at the end of 6 months while others were found to have residual lymph nodes necessitating further evaluation. Conclusions: The incidence of TBLN was high among females and in the third decade of life, predominantly affecting cervical lymph nodes. The majority were treated based on primary and ancillary diagnostic test results. Prospective   studies are recommended for more descriptive assessment.