Tuberculosis of peripheral lymph nodes in children

Introduction to lymph node tuberculosis in children Peripheral lymph node tuberculosis is the most common type of extrapulmonary tuberculosis in childhood and can be found in all ages, but it is most common in infants and preschool children. Tuberculosis can occur in all groups of lymph nodes, but the most common are the neck, submandibular, supraclavicular and axillary lymph nodes. basic knowledge Sickness ratio: 0.001%-0.005% Susceptible people: children Mode of infection: respiratory transmission Complications: anemia

Causes of lymph node tuberculosis in children

Infection (35%):

There are 4 types of Mycobacterium tuberculosis: human, bovine, bird and mouse, while human pathogenic bacteria are human tuberculosis and bovine tuberculosis. Most of the children's tuberculosis in China is caused by human tuberculosis, tubercle bacillus Strong resistance, in addition to acid resistance, alkali resistance, alcohol resistance, cold, heat, dry, light and chemical substances have strong tolerance, damp heat has strong bactericidal power against tuberculosis, At 65 ° C for 30 min, 70 ° C for 10 min, 80 ° C for 5 min to kill, dry heat sterilization is poor, dry heat 100 ° C takes more than 20 minutes to kill, so dry heat sterilization, temperature needs high, time needs to be long, inside The tuberculosis bacteria are killed within 2 hours of direct sunlight, while the ultraviolet light only takes 10 minutes. On the contrary, it can survive for several months in the dark. The tuberculosis bacteria in the sputum use 5% carbolic acid (phenol) or 20% bleaching powder. For liquid disinfection, it takes 24 hours to take effect.

Pathology (35%):

Tuberculous lymphadenitis in children is a primary infection. Peripheral lymph node tuberculosis is one of the early complications of primary tuberculosis. Most cases occur within 6 to 9 months of primary infection of tuberculosis. Some cases occur in a few years after infection. Most of the lymphatic bloodstream spread, so the surrounding lymph node tuberculosis often involves multiple sets of lymph nodes, and often with chest or intra-abdominal lymph node tuberculosis, such as the supraclavicular, submandibular and deep cervical lymph nodes, secondary to the upper lung or abdomen The primary tuberculosis lesions are caused by the upward spread of the mediastinal lymphatic vessels. In addition to the lymphatic blood vessels, a small number of peripheral lymph node tuberculosis can also be directly spread from the local lymphatic vessels, such as eyes, ears, nose, pharynx and tonsils. At the time of the stove, the cervical lymph nodes can be swollen, the local primary tumor is not easy to be found, or disappears in a short period of time, and the cervical lymph node tuberculosis can exist for a long time. The cervical lymph node tuberculosis is common, which may be related to the special richness of the oral and pharyngeal submucosal lymphatic networks. Repeated upper respiratory tract infection in children may have a certain effect on the deterioration of latent tuberculosis lesions in cervical lymph nodes.

Prevention of lymph node tuberculosis around children

1. Control the source of infection and reduce the chance of infection

Tuberculosis smear-positive patients are the main source of tuberculosis in children. Early detection and rational treatment of smear-positive tuberculosis patients is a fundamental measure to prevent tuberculosis in children. Infants and young children suffer from active tuberculosis, and their family members should be examined in detail. , PPD, etc.), regular physical examinations for primary and child care institutions, timely detection and isolation of infectious sources, can effectively reduce the chance of tuberculosis infection in children.

2. Popularization of BCG vaccination

Practice has proved that vaccination with BCG is an effective measure to prevent tuberculosis in children. BCG was invented by French physicians Calmette and Guerin in 1921, so it is also called BCG. China has vaccinated BCG in the neonatal period and inoculated BCG in the upper left arm of the left upper arm. Intradermal injection, the dose is 0.05mg / time, the scratch method is rarely used, the Ministry of Health notified in 1997 to cancel the 7-year-old and 12-year-old BCG re-integration plan, but if necessary, the child with negative age test Multiple cropping can be given, and BCG vaccine can be injected in the same day as the hepatitis B vaccine.

Contraindications for vaccination with BCG: positive sputum response; patients with eczema or skin disease; recovery period for acute infectious diseases (1 month). Congenital thymic dysplasia or severe combined immunodeficiency disease.

3. Prophylactic chemotherapy

Mainly used for the following objects:

(1) Infants under the age of 3 have not been vaccinated with BCG and have a positive test.

(2) Close contact with patients with open tuberculosis (multiple family members).

(3) The sputum test has recently changed from negative to positive.

(4) The sputum test is a strong positive responder.

(5) Children with positive serotonin test need to use adrenocortical hormone or other immunosuppressive agents for a longer period of time.

4, most of the children are infected with Mycobacterium tuberculosis for the first time, and are highly sensitive to Mycobacterium tuberculosis. Once infected with this disease, there is often a wide range of inflammatory reactions around the tuberculosis lesions. The tuberculin test is strongly positive and recurrent with herpes. Conjunctivitis, systemic lymphadenopathy, which is not found in adult tuberculosis. If you have isolated or a series of swollen lymph nodes in your child's neck and jaw, especially if you have open tuberculosis in your family, and your child has not been vaccinated with BCG, you should be more vigilant and seek medical advice for early diagnosis. treatment.

Pediatric lymph node tuberculosis complications Complications anemia

The fistula can be formed, and finally an irregularly shaped scar can be formed, which can cause sputum skin tuberculosis, generalized lymph node tuberculosis, moderate or severe anemia. There may be symptoms of tuberculosis such as fatigue, low fever, night sweats, loss of appetite, and weight loss. The initial enlarged lymph nodes are separated from each other, movable, without pain, and then the enlarged lymph nodes adhere to each other to form beaded and tender tenderness. Some patients have symptoms of tuberculosis and laryngeal tuberculosis such as cough, hemoptysis, and sore throat.

Symptoms of lymph node tuberculosis around children Common symptoms Low heat night sweat lymph node tuberculosis weight loss acute non-suppurative one... Tuberculosis poisoning lymph node swelling nodules purulent secretion weakness

In addition to low fever, lack of systemic symptoms, signs, early lymph node enlargement, hard, painless, non-adhesive, can move, usually unilateral, but due to cross drainage in the lower neck and chest lymphatic network, can be bilateral Occurrence, as the infection progresses, multiple groups of lymph nodes are involved, lymph nodes can adhere to each other into clumps, or adhere to the subcutaneous tissue, which is prone to cheese-like changes. When multiple lymph nodes on both sides of the neck are highly enlarged, the neck can be changed. Roughly like a cow's neck, the cheese is necrotic and liquefied to form a cold abscess. The palpation has a fluctuating surface. The cold abscess can form a fistula after the liquefied substance is discharged. The healing is slow, and finally an irregular shape is formed. When the fistula is not cured for a long time. At the time, there is often a small amount of purulent discharge, which can cause skin irritation in the nearby skin and sputum, and the chest radiograph is normal in about 70% of cases.

Children are often highly allergic, showing a strong positive reaction to the sputum test, often accompanied by herpetic keratoconjunctivitis, blepharitis, eczema and nodular erythema.

There is a special type of lymph node tuberculosis called generalized lymph node tuberculosis, which is the result of systemic hematogenous dissemination. The systemic multiple lymph nodes simultaneously or successively develop tuberculosis. The clinical features are rapid lymph node enlargement, tenderness, fluctuation, and severe systemic tuberculosis. Symptoms of poisoning, heat is very high, often relaxation type, persistent, retreat, night sweats, pale, weight loss, general weakness, moderate or severe anemia.

Examination of lymph node tuberculosis around children

Blood test

I have seen mild anemia and accelerated erythrocyte sedimentation rate. When there is suppuration and fistula formation, the number of white blood cells can be increased.

2. Lymph node puncture

It can be seen that epithelioid cells, Langhans giant cells and caseous necrosis and other specific tuberculosis changes, acid-fast staining can often find acid-fast bacilli.

3. Bone marrow examination

Visible hematopoietic function can be seen. I have seen 2 cases of hemoglobin as low as 50 ~ 60g / L (5 ~ 6g / dl), multiple blood transfusion can not be corrected, lymph node puncture found a large number of tubercle bacilli.

4. Regular X-ray, B-ultrasound examination.

Diagnosis and diagnosis of lymph node tuberculosis in children

diagnosis

According to the history of tuberculosis exposure, the strong positive reaction of the sputum, the presence of tuberculosis in the body, the symptoms of tuberculosis poisoning and local symptoms are not difficult to diagnose. The lymph node puncture finds tuberculosis lesions or finds tubercle bacilli to confirm the diagnosis.

Differential diagnosis

Differential diagnosis should consider acute suppurative lymphadenitis, the most common is cervical suppurative lymphadenitis, its incidence is more acute, local lymph node acute inflammation is obvious, the number of peripheral blood leukocytes and neutral polymorphonuclear granulocytes are significantly increased, these Both are helpful in identification, and should be differentiated from infectious mononucleosis and brucellosis.

Severe lymph node tuberculosis must be differentiated from Hodgkin's disease, leukemia and lymphosarcoma. Hodgkin's disease has a wide range of lymph nodes. Every time from the neck, chest to the abdomen, the lymph nodes become swollen, often compressing the esophagus and The trachea causes difficulty in swallowing and breathing, or oppression of the portal vein, but does not cause inflammation, suppuration or calcification, often repeated fever (about 1 to 2 weeks per fever) and itchy skin, sometimes visible significant splenomegaly, Diagnosis by biopsy, leukemia has a special blood picture to identify, lymphatic sarcoma is sinister, and soon the symptoms of compression such as hoarseness and dyspnea, often combined with chest pain, pleural effusion, etc., mainly rely on biopsy, in addition, lymph nodes Tuberculosis should be differentiated from lymph node reactive hyperplasia including histiocytic reactive hyperplasia and immunoblastic lymphadenopathy. The latter is characterized by relaxation and hyperthermia, systemic lymphadenopathy, hepatosplenomegaly and erythrocyte sedimentation rate. Some cases have Rash and joint pain, hormone therapy is effective, confirmed by lymph node biopsy, cervical lymph node tuberculosis must be distinguished from cervical actinomycosis Most of the necks of the latter form a tough and incapable infiltration along the mandibular margin, which can be red, swollen, softened, gradually ruptured to form a number of fistulas, secreting thin pus with sulfur-like particles, and actinomycetes can be found under the microscope. Foreign reports of cervical lymphadenitis caused by atypical mycobacteria are very similar to lymph node tuberculosis, pathological examination can not be distinguished, both can have calcification, the diagnosis depends on the PPD-B reaction positive and the culture is isolated after the bacteria is determined.

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