| BackgroundTB is one of the most serious and widespread diseases,which is still asignificant problem affecting public health, especially in the developingworld. And there has been little research working on the actual incidenceand prevalence of TB. In recent years, with the growth of HIV disease, TBalso has the tendency of increase,and it has formed a fatal partnership withHIV. LNT is the most common site of extrapulmonary tuberculosis. FaderT et al.[1]suggested that the most frequent site of extrapulmonarytuberculosis in children aged15years and under was the lymphnodes,accounting for52.9%of cases in children. A survey about LNT inchildren showed the prevalence of this disease is4.43/1000in India[2].ObjectiveThe current study aims to identify the clinical characters of pediatriclymph node tuberculosis and to summarize the experience of diagnosis andtreatment，by evaluating the diversity of clinical manifestations，physical examination，laboratory tests，radiological and histological examinations.Objects and methods1Study population:263clinical records were collectedretrospectively from Children’s Hospital of ChongQing Medical Universitybetween January2002and December2012, which were diagnosis of LNTcases.2Methods: The current study intends to conduct a retrospectiveanalysis on the263cases by evaluating diagnostic criteria and clinicalindicators (such as the history, manifestation, laboratory examinations,treatment and so on) as well as the data collected from follow-up reviewsvia telephone or letters.3Statistical analysis: The clinical data was analyzed by the statisticalsoftware SPSS17.0. P <0.05means that there was a statistical significantdifference.Results1There were156male patients and107females in our group,male:female=1.46:1. And among the263cases,87cases involve children lessthen1year old；55cases involve children from1to3years old；31casesinvolve children3~6years old；90cases involve children more than6years old. There were58cases (22.05%) from urban, while the other205cases (77.95%) were from countryside. The mean onset age was4.20±4.44years, mean duration was86.00±115.58days. 2There were68LNT cases which only involved in the left axillary,77cases combined with other organs involved by tuberculosis,118cases justlymph node involved except the left axillary LNT.3Two hundred and twenty-eight (86.69%) of263patients haddefinitely received BCG immunization.Thirty-eight (14.45%) of263patients had a history of tuberculosis contact,four (1.52%) cases had ahistory of suspicious tuberculosis contact. Fifty-two children had PPD skintest, forty (76.92%) of those reacted positive.4226/263cases(85.93%) complained of lymph node enlargement inour group.The associated manifestations were fever (83/263,31.56%),cough(38/263,14.45%),night sweats(35/263,13.31%),loss ofappetite(30/263,11.41%), weight loss (28/263,10.65%), fatigue (9/263,3.42%). The symptoms of patients between1to3years old whichcombined with other organs involved by tuberculosis are more common.5The predominant lymph node site recorded was left axillary in93(93/404,23.02%),both cervical in87(87/404,21.53%), single lymphnode involved in122(122/238,51.26%).662cases underwent ESR test,in40cases (64.52%),ESR was morethan25mm/h.93cases underwent CRP test,in30cases (32.2%),CRP wasmore than8mg/L.261cases underwent blood routine test, WBC was morethan10×109/L in95cases (36.4%), lymphocytes was been priority in46cases (17.62%), hemoglobin was less than90g/L in26cases (9.96%).247 cases underwent serum liver function test,in33cases (13.36%),ALT wasmore than50U/L and in49cases (19.8%),AST was more than55U/L.7146cases underwent serum tuberculosis antibody test,17cases(11.64%) showed positive.8144cases underwent lymph node ultrasonography，all of thoserevealed lesions.194cases underwent chest X-ray,43cases (22.16%)revealed abnormity.110cases underwent chest CT examination,92cases(83.64%) revealed abnormity.9119biopsy specimen underwent staining for acid fast bacilli,62cases (52.1%) were positive.22pus specimen underwent staining for acidfast bacilli,15cases (68.2%) were positive.15specimen which were beenaspirated from lymph node underwent staining for acid fast bacilli,12cases(80%) were positive.10Histopathology results of lymph node excision tissues were:caseation necrosis(129/156,82.69%)、 langerhan’s type of giantcells(131/156,83.97%)、 epithelioid cells(71/156,45.51%)andtubercle(106/156,67.95%).11Paradoxical upgrading reactions(PURs)in our analysis occurred in18of80cases(22.5%).12The documented relapse rate for lymph node tuberculosis was1.25%following surgery and chemotherapy. ConclusionIn the diagnosis of pediatric lymph node tuberculosis，comprehensiveassessment on clinical manifestations，physical examinations，laboratorytests，radiological and histological examinations are essential，especiallythe last one. There is no uniform consensus on treatment，and according toour experience， resection surgery combined with short coursechemotherapy is recommended.When combined with other organs involvedsuch as pulmonary tuberculusis、tuberculous meningitis，the treatmentregimen should be based on pulmonary tuberculosis and tuberculousmeningitis respectively. PURs may occur during the treatment. |
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