LYMPHADENITISR ports from the United States, Europe, and Australia in recent years have revealed the surprising finding that 75 percent of granulomatous cervical adenitis suggestive of tuberculosis is actually caused by mycobacterium other than M. akeeresdasis, explaining the fact that the incidence remains high in some areas in which most tuberculosis disease is declining rapidly. M. scrofula-com, a scotochromogen found abundantly in nature and often in tap water, M.intracellulare and less commonly M. kansasii are the responsible agents. Each of these may be the predominant cause of adenitis in certain geographic areas and not found at all in others.
These organisms are found in the soil and transiently in the respiratory f l ora. In the vast majority, the adenitis is cervical in location, but occasionally the inguinal, maxillary, or epitrochlear nodes may be involved. The portal of entry in cervical adenitis is probably the tonsils or pharyngeal lymphoid tissue, presumably as a result of ingestion of materials contaminated with soil. In the extremities, the infection usually follows a puncture wound. Cervical lymphadenitis occurs almost entirely in children, predominantly Fir laiffezey 22 early childhoods. No other manifestations of disease elsewhere in the body have been reported.
LYMPHADENITIS pathologic findings of the lesion are similar to that of tuberculosis as are the clinical manifestations. An enlarged, firm, and contender single node or group of nodes in the submandibular or upper cervical chains may appear and persist unchanged or progress to fluctuation, drainage, and sinus formation. Surgical excision is usually relied upon for both diagnosis and treatment as these organisms are notoriously drug-resistant. However, ionized treatment of granulomatous cervical adenitis is indicated prior to cultural identification of the organism to cover the possibility that the infection is due to M. tuberculosis.
If antigens are available, the demonstration of skin hypersensitivity to some other mycobacterium species and a negative or smaller reaction to PPD-S (M. tuberculosis) is regarded as diagnostic. Although recurrence may develop in an adjacent lymph node, surgical excision of grossly involved nodes is usually curative.