Traitement chirurgical des échecs du traitement médical de la tuberculose ganglionnaire cervicale.

Abstract

Tuberculosis remains a major public health issue worldwide. In Algeria, the extrapulmonary form predominates, accounting for 69.2% of all cases, thereby illustrating an epidemiological that tailored diagnostic and therapeutic . The aim of the present study is to evaluate the role of surgery as a therapeutic in managing failures of medical treatment for cervical lymph node tuberculosis and to describe the epidemiological characteristics of the disease in the region of Sétif. This is a prospective, descriptive, and analytical study conducted over a period of two years. The study included patients consulting our ENT department at the Sétif University Hospital for cervical lymph node tuberculosis without other associated localizations.95 patients were included, of whom 72 (75.8%) were managed at their first in our department and 23 (24.2%) were referred after an adequately administered medical treatment . The male-to-female ratio was 0.61. The mean age was 28.7 ± 16.6 years. Among them, 68.4% in urban areas, 26.4% were employed, and 33.7% were homemakers. A personal history of tuberculosis was noted in 1.1% of cases, while a family history of the disease was reported in 21.1% of cases. The consumption of raw milk and unpasteurized dairy products was reported by 86.3% of patients. No patient was HIV positive. The interval between symptom onset and initial consultation was 1.41 ± 1.38 months. At least one general sign of tuberculosis was observed in 86.3% of patients. The reason for consultation was one or more lateral cervical swellings at various stages of evolution in all patients, 11.6% of whom had fistulization. The most commonly affected lymph nodes were the upper and middle deep jugular nodes, with an average size of 38 ± 10.9 mm (range: 15 to 70 mm). Mantoux test was positive in 67% of cases. Cervical ultrasound revealed a hypoechoic aspect in 84.2% of cases, necrosis in 75.5% of cases and in 16.8% of cases. Fine-needle aspiration cytology was performed in 81 patients, of whom 77.8% were under guidance; yielding a positive result in 50.6% on cases and providing contributory diagnostic in 93,8% of cases. The histological study allowed diagnostic confirmation in 100% of cases. examination was conducted in only five patients. All patients were treated with antituberculous chemotherapy according to the protocol (2RHZ/RH) for an average duration of 7.4 ± 1.6 months (range: 6 to 12 months). 13.9% presented with a paradoxical reaction, occurring on average 0.75 months after treatment initiation. In 48.6% of the 72 cases managed at their first consultation in our department, the failure of medical treatment led to a selective lymph node dissection, a procedure performed without major incident; whereas the 23 referred cases underwent direct selective lymph node dissection. A single case of disease recurrence was observed over a one-year follow-up. Early diagnosis of cervical lymph node tuberculosis is based on a high index of clinical suspicion. Histological examination remains the cornerstone for establishing a definitive diagnosis in our setting