Houda Chahed1, Hela Hachicha2, Aida Berriche3, Rim Abdelmalek3, Azza Mediouni2, Badreddine Kilani3, Mohamed Ben Amor2, Hanene Tiouiri Benaissa3, Ghazi Besbes2. 1. Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Otorhinolaryngology Department, Rabta Hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia. Electronic address: houda.chahed@gmail.com. 2. Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Otorhinolaryngology Department, Rabta Hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia. 3. Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Infectious Diseases Department, Rabta Hospital, Tunis, Tunisia.
Abstract
OBJECTIVES: The aims of this study were to determine predictive factors of paradoxical reaction in patients with cervical lymph node tuberculosis (TB) and to discuss the therapeutic management of this condition. MATERIALS AND METHODS: A retrospective study was performed of 501 patients managed for cervical lymph node TB over a period of 12 years (from January 2000 to December 2011). Statistical data were analyzed using IBM SPSS Statistics version 20.0. RESULTS: Paradoxical reaction occurred in 67 patients (13.4%), with a median delay to onset after starting TB treatment of 7 months. Lymph node size ≥3cm and associated extra-lymph node TB were independently associated with paradoxical reaction. Treatment consisted of surgical excision (71.6%), restarting quadruple therapy (10.4%), reintroduction of ethambutol (23.8%), and addition of ciprofloxacin (20.8%); steroids were given in two cases . All patients recovered after an average treatment duration of 14.91±7.03 months. CONCLUSION: The occurrence of paradoxical reaction in cervical lymph node TB seems to be predicted by associated extra-lymph node TB and a swelling size ≥3cm. The treatment of paradoxical reaction remains unclear and more randomized trials are necessary to improve its management.
OBJECTIVES: The aims of this study were to determine predictive factors of paradoxical reaction in patients with cervical lymph node tuberculosis (TB) and to discuss the therapeutic management of this condition. MATERIALS AND METHODS: A retrospective study was performed of 501 patients managed for cervical lymph node TB over a period of 12 years (from January 2000 to December 2011). Statistical data were analyzed using IBM SPSS Statistics version 20.0. RESULTS: Paradoxical reaction occurred in 67 patients (13.4%), with a median delay to onset after starting TB treatment of 7 months. Lymph node size ≥3cm and associated extra-lymph node TB were independently associated with paradoxical reaction. Treatment consisted of surgical excision (71.6%), restarting quadruple therapy (10.4%), reintroduction of ethambutol (23.8%), and addition of ciprofloxacin (20.8%); steroids were given in two cases . All patients recovered after an average treatment duration of 14.91±7.03 months. CONCLUSION: The occurrence of paradoxical reaction in cervical lymph node TB seems to be predicted by associated extra-lymph node TB and a swelling size ≥3cm. The treatment of paradoxical reaction remains unclear and more randomized trials are necessary to improve its management.
Authors: Stylianos A Michaelides; George D Bablekos; Avgerinos-Romanos Michailidis; Efthalia Gkioxari; Stephanie Vgenopoulou; Maria Chorti Journal: Case Rep Med Date: 2019-07-25
Authors: Hyeri Seok; Ji Hoon Jeon; Kyung Ho Oh; Hee Kyoung Choi; Won Suk Choi; Young Hen Lee; Hyung Suk Seo; Soon Young Kwon; Dae Won Park Journal: BMC Infect Dis Date: 2019-10-21 Impact factor: 3.090