Abstract
Objectives:To investigate the clinical characteristics, risks and outcomes of Paradoxical upgrading reactions (PUR) during anti-tuberculosis treatment (ATT) in superficial tuberculous lymphadenitis (TBLA).Methods:In this nested case-control study, all patients diagnosed with TBLA based on combinations of histopathology, acid-fast bacilli (AFB) microscopy, AFB culture, and GeneXpert, between February 2013 and April 2016, were enrolled. Standard ATT was given. Demographics, clinical characteristics, occurrence of PUR and outcome were recorded.Results:TBLA was diagnosed and treated in 189 patients. PUR developed in 33 (17%), of which 77% developed new inflamed glands, 20.6% had increased size and inflammation of pre-existing glands and 5.9% had superficial chest wall abscesses requiring aspiration. All responded to regular NSAIDs except one, where a steroid course was effective. No change in dose or duration of ATT was required. Presence of anorexia (OR; 95%CI: 2.6; 1.003-6.74), bilateral extensive lymphadenopathy (OR; 95%CI: 2.9; 1.1-7.5) and lymph node specimen positive for AFB (OR; 95%CI: 3.2; 1.04-10.1) were significantly associated with PUR.Conclusion:PUR is common in TBLA. It responded to NSAIDS and does not need any modification in ATT.
Highlights
It has been long recognized that similar to leprosy, distinct immunological reactions may complicate1
Histological patterns suggestive of tuberculous lymphadenitis (TBLA) were the presence of chronic granulomatous inflammation, acute necrotizing or suppurative inflammation or extensive caseous necrosis
During a three-year study period, 221 patients were diagnosed as TBLA, of which 189 were followed on treatment with standard first-line anti-tuberculosis treatment (ATT) to record the clinical characteristics and risk factors associated with Paradoxical upgrading reactions (PUR) development (Fig.1)
Summary
To investigate the clinical characteristics, risks and outcomes of Paradoxical upgrading reactions (PUR) during anti-tuberculosis treatment (ATT) in superficial tuberculous lymphadenitis (TBLA). Methods: In this nested case-control study, all patients diagnosed with TBLA based on combinations of histopathology, acid-fast bacilli (AFB) microscopy, AFB culture, and GeneXpert, between February 2013 and April 2016, were enrolled. Demographics, clinical characteristics, occurrence of PUR and outcome were recorded. Results: TBLA was diagnosed and treated in 189 patients. PUR developed in 33 (17%), of which 77% developed new inflamed glands, 20.6% had increased size and inflammation of pre-existing glands and 5.9% had superficial chest wall abscesses requiring aspiration. It responded to NSAIDS and does not need any modification in ATT
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