Tuberculosis of the lymph nodes (tuberculous lymphadenitis) is a manifestation of tuberculosis as a general disease of the body. More often, especially in childhood, the period of primary tuberculosis is combined with damage to the intrathoracic lymph nodes. Relatively isolated damage to certain groups of lymph nodes is possible, more often in adults, against the background of old inactive tuberculous changes in other organs, when tuberculous lymphadenitis is a manifestation of secondary tuberculosis.
The frequency of tuberculous lymphadenitis depends on the severity and prevalence of tuberculosis and social conditions. Among children, tuberculous lesions of peripheral lymph nodes, according to E.I. Guseva, P.S. Murashkin (1974) and others, are observed in 11.9-22.7% of patients with active forms of extrapulmonary tuberculosis.
Etiology (causes of occurrence)
Tuberculosis of peripheral lymph nodes is caused mainly by Mycobacterium tuberculosis of the human and bovine types. Bovine mycobacteria are commonly the causative agent of tuberculous lymphadenitis in agricultural pastoral areas.
Pathogenesis
The ways of spreading the infection are different. The entry point for infection can be the tonsils, when they are damaged, the cervical or submandibular lymph nodes are involved in the process. The infection most often spreads through the lymphogenous route from affected intrathoracic lymph nodes, lungs or other organs.
Pathological anatomy
Pathomorphological changes in the affected nodes depend on the severity of the infection, the condition of the patient’s body, the type of Mycobacterium tuberculosis and other factors.
Classification
A. I. Abrikosov identifies five forms of tuberculous lesions of the lymph nodes:
- diffuse lymphoid hyperplasia;
- miliary tuberculosis;
- tuberculous large cell hyperplasia;
- caseous tuberculosis;
- indurative tuberculosis.
In clinical practice, the classification proposed by N. A. Shmelev is used, which distinguishes three forms of tuberculous lymphadenitis:
- infiltrative;
- caseous (with and without fistulas);
- indurative.
Clinical manifestations
With the acute onset of the disease, there is a high temperature, symptoms of tuberculosis intoxication, enlarged lymph nodes, often with pronounced inflammatory-necrotic changes and perifocal infiltration.
A characteristic sign of tuberculous lymphadenitis, distinguishing it from other lesions of the lymph nodes, is the presence of periadenitis. The affected lymph nodes are a conglomerate of formations of various sizes welded together. In adults, more often than in children, the onset of the disease is gradual, with less enlargement of the lymph nodes and less frequent formation of fistulas due to the predominantly productive nature of the inflammation.
A number of researchers associate the acute onset of the disease and the tendency to rapid formation of caseosis and fistulas with infection with the bovine type of mycobacterium tuberculosis. The most commonly affected are the cervical, submandibular and axillary lymph nodes. The process may involve several groups of lymph nodes on one or both sides.
Diagnostics
The diagnosis of tuberculous lymphadenitis is made on the basis of a comprehensive examination of the patient, taking into account:
- having contact with tuberculosis patients,
- results of the reaction to tuberculin (in most cases it is pronounced),
- the presence of tuberculosis damage to the lungs and other organs.
These punctures of the affected lymph node play an important role in making a diagnosis. Calcifications can form in the lymph nodes, which are detected during X-ray examination in the form of dense shadows in the soft tissues of the neck, submandibular region, axillary and groin areas.
Differential diagnosis
Tuberculous lymphadenitis is differentiated from nonspecific purulent lymphadenitis, lymphogranulomatosis, metastases of malignant tumors, etc.
Treatment
Treatment is determined by the nature of the damage to the lymph nodes and the severity of tuberculous changes in other organs. With an active process, first-line drugs are prescribed: tubazide, streptomycin in combination with PAS or ethionamide, pyrazinamide, prothionamide, ethambutol.
Treatment should be long-term – 8-15 months. In addition, streptomycin is injected (or injected) into the affected node, and bandages with streptomycin, tubazid, tibon ointment are applied.
In case of severe purulent process, broad-spectrum antibiotics are prescribed.
In case of caseous lesions of the lymph nodes, surgical intervention is indicated against the background of a general course of anti-tuberculosis therapy.
Forecast
With timely recognition of the disease and treatment of lymphadenitis, the prognosis is favorable.
Inflammation of the lymph nodes under the lower jaw is called submandibular lymphadenitis. This disease worries both adults and children. What is its reason? How to recognize submandibular lymphadenitis? What to do for a speedy recovery? Is it possible to be treated with folk remedies?
Lymphadenitis is mainly provoked by staphylococci and streptococci, which, once in the lymph flow, “migrate” to the lymph nodes. The reason for such “migration” can be the presence of a focus of inflammation in almost any organ. In the case of submandibular lymphadenitis, the greatest danger comes from diseases of the oral cavity, such as:
- caries;
- pulpitis;
- periodontitis;
- gingivitis;
- periodontal disease;
- chronic sinusitis;
- chronic tonsillitis.
Against the background of these diseases, an infection “thrives” in the mouth, which affects the lymph nodes. Less commonly, the cause of submandibular lymphadenitis is the bacterium syphilis or Koch's bacillus, which causes tuberculosis. In such a situation, inflammation of the lymph nodes is considered a secondary disease.
Sometimes lymphadenitis occurs after an injury, due to which the integrity of the skin is disrupted and pathogenic microflora enters the body. If the disease was provoked in this way, then it can be classified as primary.
Symptoms of submandibular lymphadenitis
At an early stage, the disease may not manifest itself at all, but very soon its most obvious signs become noticeable:
- Rapid enlargement of the lymph nodes under the lower jaw, their soreness on palpation and gradual hardening.
- Slight redness of the inflamed areas, which gradually become burgundy and then bluish.
- Swelling at the site of inflammation.
- Sleep disturbance.
- Sharp short-term attacks of pain radiating to the ear (so-called “lumbago”).
- Discomfort while swallowing.
- Inflammation of the oral mucosa.
- Temperature rises to 400.
- General weakness of the body.
- Increased level of leukocytes according to the results of a blood test.
For the most part, people ignore the first attacks of mild pain. At this stage, the lymph nodes are still almost not palpable, but within three days the picture changes dramatically. The swelling becomes pronounced and gradually spreads to the entire submandibular surface, and the skin seems stretched.
Typically, patients become irritable, depressed, lose interest in what is happening around them and quickly get tired. This is due to severe discomfort, which does not allow you to sleep normally and open your mouth to eat. High temperature worsens the condition.
In the future, the pain continues to intensify, and pus accumulates at the site of inflammation, as indicated by blue skin.
If you find the above symptoms of any severity, you should contact a dental surgeon. Self-medication is unacceptable. Sometimes it is difficult even for a doctor to determine an accurate diagnosis, since submandibular lymphadenitis can be disguised, for example, as inflammation of the salivary glands.
Treatment
Treatment should be carried out under the supervision of a physician. First of all, therapy is aimed at eliminating the infection that provoked the disease. The following drugs are mainly used:
- Burov's liquid (8% aluminum acetate solution). It has astringent, anti-inflammatory and moderate antiseptic properties. Burov's liquid is used for rinsing and cold lotions. Before use, the drug is diluted 10-20 times.
- Saline solution. They are recommended to rinse their mouths with chronic tonsillitis.
- Antibiotics. They can be prescribed both in tablet form and as intramuscular injections. Among the most common are Cephalexin, Clindamycin, Amoxiclav, Lincomycin, Cefuroxime. Antibiotics should be taken strictly as prescribed by the doctor, without interrupting or extending the course without permission.
If lymphadenitis was detected at an early stage, then rinses and antibiotics may be sufficient. If there is purulent inflammation in one node, a simple operation is necessary, during which an incision is made and the purulent contents are removed from the lymph node through drainage.
But in the majority of patients, several lymph nodes are affected at once. In such a situation, quite serious surgical intervention is required. During the operation, the doctor makes an incision in the area under the lower jaw, where he inserts a drainage tube and drains the pus. After the procedure is completed, the wound is closed with clamps.
Treatment with folk remedies
Self-treatment of lymphadenitis is extremely undesirable. As a maximum, folk remedies can be effective at the initial stage of the disease. But in any case, home therapy should be agreed with a doctor.
Among the most popular ways to get rid of submandibular lymphadenitis are the following:
- drink ginger tea;
- Apply a compress based on alcohol tincture of Echinacea at night. You will need to dilute 1 tbsp. l. tincture with double the amount of warm water and soak the bandage with the resulting solution;
- Take echinacea tincture orally. It is necessary to dilute 30-35 drops of tincture in 0.5 glasses of water and drink this medicine three times a day;
- drink blueberry drink. You should crush a handful of fresh berries, add water to the pulp, leave for about an hour and drink. Repeat before every meal;
- take dandelion powder. This rather unusual medicine can only be prepared in the summer. It is necessary to dry the dandelion roots, then chop them. The resulting powder should be eaten 1 tsp. half an hour before meals;
- drink beet juice. You need to extract juice from a fresh vegetable and place it in the refrigerator for 6 hours (after removing the foam). You need to drink the resulting medicine in the morning before breakfast. Since beet juice does not taste very pleasant, it can be diluted with carrot juice by a quarter;
- drink garlic infusion. You will need to pour warm water over two chopped garlic heads and leave for three days, stirring the medicine being prepared twice a day. You need to drink the infusion 2 tsp. in between meals;
- take vitamin C. Initial dose is 0.5 g three times a day. If no signs of improvement are observed, it is recommended to increase the dose to 0.75-2 g.
The use of folk remedies in the presence of pus in the lymph nodes will only take time: while the patient thinks that he is being treated, the disease continues to develop. As practice shows, jaw lymphadenitis sooner or later forces a person to go to the hospital. And it is better for the patient himself that this happens early.
Submandibular lymphadenitis can occur in acute and chronic forms. In the first case, only one or several nodes can become inflamed at the same time. Although an acute course can be observed without the presence of pus, most often it is caused by an abscess. In this case, pus can be localized in the node and fluctuate, which indicates that it moves around the node. This can provoke its breakthrough and a more extensive spread of inflammation. In addition, in acute form, the infection can affect not only the node, but also the tissues adjacent to it. They also become swollen and painful.
In the acute form, pain can affect the neck and jaw. Pain is caused by opening and closing the mouth.
Submandibular lymphadenitis in chronic form
Submandibular lymphadenitis (causes, symptoms, treatment and prevention are described in the article) can also occur in a chronic form. It can be caused by improper treatment of an acute illness. In the acute form, the lymph node swells, the skin around it becomes red, and in the chronic form, the nodes harden.
In a chronic process, as well as in an acute one, inflammation can affect tissues close to the node. The patient exhibits the same symptoms as in the acute course: fever, redness of the skin, asthenia and fever.
If the disease is chronic, doctors may resort to a surgical method during which the affected node will be removed. The acute form is stopped by removing pus from the affected node with further use of antibiotics.
The appearance of submandibular lymphadenitis in children
The disease occurs quite often in childhood. The infection can spread from various areas of inflammation. This could be an infection of the teeth, gums, throat, etc.
Infants cannot develop this disease, since the formation of lymph nodes occurs during the first three years of a child’s life.
If the process in a child is not stopped in time, surgery to remove the node may be necessary. Therefore, it is important to start therapy in a timely manner. Many parents do not even suspect that lymph nodes are located in the back of the head. Although submandibular lymphadenitis in children is easily diagnosed.
The child complains of pain in the neck or lower jaw. The parent can feel the knots. They will be soft and mobile.
Diagnosis of the disease
There are a number of methods to help diagnose this disease. A doctor can make a diagnosis only based on signs, without conducting any examinations, since the symptoms of the disease are quite vivid.
In addition to the visual method, as well as palpation, there are other diagnostic methods. For example, a doctor may prescribe a blood test for a patient. As already mentioned, the disease provokes an increase in the level of leukocytes.
They also resort to ultrasound. Ultrasound reveals the presence of pus in the node. In addition, the doctor can perform a puncture (collection of fluid for bacteriological analysis). Such manipulation will help determine which bacteria provoked the inflammation and which antibiotic is appropriate to prescribe in this case.
Basic principles of treatment
How does submandibular lymphadenitis occur? Symptoms and treatment with folk remedies, as well as traditional medicine methods, indicate that this is an inflammatory disease that causes suppuration. Therapy is based on eliminating the infection that caused the inflammation.
As a rule, they resort to drugs such as:
- aluminum 8%). It has an astringent and anti-inflammatory effect. Used as rinses and cold lotions. Before use, the product is diluted 10-20 times.
- Salt based solution. Used for rinsing.
- Use of antibiotics. They are prescribed both in the form of tablets and in the form of intramuscular injections. Among them, the most widely used drugs are Cephalexin, Clindamycin, Amoxiclav, Lincomycin, and Cefuroxime. Antibiotics should only be taken as prescribed by a doctor.
If submandibular lymphadenitis (symptoms and treatment are described) was diagnosed at an early stage, then usually the use of rinses and antibiotics is sufficient for relief.
If pus accumulates during inflammation, they usually resort to a simple operation, which involves making a small incision and removing the pus through drainage.
In most patients, several nodes are affected at once. In this case, surgery will be required. The doctor makes a small incision under the lower jaw. A drainage tube is inserted into it and the pus is removed. When the manipulation is completed, the wound is closed with clamps. After surgery, the patient must take a course of antibiotics.
The use of folk remedies in the treatment of lymphadenitis
How is submandibular lymphadenitis relieved? Symptoms and treatment with folk remedies, as well as traditional medicine methods, are presented in this article. In most cases, using traditional methods for lymphadenitis is a waste of time. The patient believes that he is easing his condition, but in fact the disease is progressing and, as practice shows, leads to a hospital bed.
Usually, traditional methods are effective only at the initial stage of the disease. In any case, you cannot resort to using home remedies without a doctor’s advice.
Among the most popular traditional methods of treatment are:
- Drinking ginger tea.
- Applying a compress with Echinacea tincture in alcohol. One tbsp. l. The drug is diluted with warm water in a ratio of 1:2. The resulting mixture is soaked in a bandage.
- Drinking echinacea tincture. For this purpose, 30-35 drops of the product are diluted in half a glass of water. The medicine is taken three times a day.
- Drinking blueberry drink. A handful of fresh berries should be crushed, the pulp should be filled with water, left for about an hour and drunk. The procedure is repeated before each meal.
- Uses of dandelion powder. This medicine can only be prepared in the summer. Dandelion roots are dried and then crushed. The resulting powder is eaten 1 tsp. 30 minutes before meals.
- Drinking beet juice. Juice is squeezed out of fresh fruits and placed in the refrigerator for 6 hours (the foam should be skimmed off). The medicine is taken in the morning before breakfast. The taste of beetroot juice is not very pleasant, so it can be diluted by a quarter with carrot juice.
- Drinking garlic infusion. Chop two heads of garlic and add warm boiled water. They are infused for 3 days. The medicine is stirred twice a day. Drink the infusion 2 tsp. between meals.
- Vitamin C intake. The starting dose is 0.5 g three times a day. If no improvement is observed, then it is recommended to increase the vine to 2 g.
Preventive measures
How submandibular lymphadenitis occurs (symptoms and treatment), the photos in this article give an idea. The disease causes excruciating pain and requires the use of antibiotics. Often surgery is required to relieve the disease.
In order not to encounter a problem such as lymphadenitis, you should avoid infection of the body and treat everything, even not very serious diseases, in a timely manner. Avoid scratching and wounding the skin. When they appear, immediately treat with antiseptic agents. Do not underestimate the timely treatment of gums and caries, since they are the ones who can provoke the development of such an unpleasant disease in the first place.
Tuberculous lymphadenitis (tuberculous lesions of the lymph nodes of the cervical and maxillofacial region) in children occupies one of the first places among all other tuberculous lymphadenitis. R.A. Kalmakhelidze noted tuberculous lesions of the lymph nodes of the maxillofacial region in 7.1% of patients with lymphadenitis.
Submitted by M.Ya. Zazulevskaya, tuberculous lymphadenitis accounts for 13.8% of the total number of perimandibular lymphadenitis.
There are two possibilities for the occurrence of tuberculosis of the lymph nodes of the maxillofacial area. In the first case, the “gates of entry” for tuberculosis infection are inflammatory foci and damage to the mucous membrane, nasal cavity, adenoids and tonsils, and affected teeth. If mycobacteria tuberculosis in the nodes do not die (phagocytosis and lysis-lymphocytes), then they are fixed and give rise to a local focus of the disease. Tuberculosis of peripheral lymph nodes can also occur as a secondary manifestation in the presence of specific changes in other organs (lungs, joints, bones, etc.). But often, with any route of penetration of tuberculosis infection into the body, the lymph nodes, primarily the submandibular and cervical ones, are affected first of all.
The acute onset of tuberculous lymphadenitis in the maxillofacial area is not typical, although it does occur. Local manifestations at the onset of the disease in such cases are similar to nonspecific acute lymphadenitis. Characteristic is sharp hyperplasia of the affected node. The lymph node can enlarge to the size of a “chicken egg”. Abscess formation is often affected
nodes with subsequent formation of a fistula. After the acute inflammatory phenomena subside, the node remains enlarged, mobile, elastic, slightly fused with the surrounding tissues for a long time. General manifestations of acute tuberculous lymphadenitis resemble those of acute nonspecific lymphadenitis.
The chronic course of the disease is more common than acute. The process begins with an enlargement of a lymph node or groups of nodes in a particular area. The affected nodes have a densely elastic consistency with clear contours and a somewhat bumpy surface, painless or slightly painful on palpation, in most cases mobile, sometimes fused with surrounding tissues and skin. The color of the skin over the nodes is not changed, it folds freely or with some difficulty. This condition of the lymph node or nodes persists for a long time. As the disease develops, neighboring nodes are also involved in the process, forming “packages” of lymph nodes welded together. Along with “packages” of nodes fixedly fused to the skin, individual moving nodes are observed without the phenomena of periadenitis and skin changes. The tendency to cheesy disintegration and suppuration leads to the formation of fistulas with copious purulent discharge and inflammatory changes in the skin circumference. Fistulas do not heal for a long time, periodically closing and opening. Tuberculosis damage to the lymph nodes can be unilateral or bilateral, affecting one or more groups. With secondary lymphadenitis, perifocal infiltration is insignificant, signs of hyperplasia of the affected nodes predominate (Fig. 67, inset).
In some cases, foci of softening are identified; sometimes the softened nodes cover the entire “package” of lymph nodes tightly fused to each other and to the skin. When lymphadenitis begins with damage to several nodes at once, the process of formation of “packets” and the further development of the disease are characterized by a more rapid course. In the later stages of the disease, especially in cases where the patient is examined for the first time, 1-2 years after the onset of the disease, slightly enlarged but sharply compacted lymph nodes can be detected, which may indicate previous caseous decay and subsequent calcification of the affected node.
Along with damage to the submandibular and cervical lymph nodes
phatic nodes, almost all children have micropolyadenitis. The general condition of children with isolated primary lesions of the lymph nodes almost does not worsen.
The diagnosis of tuberculous lymphadenitis in the maxillofacial area in children presents certain difficulties due to the similarity of the clinical course in the initial stages of the disease with acute or chronic nonspecific lymphadenitis. But as the process progresses, local manifestations typical of tuberculous lymphadenitis appear.
The diagnosis is based on a comparison of data from the anamnesis, clinical course and laboratory tests: cutaneous and intradermal tests (Pirquet and Mantoux reactions), cytological examination of punctate and discharge from fistulas. The presence of caseosis, cellular elements of tuberculosis inflammation, and mycobacterium tuberculosis in the punctate confirms the nature of the pathological process. To exclude the primary focus of pulmonary tuberculosis, all children should undergo chest radiography and fluoroscopy. Radiography of the affected area has a certain diagnostic value. In chronic processes with partial or complete calcification of the affected node, shadows of these calcifications are detected on radiographs.
Differential diagnosis of tuberculous lymphadenitis is carried out with nonspecific chronic lymphadenitis, chronic sialadenitis, actinomycosis of lymph nodes, systemic blood diseases, tumors and tumor-like processes.
For tuberculous lymphadenitis, restorative, stimulating, desensitizing and specific anti-tuberculosis therapy is carried out. In cases of abscess formation, surgical intervention is indicated - opening the abscess with drainage of the cavity.
Treatment of patients with tuberculous lymphadenitis is long-term and should be carried out in a specialized medical institution or on an outpatient basis under the supervision of a phthisiatrician. Contact and joint observation of this group of patients by a dentist and a phthisiatrician is necessary. In recent years, due to the use of many anti-inflammatory drugs in surgical practice and the widespread spread of atypical mycobacteria resistant to the specific drugs used
kim anti-tuberculosis drugs, the surgical method of excision of lymph nodes for isolated lesions is more widely used
