Scrofula

Definition:

A tuberculous infection of the skin of the neck, most often caused by mycobacteria (including Mycobacteriumtuberculosis), in adults. In children, it is usually caused by Mycobacterium scrofulaceum and Mycobacterium avium.

Alternative Names:

Tuberculous adenitis

Causes, incidence, and risk factors:

Infection with mycobacteria is usually caused by inhaling air contaminated by these organisms. The bacteria spread throughout the body, and may cause rubbery enlargement of the lymph nodes in the neck (cervical lymph nodes) as well as elsewhere. If these are not treated, the lymph nodes may become ulcerated, producing draining sores.

Symptoms:

painless swelling of cervical (neck) lymph nodes
ulceration is rare today
lymph nodes may be enlarged elsewhere
fevers, chills, sweats, and weight loss can occur in 20% of individuals

Signs and tests:

histology (examination under a microscope) shows granulomas
special stains (such as AFB of the material) may be positive
Mycobacteriumtuberculosis and other mycobacteria can be cultured from lymph node specimens
TB tine or PPD tests are usually positive
Chest X-rays can be abnormal due to old tuberculosis infection or simultaneous pulmonary tuberculosis

Treatment:

When infection is caused by Mycobacteriumtuberculosis, treatment is usually with 9 to 12 months of antibiotics. Several antibiotics need to be used at once, to avoid the bacterium becoming antibiotic-resistant. Common antibiotics for scrofula include:

INH
rifampin
pyrazinamide
ethambutol

When infection is caused by mycobacteria other than Mycobacterium tuberculosis, as is often seen in children, therapy usually involves antibiotics, such as rifampin, ethambutol, and clarithromycin.

Surgery is seldom necessary, and is reserved for cases where medical therapy is only partially effective.

Expectations (prognosis):

Recovery is usually complete.

Complications:

scarring
formation of a draining fistula in the neck (especially after biopsy)

Calling your health care provider:

Call your provider if your child has a swelling or group of swellings in the neck. Scrofula can occur in children without exposure to someone with tuberculosis.

Prevention:

Prevention of tuberculosis requires identification of individuals with inactive or latent infection. This is done with a PPD or Tine test. Individuals who have been exposed to someone with tuberculosis of the lungs should have such a skin test performed.

Many occupations, such as nursing and medicine, require practitioners to get regular skin tests. Individuals who immigrate to the United States from areas of the world where tuberculosis is common are also screened with such skin tests.

Review Date: 8/7/2002
Reviewed By: Camille Kotton, M.D., Infectious Diseases Division, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

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