http://emedicine.medscape.

com/article/960858-
overview#a6
Background
Lymphadenitis is the inflammation or enlargement of a lymph node. Lymph
nodes are small, ovoid nodules normally ranging in size from a few millimeters
to 2 cm. They are distributed in clusters along the course of lymphatic vessels
located throughout the body. The primary function of lymph nodes is to filter
out microorganisms and abnormal cells that have collected in lymph fluid. [1]
Lymph node enlargement is a common feature in a variety of diseases and
may serve as a focal point for subsequent clinical investigation of diseases of
the reticuloendothelial system or regional infection. The majority of cases
represent a benign response to localized or systemic infection. Most children
with lymphadenitis exhibit small, palpable cervical, axillary, and inguinal lymph
nodes. Less common is enlargement of the suboccipital or postauricular
nodes. Palpable supraclavicular, epitrochlear, and popliteal lymph nodes are
uncommon, as are enlarged mediastinal and abdominal nodes.
Lymphadenitis may affect a single node or a group of nodes (regional
adenopathy) and may be unilateral or bilateral. The onset and course of
lymphadenitis may be acute, subacute, or chronic.

Pathophysiology

Increased lymph node size may be caused by the following:

Multiplication of cells within the node, including lymphocytes, plasma

cells, monocytes, or histiocytes
Infiltration of cells from outside the node, such as malignant cells or
neutrophils
Draining of an infection (eg, abscess) into local lymph nodes

Scrofula Overview of Scrofula

Updated: May 17, 2015
Author: Michael R Lewis, MD; Chief Editor: Arlen D Meyers, MD,
MBA more...
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Overview of Scrofula

Tuberculosis (TB) is the oldest documented infectious disease. In the United

States, pulmonary tuberculosis accounts for most tuberculosis cases. Scrofula
is the Latin word for brood sow, and it is the term applied to tuberculosis of the
neck. Cervical tuberculosis is usually a result of an infection in the lymph
nodes, known as lymphadenitis. Extrapulmonary tuberculosis, such as
scrofula, is observed most often in individuals who are immunocompromised,
accounting for up to 50% of these cervical infections.

Scrofula has been known to afflict people since antiquity, and during the
Middle Ages, the king's touch was thought to be curative. In modern times,
surgery has played a pivotal role in the diagnosis and treatment of scrofula.
Over the past several decades, however, surgical intervention has played a
decreasing role because it has been fraught with persistent disease and
complications. As in pulmonary tuberculosis, antituberculous chemotherapy
has become the standard of care for scrofula, and newer diagnostic
techniques (eg, fine-needle aspiration) have replaced more invasive methods
of tissue harvesting.

Today, approximately 95% of mycobacterial cervical infections in adults are

caused by Mycobacterium tuberculosis, and the remainder are caused by
atypical mycobacterium, or nontuberculous mycobacterium (NTM). In children,
this trend is reversed, with 92% of cases due to atypical mycobacterium.

NTM was first recognized as a cause of cervical adenitis in 1956. More than
50 species have now been identified, of which one half are recognized as
pathogenic. Statistics indicate an increase in the prevalence and isolation of
cervical lymphadenitis caused by NTM, far outnumbering tuberculosis as the
cause of chronic cervical adenitis in children. The distinction has both
diagnostic as well as therapeutic implications. Historically, scrofula was a term
used to describe tuberculosis adenitis; however, NTM adenitis is included in
the following text for completeness.

Pathophysiology of Scrofula

Mycobacterium tuberculosis is an obligate aerobe, nonspore-forming,

slender rod. Humans are its only reservoir. Transmission is from person to
person via respiratory route by inhalation of small aerosols. After a short
period of replication in the lungs, silent dissemination occurs through the
lymphohematogenous system to extrapulmonary sites, including the cervical
lymph nodes.

A study by Bruzgielewicz et al of patients with head and neck tuberculosis

found that among the 26 patients with lymph node tuberculosis, 15 patients
had infected lymph nodes of the second and third cervical regions and 11 had
infected lymph nodes of the first cervical region. [1]

Nontuberculous mycobacterium (NTM) differs from M tuberculosis in 2

respects: person-to-person transmission generally does not occur, and NTM
species are ubiquitous in nature and not necessarily pathogenic or equated
with disease. The oral cavity may serve as a common portal of entry because
the disease primarily occurs in children who have a propensity to put
contaminated objects in their mouth.