Tuberculosis de cabeza y cuello

Nasopharyngeal Tuberculosis: Epidemiology, Mechanism of Infection, Clinical Manifestations, and Management

Nasopharyngeal tuberculosis (NPTB) is a noteworthy disease especially in its worldwide spread of the Mycobacterium infection. Although NPTB has been identified in less than one percent of TB cases, recent multiple case reports indicate an either increased awareness or incidence of this disease. The most helpful diagnostic tool is an uncomplicated nasopharyngeal biopsy. However, NPTB is usually ignored because it has varied clinical manifestations and similar presentations with other more common head and neck diseases. Furthermore, the most common presenting symptom is cervical lymphadenopathy mimicking nasopharyngeal carcinoma, a more common and serious disease. Treatment outcomes of NPTB are good in both HIV-positive or HIV-negative patients. In addition, pulmonary tuberculosis association was reported in wide range between 8.3% and 82% which should be considered in a treatment program. In conclusion, early diagnosis and management in NPTB can be achieved by (1) increased awareness of this disease, (2) improvement in knowledge regarding clinical manifestations, and (3) improvement of diagnostic techniques.

Head and neck tuberculosis: 6-year retrospective study

INTRODUCTION

Pulmonary involvement exists in 80% of cases of infection with Mycobacterium tuberculosis; however, in up to 20% of cases there may be extra-pulmonary involvement. In the ENT area, the most common site is cervical lymphadenitis, affecting approximately 95% of cases.

MATERIALS AND METHODS

This was a retrospective study of patients attending an ENT department in a tertiary hospital for head and neck symptoms that were diagnosed with tuberculosis (TB), between December 2007 and December 2013.

RESULTS

The study included 73 patients, 41 (56.2%) males and 32 (43.8%) females (M/F ratio=1.28), with a mean age of 39.4 years (± 26.5 years; Min 1, Max 88). There were 53 (72.6%) cases of cervical lymphadenopathy, 11 (15%) of laryngeal tuberculosis 3 (4.1%) of hypopharyngeal tuberculosis, and six cases in other locations. Of the total, 14 (19.2%) patients were HIV positive and 10 (13.7%) had a history of contact with relatives who had suffered pulmonary tuberculosis. PCR was performed in 51 (69.8%) cases to confirm being positive, of which 47 (92.1%) cases were.

CONCLUSION

The similarity of tuberculosis to diseases of poor prognosis and the difficulty of its diagnosis make considering tuberculosis necessary when exploring patients with ulcerative or granulomatous ENT lesions. Analysing our results, the incidence of TB according to its ENT area location is similar to that reported in the literature. It is important to make special mention of the use of PCR in our study and the benefits that its implementation means for diagnosis.

Tuberculous retropharyngeal abscess presenting with symptoms of obstructive sleep apnea

Chronic retropharyngeal abscess (RPA) caused by tuberculosis is an uncommon manifestation of extrapulmonary tuberculosis within the head and neck. Obstructive sleep apnea (OSA) in adults is a common condition with many etiologies that have been well described. Here, we present a case of retropharyngeal abscess caused by chronic tuberculosis with an unusual and interesting presenting symptom in an adult that has not been mentioned in literature, new-onset and worsening stertor or snoring, with signs and symptoms of OSA. The purpose of this manuscript is to present our experience with this case, as well as to emphasize the diagnosis, clinical course, and management of tuberculous retropharyngeal abscess in adults, while also signifying the need to include retropharyngeal abscess in the differential diagnosis for symptoms presenting as new-onset stertor and airway obstruction.