Epidemiological, clinical, and bacteriological findings among tunisian patients with tuberculous cervical lymphadenitis

The incidence of tuberculous cervical lymphadenitis (TCL) is likely to be on the rise in Tunisia over the last two decades. However, this pathological condition remains poorly characterized, in regard to involved mycobacterial species. Purpose: To study the etiology and treatment outcome of TCL among Tunisian patients; to indicate the mycobecteria responsible for the majority of TCL cases. This prospective study has involved 114 patients, clinically diagnosed as TCL, presenting to a National referral hospital in Tunis, from November 2011 to January 2014. Results: 69 patients displayed typical cytological signs of TCL, whose mycobacterial etiology was confirmed in 23 cases. 4 cases may be a possible disseminated TB. Mycobacterial species assignment could be established for 15 culture-positive specimens, 11 of which were found to be Mycobacterium bovis, while the remaining were identified as tuberculosis. 6 of M. bovis isolates belonged to the BOVIS1 spoligopattern, and 3 of the M. tuberculosisisolates to the Haarlem3, one of the most prevalent genotype associated with pulmonary tuberculosis in Tunisia. Although all subjects lived in an urban area, the majority declared having consumed raw milk and derived products. The cure rate was low, as among patients that completed an anti-tubercular chemotherapy of at least 8 months, only 55.5% were cured. Conclusion: Our results are consistent with literature since positive cases demonstrated by AFB smear test don’t exceed 37.4% and varied by culture between 19 and 71%. This is the first indication that M. bovis is a significant cause of TCL in Tunisia. Consumption of unpasteurized dairy products is the most likely source of transmission. The low cure rates among TCL cases should call health authorities for improved management and therapeutic schemes.