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DOI: 10.1055/s-0031-1283140
Erstdiagnose einer Tuberkulose im HNO-Bereich
Initial Diagnosis of Head and Neck TuberculosisPublikationsverlauf
eingereicht31. März 2011
akzeptiert 21. Juni 2011
Publikationsdatum:
20. Oktober 2011 (online)
![](https://www.thieme-connect.de/media/lro/201110/lookinside/thumbnails/10.1055-s-0031-1283140-1.jpg)
Zusammenfassung
Hintergrund:
Die Inzidenz von Tuberkuloseneuerkrankungen ist deutschlandweit rückläufig. Hauptmanifestationsort der Erkrankung ist die Lunge, in selteneren Fällen kann der Kopf-Hals-Bereich betroffen sein.
Material und Methoden:
Retrospektiv wurden am HNO Universitätsklinikum Bonn im Zeitraum zwischen 1997 und 2010 alle Patienten mit Erstdiagnose einer Tuberkulose im Kopf-Hals-Bereich ausgewertet.
Ergebnisse:
Es wurden 38 Patienten (24 weiblich, 14 männlich, Altersmedian 43,5±19,7 Jahre) erfasst. In über 60% der Fälle waren die Patienten ausländische Staatsbürger. Hauptsächlich betroffen waren die zervikalen Lymphknoten (87% ), seltener kam es zu extranodulären Manifestationen mit organspezifischen Beschwerden (Sinus maxillaris, Cavum tympani, Larynx, Tonsillen). In nur 3 Fällen wurde präoperativ der explizite Verdacht auf eine Tuberkulose gestellt.
Schlussfolgerung:
Nur die Kenntnis der unterschiedlichen Manifestationsorte sowie eine genaue Infektionsanamnese können zur präoperativen Verdachsdiagnose einer mykobakteriellen Erkrankung führen.
Abstract
Initial Diagnosis of Head and Neck Tuberculosis
Background:
In Germany tuberculosis has a decreasing incidence. The lung is the most common focus, whereas head and neck manifestation occurs rarely.
Material and Methods:
Between 1997 and 2010 all patients with initial diagnosis of tuberculosis of the head and neck region were retrospectively reviewed at the University Hospital of Bonn, Germany.
Results:
38 patients (24 female, 14 male, median age 43.5±19.7 years) were analysed. More than 60% were of foreign nationality. The majority of patients (87% ) presented with an unspecific cervical lymph node swelling. Extranodular manifestations (maxillary sinus, middle ear, larynx, tonsil) leading to organ specific symptoms rarely occurred. In only 3 cases a mycobacterial infection was suspected before surgery.
Conclusions:
Only the knowledge of different manifestation patterns as well as an accurate anamnesis of infectious diseases can lead to the tentative diagnosis of tuberculosis prior to surgery.
Autorenschaft: Es liegt eine geteilte Erstautorenschaft der Autoren A. Schröck und F. Göke vor.
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Literatur
- 1 Yepes JF, Sullivan J, Pinto A. Tuberculosis: medical management undate. Oral Surg Med Oral Pathol Oral Radiol Endod 2004; 98: 267-273
- 2 Miziara ID. Tuberculosis affecting the oral cavity in Brazilian HIV-infected patients. Oral Surg Med Oral Pathol Oral Radiol Endod 2005; 100: 179-182
- 3 Brodhun B, Altmann D, Haas W. Bericht zur Epidemiologie der Tuberkulose in Deutschland für. 2008 www.rki.de
- 4 Mohapatra PR, Janmeja AK. Tuberculous lymphadenitis. J Assoc Physicians India 2009; 57: 585-590
- 5 Manolidis S, Frenkiel S, Yoskovitch A, Black M. Mycobacterial infections of the head and neck. Otolaryngol Head Neck Surg 1993; 109: 427-433
- 6 Brizi MG, Celi G, Scaldazza AV, Barbaro B. Diagnostic imaging of abdominal tuberculosis: gastrointestinal tract, peritoneum, lymph nodes. Rays 1998; 23: 115-125
- 7 Ghompson MM, Underwood MJ, Sayers RD, Dookeran KA, Bell PR. Peripheral tuberculous lymphadenopathy: a review of 67 cases. Br J Surg 1992; 79: 763-764
- 8 Thompson MM, Underwood MJ, Sayers RD, Dookeran KA, Bell PR. Peripheral tuberculous lymphadenopathy: a review of 67 cases. Br J Surg 1992; 79: 763-764
- 9 Jäckel MC, Sattler B. Tuberculous and nontuberculous mycobacterial diseases of the cervical lymph nodes. HNO 2001; 49: 320-330
- 10 Enarson DA, Ashley MJ, Grzybowski S, Ostapkowicz E, Dorken E. Non-respiratory tuberculosis in Canada. Epidemiologic and bacteriologic features. Am J Epidemiol 1980; 112: 341-351
- 11 Roberts DS, Dowall JR, Winter L, Sulis AC, Grillone GA, Grundfast KM. Cervical Tuberculosis: A decision tree for protecting healthcare workers. Laryngoscope 2008; 118: 1345-1349
- 12 Kanlikama M, Gökalp A. Management of mycobacterial cervical lymphadenitis. World J Surg 1997; 21: 516-519
- 13 Kanlikama M, Mumbuc S, Bayazit Y, Sirikci A. Management strategy of mycobacterial cervical lymphadenitis. J Laryngol Otol 2000; 114: 274-278
- 14 Penfold CN, Revington PJ. A review of 23 patients with tuberculosis of the head and neck. Br J Oral Maxillofac Surg 1996; 34: 508-510
- 15 Laffers W, Eggert K, Schildhaus HU, Bootz F, Gerstner AOH. Histologic diagnoses in persistently swollen cervical lymph nodes. Head & Neck 2011; im Druck
- 16 Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg 1990; 77: 911-912
- 17 Levin-Epstein AA, Lucente FE. Scrofula – the dangerous masquerader. Laryngoscope 1982; 92: 938-943
- 18 Lee KC, Tami TA, Lalwani AK, Schecter G. Contemporary management of cervical tuberculosis. Laryngoscope 1992; 102: 60-64
- 19 Nalini B, Vinayak S. Tuberculosis in ear, nose, and throat practice: its presentation and diagnosis. Am J Otolaryngol 2006; 27: 39-45
- 20 Bailey CM, Windle-Taylor PC. Tuberculous laryngitis. Laryngoscope 1981; 91: 93-100
- 21 Williams RG, Douglas-Jones T. Mycobacterium marches back. J Laryngol Otol 1995; 109: 5-13
- 22 Smulders YE, De Bondt BJ, Lacko M, Al Hodge J, Kross KW. Laryngeal tuberculosis presenting as a supraglottic carcinoma: a case report and review of the literature. J Med Case Reports 2009; 20 ((3)) 9288
- 23 Sierra C, Fortun J, Barros C, Melcon E, Condes E, Cobo J. et al.. Extra-laryngeal head and neck tuberculosis. Clin Microbiol Infect 2000; 6: 644-648
- 24 Mert A, Kumbasar H, Ozaras R, Erten S, Tasli L, Tabak F, Ozturk R. Erythema nodosum: an evaluation of 100 cases. Clin Exp Rheumatol 2007; 25: 563-570
- 25 Gupta SN, Flaherty JP, Shaw JC. Erythema nodosum associated with reactivation tuberculous lymphadenitis (scrofula). Int J Dermatol 2002; 41: 173-175
- 26 Höhmann D, Höhmann M. Tuberculous pre- and paravertebral abscess with spondylitis. HNO 1992; 40: 64-66
- 27 Andratschke M, Nerlich AG, Hagedorn H. Floride Herdtuberkulose im Bereich der Nasennebenhöhlen. HNO 2009; 57: 1209-1212
- 28 Nawaz G, Khan MR. Primary sinonasal tuberculosis in north-west Pakistan. J Coll Physicians Surg Pak 2004; 14: 221-224
- 29 Cho YS, Lee HS, Kim SW, Chung KH, Lee DK, Koh WJ, Kim MG. Tuberculous otitis media: a clinical and radiologic analysis of 52 patients. Laryngoscope 2006; 116: 921-927
- 30 Vaamonde P, Castro C, Garcia-Soto N, Labella T, Lozano A. Tuberculous otitis media: a significant diagnostic challenge. Otolaryngol Head and Neck Surg 2004; 130: 759-766
- 31 Vaid S, Lee YYP, Rawat S, Luthra A, Shah D, Ahuja AT. Tuberculosis in the head and neck – a forgotten differential diagnosis. Clin Radiol 2010; 65: 73-81
- 32 Singh B. Role of surgery in tuberculous mastoiditis. J Laryngol Otol 1991; 105: 907-915