Tuberculous adenitis

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Clinical Manifestations

Paradoxical Reactions

  • Paradoxial reaction including paradoxical upgrading reaction
  • Occurs in 25% of adenitis
    • Usually during treatment but can occur after treatment
  • Likely reaction to antigenic stimulus in poorly-cleared disease
  • In post-treatment paradoxical reactions, need to differentiate from relapse
  • About half will be PCR positive, 20% will be AFB positive, but none are culture positive

References

  1. ^  C. R. Hawkey, T. Yap, J. Pereira, D. A. J. Moore, R. N. Davidson, G. Pasvol, O. M. Kon, R. A. Wall, R. J. Wilkinson. Characterization and Management of Paradoxical Upgrading Reactions in HIV-Uninfected Patients with Lymph Node Tuberculosis. Clinical Infectious Diseases. 2005;40(9):1368-1371. doi:10.1086/429317.
  2. ^  Sabine M. Hermans, Onno W. Akkerman, Graeme Meintjes, Martin P. Grobusch. Post-tuberculosis treatment paradoxical reactions. Infection. 2024;52(5):2083-2095. doi:10.1007/s15010-024-02310-0.
  3. ^  JH van Loenhout-Rooyackers, RJ Laheij, C Richter, AL Verbeek. Shortening the duration of treatment for cervical tuberculous lymphadenitis. European Respiratory Journal. 2000;15(1):192-195. doi:10.1183/09031936.00.15119200.