Evaluation of Clinical Outcome of 6 months Anti-TB therapy in Rifampicin sensitive Tubercular Cervical Lymphadenopathy in Tertiary Level Hospital, Dhaka, Bangladesh

Open Access

Abstract

Background: Tuberculous lymphadenitis (TBL) is the most common form of extrapulmonary tuberculosis and a major cause of lymph node enlargement in tuberculosis-endemic countries. It is characterized by chronic, painless lymphadenopathy with granulomatous inflammation and caseous necrosis. Although antitubercular therapy (ATT) is the standard treatment, clinical response is often slower than in pulmonary tuberculosis and treatment outcomes remain variable despite the recommended 6-month regimen in Bangladesh. Objective: To evaluate the clinical outcome of anti-tubercular therapy in rifampicin-sensitive tubercular cervical lymphadenopathy at a tertiary-level hospital. Methods & Materials: This prospective interventional study was conducted in the Department of Otolaryngology and Head-Neck Surgery, Dhaka Medical College Hospital, from October 2021 to September 2022. Patients with newly diagnosed, cytologically confirmed tubercular cervical lymphadenopathy were enrolled using purposive sampling. Detailed history, clinical examination and relevant investigations were performed. All patients received Category I ATT according to national guidelines. Data were recorded in structured case report forms and analyzed using SPSS version 22 and Microsoft Excel. Results: A total of 100 patients were included. The majority (44%) were aged 31-45 years, with a mean age of 39.05 ± 9.32 years. Females predominated (68%), with a male-to-female ratio of 1:2.1. Painless lymph node swelling was present in all patients. Common associated symptoms included weakness (35%), weight loss (26%), cough (15%), and night sweats (12%). Lymphadenopathy was unilateral in all cases, single in 87%, and most commonly measured 3-6 cm (65%). Solid lymph nodes were noted in 92% of patients. Successful treatment outcomes were observed in 92% of cases after 6 months of ATT. Treatment failure occurred in 8%, including 3 presumptive and 5 bacteriologically confirmed failures. Five percent of cases were microbiologically positive. Eight patients required surgical excision due to persistent lymphadenopathy despite clinical improvement. Conclusion: Six-month ATT for rifampicin-sensitive tubercular cervical lymphadenopathy demonstrated high efficacy with a 92% treatment success rate and an 8% failure rate supporting its effectiveness as standard therapy.