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Cited by 299Diagnosis and treatment of tuberculosisTuberculosis Research and EpidemiologyLymphadenopathy Diagnosis and Analysis

Current diagnosis and management of peripheral tuberculous lymphadenitis.

Fontanilla, J.-M., Barnes, A., von Reyn, C. F.·2011·Clinical Infectious Diseases
DOI 10.1093/cid/cir454
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Abstract

Peripheral tuberculous lymphadenitis accounts for ~10% of tuberculosis cases in the United States. Epidemiologic characteristics include a 1.4:1 female-to-male ratio, a peak age range of 30-40 years, and dominant foreign birth, especially East Asian. Patients present with a 1-2 month history of painless swelling of a single group of cervical lymph nodes. Definitive diagnosis is by culture or nucleic amplification of Mycobacterium tuberculosis; demonstration of acid fast bacilli and granulomatous inflammation may be helpful. Excisional biopsy has the highest sensitivity at 80%, but fine-needle aspiration is less invasive and may be useful, especially in immunocompromised hosts and in resource-limited settings. Antimycobacterial therapy remains the cornerstone of treatment, but response is slower than with pulmonary tuberculosis; persistent pain and swelling are common, and paradoxical upgrading reactions may occur in 20% of patients. The role of steroids is controversial. Initial excisional biopsy deserves consideration for both optimal diagnosis and management of the otherwise slow response to therapy.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes the epidemiology, clinical presentation, diagnosis, and management of peripheral tuberculous lymphadenitis, emphasizing its distinct features and frequent slow or paradoxical response to therapy. It concludes that excisional biopsy offers the best diagnostic yield and may be considered as an adjunct to standard antimycobacterial treatment, while corticosteroid use remains controversial.

Key findings

  • Peripheral tuberculous lymphadenitis accounted for about 10% of US tuberculosis cases; in 2008, 1,103 of 12,904 cases (8.5%) were lymphadenitis. It is more common in women (composite female-to-male ratio 1.4:1), peaks at ages 30–40 years, and in non-endemic countries predominantly affects foreign-born patients, especially those from Southeast Asia and India.
  • Typical presentation is painless swelling of a single cervical lymph node group lasting 1–2 months; median node size is 3 cm, cervical involvement is reported in 45%–70%, and concomitant pulmonary tuberculosis in 18%–42%. Systemic symptoms are more frequent in HIV-positive patients.
  • Definitive diagnosis requires culture or nucleic acid amplification of *Mycobacterium tuberculosis*. Excisional biopsy had the highest sensitivity in one Hong Kong study (80% culture-positive vs 17% for fine-needle aspiration), though FNA is less invasive and useful in resource-limited or immunocompromised settings. NAAT performance was highly variable (sensitivity 2%–100%; specificity 28%–100%).
  • IDSA recommends 6 months of antimycobacterial therapy, supported by cure rates of 89%–94% and relapse rates of 3%. Paradoxical upgrading reactions occurred in 20%–23% of HIV-negative patients and 22%–60% of HIV-positive patients initiating ART; steroids are controversial, and early excisional biopsy may improve diagnosis and management of slow responses.

Methods

  • Narrative review of English-language articles identified through Medline using “Tuberculosis, Lymph Node” as a major Medical Subject Heading from 1990 through 2011.
  • Synthesized epidemiologic data from 14 studies, along with literature on diagnostic tests, antibiotic treatment, steroid therapy, paradoxical reactions, and surgical management.
  • No primary data collection or formal meta-analysis was performed.

Limitations

  • The paper does not explicitly state limitations. Evident from the text: it is a narrative review restricted to English-language Medline articles from 1990–2011, so selection and language bias are possible and study quality was not systematically appraised.
  • Evident from the text: reported rates of paradoxical upgrading reactions vary with definitions, and many cited studies are retrospective or uncontrolled, particularly those on steroid use in adults.
  • Evident from the text: the recommendation to consider early excisional biopsy as an adjunct lacks controlled comparisons against antibiotic therapy alone, as the authors note.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/cid/cir454

Cites

66 of 66 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

9 of 108 cited sources checked · 2 supported · 2 flagged · accuracy not yet measured

  • Premisecitation
    § CLINICAL FEATURES · p. 3

    In series from Qatar and India, fever and weight loss were reported in 40%-60% of HIV-negative patients.

    “In contrast, fever and weight loss were reported in 40%-60% of HIV-negative patients in series from Qatar and India [17, 24].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [17] 17. Khan FY. Clinical pattern of tuberculous adenitis in Qatar: experience with 35 patients. Scand J Infect Dis 2009 ; 41:128-34.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [24] 24. Purohit MR, Mustafa T, Morkve O, Sviland L. Gender differences in the clinical diagnosis of tuberculous lymphadenitis-a hospital-based study from Central India. Int J Infect Dis 2009 ; 13:600-5. source

      The Results report that none of the 219 patients in the Indian series had HIV infection, and identify fever and weight loss as symptoms. They give 56.6% for patients with one or more constitutional symptoms, not a 40%–60% rate for fever and weight loss individually. The Qatar series is not assessed against this source. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation
    § MICROBIOLOGY · p. 2

    M. tuberculosis is the usual cause of tuberculous lymphadenitis.

    “M. tuberculosis is the usual cause of tuberculous lymphadenitis [23].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [23] 23. Yates MD, Grange JM. Bacteriological survey of tuberculous lymphadenitis in southeast England, 1981-1989. J Epidemiol Community Health 1992 ; 46:332-5. source
  • Premisecitation
    § CLINICAL FEATURES · p. 3

    Tuberculous lymphadenitis usually presents as slowly progressive, painless swelling of a single group of lymph nodes.

    “Tuberculous lymphadenitis usually presents as a slowly progressive, painless swelling of a single group of lymph nodes [3, 24].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [3] 3. Artenstein AW, Kim JH, Williams WJ, Chung RC. Isolated peripheral tuberculous lymphadenitis in adults: current clinical and diagnostic issues. Clin Infect Dis 1995 ; 20:876-82.
    • cites [24] 24. Purohit MR, Mustafa T, Morkve O, Sviland L. Gender differences in the clinical diagnosis of tuberculous lymphadenitis-a hospital-based study from Central India. Int J Infect Dis 2009 ; 13:600-5. source

      The Results (page unavailable) report that all 219 patients presented with a neck mass, with durations ranging from four days to eight months. The Discussion (page unavailable) says women usually had a single unilateral node, but describes different patterns in men. The paper does not establish that swelling is usually slowly progressive or painless, or that a single group of nodes is the usual presentation across patients. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Interpretationcitation
    § EPIDEMIOLOGY · p. 2

    Africans may also have an increased risk of lymph node tuberculosis.

    “which suggests that Africans may also have an increased risk of lymph node tuberculosis.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [6] 6. Rock RB, Sutherland WM, Baker C, Williams DN. Extrapulmonary tuberculosis among Somalis in Minnesota. Emerg Infect Dis 2006 ; 12:1434-6. source

      The Conclusions (page unavailable) report that extrapulmonary tuberculosis was more common among Somalis in Minnesota than among foreign-born tuberculosis patients overall, and that 50% of Somali patients with extrapulmonary tuberculosis had lymphatic disease. This suggests a possible elevated risk in the studied Somali population, but the paper does not establish an increased risk of lymph node tuberculosis among Africans generally. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation
    § EPIDEMIOLOGY · p. 2

    In HIV-negative Somalis in Minnesota, 30% of 407 patients with tuberculosis had lymphadenitis.

    “In a study involving HIV-negative Somalis in Minnesota [6], 30% of 407 patients with tuberculosis had lymphadenitis”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [6] 6. Rock RB, Sutherland WM, Baker C, Williams DN. Extrapulmonary tuberculosis among Somalis in Minnesota. Emerg Infect Dis 2006 ; 12:1434-6. source

      The Study reports 407 Somali tuberculosis cases, of which 239 had extrapulmonary involvement; lymph nodes accounted for 50% of extrapulmonary disease sites, approximately 30% of the 407 cases. But the 407-patient cohort was not established as HIV-negative: HIV results are reported for only 179 of the 239 patients with extrapulmonary tuberculosis, and two tested positive. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 24
  • May combine two claims. 40

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § CLINICAL FEATURES · p. 3

    A draining sinus may be present in 4%-11% of cases.

    “A draining sinus may be present in 4%-11% of cases [3, 17, 24].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [3] 3. Artenstein AW, Kim JH, Williams WJ, Chung RC. Isolated peripheral tuberculous lymphadenitis in adults: current clinical and diagnostic issues. Clin Infect Dis 1995 ; 20:876-82. source
    • cites [17] 17. Khan FY. Clinical pattern of tuberculous adenitis in Qatar: experience with 35 patients. Scand J Infect Dis 2009 ; 41:128-34.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [24] 24. Purohit MR, Mustafa T, Morkve O, Sviland L. Gender differences in the clinical diagnosis of tuberculous lymphadenitis-a hospital-based study from Central India. Int J Infect Dis 2009 ; 13:600-5. source

      The Results report a discharging sinus in three of 219 patients (1.4%), below the claimed 4%–11% range. The paper confirms that a sinus can occur, but its reported frequency is contrary to the range attributed to it. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § PRIMARY DIAGNOSTIC STUDIES · p. 4

    In a study from Germany, 6 of 10 culture-confirmed tuberculous lymphadenitis cases were detected by the newer GeneXpert test; 3 cases with positive results had negative culture results, but subsequent investigation suggested these were true cases.

    “In a study from Germany, 6 of 10 tuberculous lymphadenitis cases confirmed by culture were detected by the newer GeneXpert test; 3 cases with positive results had negative culture results, but subsequent investigation suggested that these were true cases [36].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [36] 36. Hillemann D, Ruesch-Gerdes S, Boehme C, Richter E. Rapid molecular detection of extrapulmonary tuberculosis by automated GeneXpert(R) MTB/RIF system. J Clin Microbiol 2011 ; 49:1202-5. source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § CLINICAL FEATURES · p. 3

    In a series from India, the mean duration of symptoms was significantly longer in men than in women.

    “In a series of patients in India, the mean duration of symptoms was significantly longer in men than in women [24].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [24] 24. Purohit MR, Mustafa T, Morkve O, Sviland L. Gender differences in the clinical diagnosis of tuberculous lymphadenitis-a hospital-based study from Central India. Int J Infect Dis 2009 ; 13:600-5. source

  • May combine two claims.

    Premisecitation
    § CLINICAL FEATURES · p. 3

    The duration of symptoms at presentation is typically 1-2 months, ranging from 3 weeks to 8 months.

    “The duration of symptoms at the time of presentation is typically 1-2 months, varying from 3 weeks to 8 months [3, 5, 24].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [3] 3. Artenstein AW, Kim JH, Williams WJ, Chung RC. Isolated peripheral tuberculous lymphadenitis in adults: current clinical and diagnostic issues. Clin Infect Dis 1995 ; 20:876-82. source
    • cites [5] 5. Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore) 2005 ; 84:350-62. source
    • cites [24] 24. Purohit MR, Mustafa T, Morkve O, Sviland L. Gender differences in the clinical diagnosis of tuberculous lymphadenitis-a hospital-based study from Central India. Int J Infect Dis 2009 ; 13:600-5. source

      The Results (page not available in our copy) report a neck-mass duration of 3 weeks to 8 months for men, but 4 days to 8 weeks for women; the range for all patients is 4 days to 8 months. The paper does not establish that symptom duration was typically 1–2 months, and the cited 3-week lower bound does not apply to the full cohort. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § CLINICAL FEATURES · p. 3

    Median lymph node size is 3 cm, but nodes may be up to 8-10 cm in diameter.

    “Median lymph node size is 3 cm, but nodes may be up to 8-10 cm in diameter [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] 15. Wei YF, Liaw YS, Ku SC, Chang YL, Yang PC. Clinical features and predictors of a complicated treatment course in peripheral tuberculous lymphadenitis. J Formos Med Assoc 2008 ; 107:225-31. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § MICROBIOLOGY · p. 2

    M. bovis was historically a common cause of tuberculous lymphadenitis, but pasteurization and bovine tuberculosis programs have virtually eliminated this source in developed countries.

    “M. bovis was historically a common cause of tuberculous lymphadenitis, but pasteurization and bovine tuberculosis programs have virtually eliminated this source of human infection in developed countries”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] 22. Kazwala RR, Daborn CJ, Sharp JM, Kambarage DM, Jiwa SF, Mbembati NA. Isolation of Mycobacterium bovis from human cases of cervical adenitis in Tanzania: a cause for concern? Int J Tuberc Lung Dis 2001 ; 5:87-91.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § EPIDEMIOLOGY · p. 1

    In the United States in 2008, 1103 of 12,904 tuberculosis cases, or 8.5%, were lymphadenitis.

    “Of the 12 904 cases of tuberculosis in the United States in 2008, 1103 (8.5%) represented lymphadenitis [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] 1. CDC. Reported tuberculosis in the United States, 2008. Atlanta, GA: U.S. Department of Health and Human Services, CDC, 2009. September 2009.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisenone given
    § EPIDEMIOLOGY · p. 1

    In countries where tuberculosis is not endemic, most patients with tuberculous lymphadenitis are foreign-born, consistent with reactivation disease.

    “In countries where tuberculosis is not endemic, the majority of patients are foreign-born, with a pattern consistent with reactivation disease.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § CLINICAL FEATURES · p. 3

    Patients generally do not report significant pain at presentation, and node tenderness is noted in only 10%-35% of cases.

    “Patients do not generally report significant pain at presentation, and node tenderness during examination is noted in only 10%-35% of cases [3, 15, 17].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [3] 3. Artenstein AW, Kim JH, Williams WJ, Chung RC. Isolated peripheral tuberculous lymphadenitis in adults: current clinical and diagnostic issues. Clin Infect Dis 1995 ; 20:876-82. source
    • cites [15] 15. Wei YF, Liaw YS, Ku SC, Chang YL, Yang PC. Clinical features and predictors of a complicated treatment course in peripheral tuberculous lymphadenitis. J Formos Med Assoc 2008 ; 107:225-31. source
    • cites [17] 17. Khan FY. Clinical pattern of tuberculous adenitis in Qatar: experience with 35 patients. Scand J Infect Dis 2009 ; 41:128-34.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisenone given
    § PRIMARY DIAGNOSTIC STUDIES · p. 3

    A definitive diagnosis of tuberculous lymphadenitis can be made by culture or polymerase chain reaction demonstration of M. tuberculosis in an affected lymph node, permitting distinction from other mycobacteria.

    “Adefinitive diagnosis of tuberculous lymphadenitis can be made by culture or polymerase chain reaction demonstration of M. tuberculosis in an affected lymph node, thereby permitting distinction from other mycobacteria that may cause lymphadenitis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § EPIDEMIOLOGY · p. 2

    Diabetes mellitus may reduce the relative risk of tuberculous lymphadenitis, despite being a risk factor for pulmonary tuberculosis.

    “Although diabetes mellitus is a risk factor for pulmonary tuberculosis, studies suggest that it may reduce the relative risk of tuberculous lymphadenitis [4, 5].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] 4. Gonzalez OY, Teeter LD, Thanh BT, Musser JM, Graviss EA. Extrathoracic tuberculosis lymphadenitis in adult HIV seronegative patients: a population-based analysis in Houston, Texas, USA. Int J Tuberc Lung Dis 2003 ; 7:987-93.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [5] 5. Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore) 2005 ; 84:350-62. source

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given
    § PRIMARY DIAGNOSTIC STUDIES · p. 3

    A positive acid-fast bacilli stain indicates a mycobacterial etiology and has excellent specificity for M. tuberculosis in adults.

    “A positive acid-fast bacilli (AFB) stain result indicates a mycobacterial etiology and has excellent specificity for M. tuberculosis in adults.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § EPIDEMIOLOGY · p. 2

    In a Texas study, the odds ratio for tuberculous lymphadenitis was 11.3 for patients from Southeast Asia and 12.7 for patients from India compared with other ethnicities.

    “In a study from Texas, the odds ratio (OR) was 11.3 for patients from Southeast Asia ( P , .01) and 12.7 for patients from India ( P , .01), compared with other ethnicities [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] 4. Gonzalez OY, Teeter LD, Thanh BT, Musser JM, Graviss EA. Extrathoracic tuberculosis lymphadenitis in adult HIV seronegative patients: a population-based analysis in Houston, Texas, USA. Int J Tuberc Lung Dis 2003 ; 7:987-93.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § PRIMARY DIAGNOSTIC STUDIES · p. 3

    Rare complications of excisional biopsy include postsurgical pain, wound infection, sinus formation, and scar.

    “Rare complications of biopsy include postsurgical pain, wound infection, sinus formation, and scar [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] 28. Lee KC, Tami TA, Lalwani AK, Schecter G. Contemporary management of cervical tuberculosis. Laryngoscope 1992 ; 102:60-4. source

  • May combine two claims.

    Premisenone given
    § PRIMARY DIAGNOSTIC STUDIES · p. 3

    Culture remains the gold standard for diagnosis but may take 2-4 weeks to yield results.

    “Culture remains the gold standard for diagnosis, but may take 2-4 weeks to yield results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given
    § PRIMARY DIAGNOSTIC STUDIES · p. 4

    Fine-needle aspiration is safer, less invasive, and more practical than biopsy, especially in resource-limited settings.

    “FNA is safer, less invasive, and more practical than biopsy, especially in resource-limited settings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given
    § EPIDEMIOLOGY · p. 1

    The peak age range in recent series of tuberculous lymphadenitis is 30-40 years.

    “Although formerly a disease of children, the peak age range in recent series has been 30-40 years.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § CLINICAL FEATURES · p. 3

    In a series of 104 predominantly HIV-negative patients from California, fever was reported in 19% and weight loss in 16%.

    “In a series of 104 predominantly HIV-negative patients from California, fever was reported in 19% and weight loss in 16% [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] 5. Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore) 2005 ; 84:350-62. source

  • May combine two claims.

    Premisecitation
    § EPIDEMIOLOGY · p. 1

    In most series, tuberculous lymphadenitis is more common among women than men, with a composite female-to-male ratio of 1.4:1.

    “In most series, tuberculous lymphadenitis is more common among women than among men (composite ratio, 1.4:1)-a different pattern than for pulmonary tuberculosis, for which disease is more common among men [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] 13. Chen YM, Lee PY, Su WJ, Perng RP. Lymph node tuberculosis: 7-year experience in Veterans General hospital, Taipei, Taiwan. Tubercle Lung Dis 1992 ; 73:368-71. source

  • May combine two claims.

    Premisecitation
    § PRIMARY DIAGNOSTIC STUDIES · p. 4

    In a UK study of 97 cases, 90% of which were in foreign-born patients, 67% of fine-needle aspiration specimens had positive culture results and 79% had granulomatous inflammation.

    “In a study of 97 cases from the United Kingdom (90% of which were in foreign-born patients), 67% of FNA specimens had positive culture results, and 79% had GI.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] 12. Asimacopoulos EP, Berry M, Garfield B, et al. The diagnostic efficacy of fine-needle aspiration using cytology and culture in tuberculous lymphadenitis. Int J Tuberc Lung Dis 2010 ; 14:93-8.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § EPIDEMIOLOGY · p. 2

    Extrapulmonary tuberculosis, including lymphatic tuberculosis, is more common among immunocompromised patients, including those with HIV infection.

    “Extrapulmonary tuberculosis, including lymphatic tuberculosis, is more common among immunocompromised patients, including those with HIV infection [20, 21].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [20] 20. Aaron L, Saadoun D, Calatroni I, et al. Tuberculosis in HIV-infected patients: a comprehensive review. Clin Microbiol Infect 2004 ; 10:388-98. source
    • cites [21] 21. Lee PP, Chan KW, Jiang L, et al. Susceptibility to mycobacterial infections in children with X-linked chronic granulomatous disease: a review of 17 patients living in a region endemic for tuberculosis. Pediatr Infect Dis J 2008 ; 27:224-30. source

  • May combine two claims.

    Premisecitation
    § CLINICAL FEATURES · p. 3

    In the same Zambian study, symmetrical adenopathy was observed in only 11% of HIV-negative patients with tuberculous lymphadenitis, and nodes in this group were typically greater than 3 cm.

    “In contrast, symmetrical adenopathy was observed in only 11% of HIV-negative patients with tuberculosis lymphadenitis, and nodes in this group were typically . 3 cm [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] 14. Bem C. Human immunodeficiency virus-positive tuberculous lymphadenitis in Central Africa: clinical presentation of 157 cases. Int J Tuberc Lung Dis 1997 ; 1:215-9.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation
    § PARADOXICAL UPGRADING REACTIONS · p. 6

    PUR is independently associated with male sex (OR 2.60) and local tenderness at diagnosis (OR 2.90).

    “Male sex (OR, 2.60) and the presence of local tenderness at the time of diagnosis (OR, 2.90) were independently associated with PUR [49].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] 49. Cho OH, Park KH, Kim T, et al. Paradoxical responses in non-HIVinfected patients with peripheral lymph node tuberculosis. J Infect 2009 ; 59:56-61. source

  • May combine two claims.

    Premisecitation
    § ANCILLARY DIAGNOSTIC TESTS · p. 4

    In a study of tuberculous lymphadenitis from South Korea, the sensitivity and specificity of tuberculin skin testing were 86% and 67%, respectively, and of interferon-gamma release assays were 86% and 87%, respectively.

    “In a study of tuberculous lymphadenitis from South Korea, the sensitivity and specificity of TST were 86% and 67%, respectively, and of IGRAs, 86% and 87%, respectively [37].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] 37. Song KH, Jeon JH, Park WB, et al. Usefulness of the whole-blood interferon-gamma release assay for diagnosis of extrapulmonary tuberculosis. Diagn Microbiol Infect Dis 2009 ; 63:182-7. source

  • May combine two claims.

    Premisecitation
    § ANTIBIOTIC TREATMENT · p. 5

    Studies show no difference between 6 and 9 months of treatment in cure rates (89%-94%) or relapse rates (3%).

    “The 6-month recommendation is supported by studies that showed no difference between 6 and 9 months of treatment in cure rates (89%-94%) [45, 46] or relapse rates (3%) [47].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [45] 45. Campbell IA, Ormerod LP, Friend JA, Jenkins PA, Prescott RJ. Six months versus nine months chemotherapy for tuberculosis of lymph nodes: final results. Respir Med 1993 ; 87:621-3. source
    • cites [46] 46. Yuen AP, Wong SH, Tam CM, Chan SL, Wei WI, Lau SK. Prospective randomized study of thrice weekly six-month and nine-month chemotherapy for cervical tuberculous lymphadenopathy. Otolaryngol Head Neck Surg 1997 ; 116:189-92. source
    • cites [47] 47. van Loenhout-Rooyackers JH, Laheij RJ, Richter C, Verbeek AL. Shortening the duration of treatment for cervical tuberculous lymphadenitis. Eur Respir J 2000 ; 15:192-5. source

  • May combine two claims.

    Premisenone given
    § EPIDEMIOLOGY · p. 1

    Overall rates of pulmonary tuberculosis have continued to decrease in the United States, while the proportion of extrapulmonary cases, with lymphadenitis as the principal subset, has increased.

    “While overall rates of pulmonary tuberculosis have continued to decrease in the United States, the proportion of extrapulmonary cases, with their principal subset, lymphadenitis, has increased.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § PARADOXICAL UPGRADING REACTIONS · p. 6

    IRIS typically appears after several weeks of ART; 90% of cases arise within 3 months of starting ART, and rates are higher with lower CD4 counts at ART initiation.

    “IRIS usually develops after at least several weeks of ART, 90% of cases occur within 3 months after starting ART, and rates are higher when ART is started at lower CD4 cell counts [55, 56].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [55] 55. Haddow LJ, Easterbrook PJ, Mosam A, et al. Defining immune reconstitution inflammatory syndrome: evaluation of expert opinion versus 2 case definitions in a South African cohort. Clin Infect Dis 2009 ; 49:1424-32. source
    • cites [56] 56. Breton G, Duval X, Estellat C, et al. Determinants of immune reconstitution inflammatory syndrome in HIV type 1-infected patients with tuberculosis after initiation of antiretroviral therapy. Clin Infect Dis 2004 ; 39:1709-12. source

  • May combine two claims.

    Premisecitation
    § ANCILLARY DIAGNOSTIC TESTS · p. 4

    Because interferon-gamma release assays are not affected by BCG or nontuberculous mycobacteria other than M. marinum, M. kansasii, and M. szulgai, they are more specific than the tuberculin skin test.

    “Because interferonc release assays (IGRAs) are not affected by BCG or nontuberculous mycobacteria other than M. marinum , M. kansasii, and M. szulgai, they are more specific than the TST [39].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] 39. Pai M, Riley LW, Colford JM Jr. Interferon-gamma assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis 2004 ; 4:761-76. source

  • May combine two claims.

    Premisecitation
    § PARADOXICAL UPGRADING REACTIONS · p. 6

    PUR manifestations have included node enlargement in 32%-68%, new nodes in 27%-36%, pain in 60%, and draining sinuses in 12%-60%.

    “Manifestations of PUR have included enlarging lymph nodes in 32%-68% of cases [50], new nodes in 27%-36%, pain in 60%, and draining sinuses in 12%60% [5, 49, 50].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [5] 5. Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore) 2005 ; 84:350-62. source
    • cites [49] 49. Cho OH, Park KH, Kim T, et al. Paradoxical responses in non-HIVinfected patients with peripheral lymph node tuberculosis. J Infect 2009 ; 59:56-61. source
    • cites [50] 50. Hawkey CR, Yap T, Pereira J, et al. Characterization and management of paradoxical upgrading reactions in HIV-uninfected patients with lymph node tuberculosis. Clin Infect Dis 2005 ; 40:1368-71. source

  • May combine two claims.

    Premisecitation
    § PRIMARY DIAGNOSTIC STUDIES · p. 4

    In a study from India, 17 of 22 cases diagnosed by culture and detection of granulomatous inflammation, or 77%, were detected by testing of excisional biopsy samples, compared with 9 of 22, or 41%, by testing of fine-needle aspiration samples.

    “In a study from India, 17 (77%) of 22 cases diagnosed by culture and detection of GI were detected by testing of excisional biopsy samples, compared with 9 (41%) of 22 by testing of FNA samples.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] 30. Singh KK, Muralidhar M, Kumar A, et al. Comparison of in house polymerase chain reaction with conventional techniques for the detection of Mycobacterium tuberculosis DNA in granulomatous lymphadenopathy. J Clin Pathol 2000 ; 53:355-61. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given
    § Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis · p. 1

    Persistent pain and swelling are common during treatment of tuberculous lymphadenitis.

    “persistent pain and swelling are common”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § STEROID THERAPY · p. 6

    IDSA guidelines advise against steroid use for tuberculous lymphadenitis.

    “IDSA guidelines do not recommend the use of steroids in the treatment of tuberculous lymphadenitis [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] 44. Treatment of tuberculosis. Centers for Disease Control. MMWR Recomm Rep 2003 ; 52:1-77.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation
    § PARADOXICAL UPGRADING REACTIONS · p. 6

    Reports from California and South Korea described PUR onset at a mean of 2-3.5 months after treatment began, resolving after a mean of 3.9 further months.

    “In reports from California and South Korea, onset occurred at a mean of 2-3.5 months after initiation of treatment and resolved at a mean of 3.9 additional months [5, 49].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] 5. Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore) 2005 ; 84:350-62. source
    • cites [49] 49. Cho OH, Park KH, Kim T, et al. Paradoxical responses in non-HIVinfected patients with peripheral lymph node tuberculosis. J Infect 2009 ; 59:56-61. source

  • May combine two claims.

    Premisecitation
    § PARADOXICAL UPGRADING REACTIONS · p. 6

    A London study found PUR onset at a median of 1.5 months (46 days; IQR 21-139) after starting treatment, with median persistence of 2 months (67 days; IQR 34-111).

    “It occurred at a median of 1.5 months (46 days; interquartile range, 21-139 days) after initiation of treatment in a study from London and persisted for a median of 2 months (67 days; interquartile range, 34-111 days) [50].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] 50. Hawkey CR, Yap T, Pereira J, et al. Characterization and management of paradoxical upgrading reactions in HIV-uninfected patients with lymph node tuberculosis. Clin Infect Dis 2005 ; 40:1368-71. source

  • May combine two claims.

    Premisecitation
    § PARADOXICAL UPGRADING REACTIONS · p. 6

    Nodes affected by PUR usually show granulomas on biopsy or culture, with negative cultures and sometimes positive AFB stains.

    “Biopsy or culture of nodes involved in PUR typically shows granuloma formation and negative culture results with or without positive AFB stains [5, 50].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] 5. Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore) 2005 ; 84:350-62. source
    • cites [50] 50. Hawkey CR, Yap T, Pereira J, et al. Characterization and management of paradoxical upgrading reactions in HIV-uninfected patients with lymph node tuberculosis. Clin Infect Dis 2005 ; 40:1368-71. source

  • May combine two claims.

    Premisecitation
    § PRIMARY DIAGNOSTIC STUDIES · p. 4

    A systematic review of nucleic acid amplification testing in tuberculous lymphadenitis revealed highly variable and inconsistent results, with sensitivity 2%-100% and specificity 28%-100%, and more favorable performance from commercial assays and sample sizes greater than 20 microliters.

    “A systematic review of NAAT in tuberculous lymphadenitis revealed highly variable and inconsistent results (sensitivity, 2%-100%; specificity, 28%100%), with more favorable performance from commercial assays and with sample sizes . 20 uL [35].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] 35. Daley P, Thomas S, Pai M. Nucleic acid amplification tests for the diagnosis of tuberculous lymphadenitis: a systematic review. Int J Tuberc Lung Dis 2007 ; 11:1166-76.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisenone given
    § ANCILLARY DIAGNOSTIC TESTS · p. 4

    Ancillary diagnostic tests may be useful in raising the suspicion of tuberculous lymphadenitis before definitive diagnosis or in supporting the diagnosis of cases with nondiagnostic microbiologic or histologic findings.

    “Ancillary diagnostic tests may be useful in raising the suspicion of tuberculous lymphadenitis before definitive diagnosis or in supporting the diagnosis of cases with nondiagnostic microbiologic or histologic findings (Table 4).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisereasoning
    § PARADOXICAL UPGRADING REACTIONS · p. 6

    Steroids have been proposed to dampen the strong immune response in PUR, though their role remains debated.

    “Steroids have been considered as a means to reduce the robust immune response in PUR, but their use is controversial.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given
    § ANCILLARY DIAGNOSTIC TESTS · p. 4

    Chest radiograph findings may be positive in 10%-40% of patients with tuberculous lymphadenitis.

    “Chest radiograph findings may be positive in 10%-40% of patients”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning
    § PARADOXICAL UPGRADING REACTIONS · p. 6

    PUR rates reported in the literature differ, partly because definitions vary.

    “Reported rates of PUR vary and depend, in part, on the definition that has been applied.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given
    § Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis · p. 1

    Paradoxical upgrading reactions may occur in 20% of patients with tuberculous lymphadenitis.

    “paradoxical upgrading reactions may occur in 20% of patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § ANCILLARY DIAGNOSTIC TESTS · p. 5

    Mycobacterial adenitis caused by nontuberculous mycobacteria such as M. avium complex is typically seen in non-BCG immunized children in developed countries.

    “Mycobacterial adenitis, caused by nontuberculous mycobacteria, such as M. avium complex, is typically seen in non-BCG immunized children in developed countries [42].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] 42. Romanus V, Hallander HO, Wahlen P, Olinder-Nielsen AM, Magnusson PH, Juhlin I. Atypical mycobacteria in extrapulmonary disease among children. Incidence in Sweden from 1969 to 1990, related to changing BCG-vaccination coverage. Tubercle Lung Dis 1995 ; 76:300-10. source

  • May combine two claims.

    Premisenone given
    § Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis · p. 1

    Response to therapy may be slow or paradoxical, with frequent development of enlarging or new lymph nodes during and even after effective treatment in HIV-negative patients and immune reconstitution inflammatory syndrome in HIV-positive patients.

    “response to therapy may be slow or paradoxical, with the frequent development of enlarging or new lymph nodes during and even after effective treatment in HIV-negative patients and of immune reconstitution inflammatory syndrome (IRIS) in HIV-positive patients.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation
    § ANTIBIOTIC TREATMENT · p. 5

    IDSA recommends 6 months of isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months followed by isoniazid and rifampin for 4 months for lymphadenitis caused by drug-susceptible organisms.

    “The Infectious Disease Society of America (IDSA) recommends 6 months of the following treatment for lymphadenitis caused by drug-susceptible organisms [44]: isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, followed by isoniazid and rifampin for another 4 months.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] 44. Treatment of tuberculosis. Centers for Disease Control. MMWR Recomm Rep 2003 ; 52:1-77.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisenone given
    § Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis · p. 1

    Antimycobacterial therapy remains the cornerstone of treatment, but response is slower than with pulmonary tuberculosis.

    “Antimycobacterial therapy remains the cornerstone of treatment, but response is slower than with pulmonary tuberculosis”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § Clinical Infectious Diseases 2011;53(6):555-562 · p. 1

    The authors searched Medline for English-language articles indexed under the Medical Subject Heading term Tuberculosis, Lymph Node as a major topic from 1990 through 2011.

    “We searched Medline for English articles with use of the Medical Subject Heading term ''Tuberculosis, Lymph Node'' as a major topic from 1990 through 2011”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § PARADOXICAL UPGRADING REACTIONS · p. 6

    Although some authors report steroid benefit, retrospective studies found that steroids started at treatment onset neither prevented PUR nor shortened its duration.

    “Some authors report benefit [52, 53], but retrospective studies have shown that steroids did not prevent PUR in patients who received them from the onset of treatment [59] and had no effect on the duration of PUR [49, 50].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [52] 52. Garcia Vidal C, Garau J. Systemic steroid treatment of paradoxical upgrading reaction in patients with lymph node tuberculosis. Clin Infect Dis 2005 ; 41:915-6; author reply 6-7. source
    • cites [53] 53. Park KH, Cho OH, Chong YP, et al. Post-therapy paradoxical response in immunocompetent patients with lymph node tuberculosis. J Infect 2010 ; 61:430-4. source
    • cites [59] 59. Afghani B, Lieberman JM. Paradoxical enlargement or development of intracranial tuberculomas during therapy: case report and review. Clin Infect Dis 1994 ; 19:1092-9. source
    • cites [49] 49. Cho OH, Park KH, Kim T, et al. Paradoxical responses in non-HIVinfected patients with peripheral lymph node tuberculosis. J Infect 2009 ; 59:56-61. source
    • cites [50] 50. Hawkey CR, Yap T, Pereira J, et al. Characterization and management of paradoxical upgrading reactions in HIV-uninfected patients with lymph node tuberculosis. Clin Infect Dis 2005 ; 40:1368-71. source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given
    § Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis · p. 1

    The role of steroids in tuberculous lymphadenitis is controversial.

    “The role of steroids is controversial.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § PARADOXICAL UPGRADING REACTIONS · p. 6

    Paradoxical IRIS definitions in HIV infection differ, but usually demand evidence of ART response plus worsening of the complicating infection.

    “Definitions of paradoxical IRIS in HIV infection vary but typically require some evidence of response to ART (eg, decreased viral load or increased CD4 cell count) and evidence of a worsening of the complicating infection [55].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] 55. Haddow LJ, Easterbrook PJ, Mosam A, et al. Defining immune reconstitution inflammatory syndrome: evaluation of expert opinion versus 2 case definitions in a South African cohort. Clin Infect Dis 2009 ; 49:1424-32. source

  • May combine two claims.

    Premisecitation
    § PRIMARY DIAGNOSTIC STUDIES · p. 4

    Among 106 predominantly HIV-negative cases from California, the rate of culture positivity from excisional biopsy and fine-needle aspiration specimens was similar, at 71% and 62% respectively, with P=.4.

    “Among 106 predominantly HIV-negative cases from California, the rate of culture positivity from excisional biopsy and FNA specimens was similar (71% and 62% respectively; P 5 .4) [5].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] 5. Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore) 2005 ; 84:350-62. source

  • May combine two claims.

    Premisecitation
    § SURGICAL THERAPY · p. 6

    For children with cervical lymphadenitis from nontuberculous mycobacteria, surgical excision is recommended and has been linked to better outcomes than 3 months of two-drug antibiotics.

    “Surgical excision is the recommended therapy for cervical lymphadenitis due to nontuberculous mycobacteria in children and has been associated with better outcomes than 3 months of 2-drug antibiotic therapy [62-64].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [62] 62. Lindeboom JA, Kuijper EJ, Bruijnesteijn van Coppenraet ES, Lindeboom R, Prins JM. Surgical excision versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children: a multicenter, randomized, controlled trial. Clin Infect Dis 2007 ; 44:1057-64. source
    • cites [63] 63. Zeharia A, Eidlitz-Markus T, Haimi-Cohen Y, Samra Z, Kaufman L, Amir J. Management of nontuberculous mycobacteria-induced cervical lymphadenitis with observation alone. Pediatr Infect Dis J 2008 ; 27:920-2. source
    • cites [64] 64. Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007 ; 175:367-416. source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given
    § CONCLUSION · p. 7

    Rates are highest in patients aged 30-40 years, and the disease is more frequent in women and people of Asian descent.

    “Disease rates are highest among patients aged 30-40 years, and disease is more common among women and patients of Asian descent.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § SURGICAL THERAPY · p. 6

    Surgical excision has been advised for PUR, for treatment failure in tuberculous lymphadenitis, and for discomfort from tense, fluctuant nodes.

    “Surgical excision has been recommended for PUR and for treatment failure in cases of tuberculous lymphadenitis and for patients who have discomfort from tense, fluctuant lymph nodes [5, 61].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] 5. Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore) 2005 ; 84:350-62. source
    • cites [61] 61. Ammari FF, Bani Hani AH, Ghariebeh KI. Tuberculosis of the lymph glands of the neck: a limited role for surgery. Otolaryngol Head Neck Surg 2003 ; 128:576-80. source

  • May combine two claims.

    Interpretationnone given
    § CONCLUSION · p. 7

    Standard antibiotics may produce a slow response in tuberculous lymphadenitis, with ongoing discomfort and culture-negative paradoxical upgrading reactions in up to 20% of patients.

    “Tuberculous lymphadenitis may respond slowly to standard antibiotic treatment, with persistent discomfort and the development of culture-negative paradoxical upgrading reactions in as many as 20% of patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given
    § CONCLUSION · p. 7

    In the United States, tuberculous lymphadenitis accounts for 10% of tuberculosis cases and is often the only extrapulmonary manifestation.

    “Tuberculous lymphadenitis represents 10% of cases of tuberculosis in the United States and is frequently the sole manifestation of extrapulmonary tuberculosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § SURGICAL THERAPY · p. 6

    IDSA guidelines reserve surgical excision for unusual circumstances, which are not explicitly defined.

    “IDSA guidelines recommend surgical excision only in unusual circumstances, and these circumstances are not defined explicitly [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] 44. Treatment of tuberculosis. Centers for Disease Control. MMWR Recomm Rep 2003 ; 52:1-77.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

56 of 56

  • The paper relies on this without support.

    Local discomfort is a significant problem for some patients with peripheral tuberculous lymphadenitis.

    “Steroids have been used selectively for local discomfort [31], a significant issue for some patients in our experience.”
1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Biopsy result has more positive specimens than specimens tested

    Major

    Table 3 reports 36 positive specimens out of 31 tested as 88%. That fraction is approximately 116%, so at least one of the three figures is wrong.

    Reported 88 · recomputed 116.129032

  • Chest-radiograph range excludes a value in Table 4

    Minor

    The text gives a 10%-40% range, whereas Table 4 reports abnormal chest radiographs in 55% of the UK study.

  • Pulmonary-involvement range excludes a value in Table 1

    Minor

    The stated range starts at 18%, but Table 1 reports pulmonary involvement of 3% for the Australian study.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 11

  1. Gonzalez, 2003, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 7, 987
  2. Fain, 1999, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 3, 162
  3. Asimacopoulos, 2010, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 14, 93
  4. Bem, 1997, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 1, 215
  5. Hesseling, 2010, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 14, 1252
  6. Kazwala, 2001, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 5, 87
  7. Blaikley, 2011, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 15, 375
  8. van Wyk, 2011, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 15, 56
  9. Daley, 2007, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 11, 1166
  10. 2003, CENTERS FOR DISEASE CONTROL MMWR RECOMM REP, 52, 1
  11. Nemir, 1967, The American review of respiratory disease, 95, 402

Cited by

Sorted by citations

Related

Authors
Fontanilla, J.-M., Barnes, A., & von Reyn, C. F.
Affiliations
  • Marshall University (US)
  • University of Mississippi Medical Center (US)
ORCID
Barnes, A.
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2011-08-24
Volume
53
Issue
6
Pages
555-562
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1093/cid/cir454
OpenAlex
W2170899957
Cited by
299
References
66
Citations by year
2026: 24 · 2025: 17 · 2024: 14 · 2023: 26 · 2022: 26 · 2021: 28 · 2020: 25 · 2019: 16 · 2018: 18 · 2017: 29 · 2016: 23 · 2015: 20 · 2014: 12 · 2013: 16 · 2012: 5
FWCI
1.91
Type
journal article
Language
en
Open access
closed
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Diagnosis and treatment of tuberculosis
  • Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
  • Health Sciences › Medicine › Surgery › Lymphadenopathy Diagnosis and Analysis
Keywords
cervical lymphadenopathy, Mycobacterium tuberculosis, excisional biopsy, fine-needle aspiration, acid-fast bacilli, granulomatous inflammation, antimycobacterial therapy, paradoxical reaction, corticosteroids, immunocompromised patients, tuberculosis epidemiology
MeSH terms
Adult, Antitubercular Agents, Female, Humans, Male, Mycobacterium tuberculosis, Tuberculosis, Lymph Node, United States, Disease Management

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-01.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-01.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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