Alternative Names: Tuberculous adenitis
Definition: Scrofula (scrophula or struma) is any of a variety of skin diseases; in particular, a form of tuberculosis, affecting the lymph nodes of the neck. In adults it is caused by Mycobacterium tuberculosis and in children by nontuberculous mycobacteria. The word comes from the Latin scrofulae, meaning brood sow. It is a tuberculous infection of the skin on the neck.
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Scrofula is the term used for tuberculosis of the neck, or, more precisely, a cervical tuberculous lymphadenopathy. Scrofula is usually a result of an infection in the lymph nodes, known as lymphadenitis and is most often observed in immunocompromised patients (about 50% of cervical tuberculous lymphadenopathy). About 95% of the scrofula cases in adults are caused by Mycobacterium tuberculosis, but only 8% in children. The rest are caused by atypical mycobacterium (Mycobacterium scrofulaceum) or nontuberculous mycobacterium (NTM). With the stark decrease of tuberculosis in the second half of the 20th century, scrofula became a very rare disease. With the appearance of AIDS, however, it has shown a resurgence, and presently affects about 5% of severely immunocompromised patients
The most usual signs and symptoms are the appearance of a chronic, painless mass in the neck, which is persistent and usually grows with time. The mass is referred to as a “cold abscess”, because there is no accompanying local color or warmth and the overlying skin acquires a violaceous (bluish-purple) color. NTM infections do not show other notable constitutional symptoms, but scrofula caused by tuberculosis is usually accompanied by other symptoms of the disease, such as fever, chills, malaise and weight loss in about 43% of the patients. As the lesion progresses, skin becomes adhered to the mass and may rupture, forming a sinus and an open wound.
*Painless swelling of lymph nodes in neck and elsewhere in body
*Fevers, chills, sweats, and weight loss can occur in 20% of patients
Scrofula in adults is most often caused by the bacteria Mycobacterium tuberculosis. In children, it is usually caused by Mycobacterium scrofulaceum or Mycobacterium avium.
Infection with mycobacteria is usually caused by breathing in air that is contaminated by these organisms. The bacteria spreads throughout the body, and may cause swelling the lymph nodes in the neck and other parts of the body. If left untreated, the lymph nodes may become ulcerated, producing draining sores.
Diagnosis is usually performed by needle aspiration biopsy or excisional biopsy of the mass and the histological demonstration of stainable acid-fast bacteria in the case of infection by M. tuberculosis (Ziehl-Neelsen stain), or the culture of NTM using specific growth and staining techniques.
Tests to diagnose scrofula include:
*Histology (examination of tissue sample under a microscope)
*Cultures to check for the bacteria in tissue samples taken from the lymph nodes
*TB tine or PPD tests (usually positive)
*Chest x-rays (may be abnormal)
When infection is caused by Mycobacterium tuberculosis, treatment usually involves 9 to 12 months of antibiotics. Several antibiotics need to be used at once. Common antibiotics for scrofula include:
When infection is caused by another type of bacteria, as is often seen in children, therapy usually involves antibiotics such as rifampin, ethambutol, and clarithromycin.
Surgery is not usually needed, and only done when medicines do not work well.
Treatment approaches are highly dependent on the kind of infection. Surgical excision of the scrofula does not work well for M. tuberculosis infections, and has a high rate of recurrence and formation of fistulae. Furthermore, surgery may spread the disease to other organs. The best approach then is to use conventional treatment of tuberculosis with antibiotics. Scrofula caused by NTM, on the other hand, responds well to surgery, but is usually resistant to antibiotics. The affected nodes can be removed either by repeated aspiration, curettage or total excision (with the risk in the latter procedure, however, of causing cosmetically negative effects or damage to the facial nerve, or both).
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With adequate treatment, clinical remission is practically 100%. In NTM infections, with adequate surgical treatment, clinical remission is greater than 95%. It is recommended that persons in close contact with the diseased person, such as family members, should undergo testing for tuberculosis.
Formation of a draining fistula in the neck
Prevention of tuberculosis requires identification of individuals with inactive or latent infection. This is done with a PPD or Tine test. Individuals who have been exposed to someone with tuberculosis of the lungs should have such a skin test performed.
Many occupations, such as nursing and medicine, require practitioners to get regular skin tests. Individuals who immigrate to the United States from areas of the world where tuberculosis is common are also screened with such skin tests.
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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
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