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Scrofula

Definition

Scrofula is a tuberculous infection of the lymph nodes in the neck.

Alternative Names

Tuberculous adenitis

Causes, incidence, and risk factors

Scrofula in adults is most often caused by the bacteria Mycobacterium tuberculosis. In children, can also be caused by Mycobacterium scrofulaceum or Mycobacterium avium.

Infection with mycobacteria is usually caused by breathing in air that is contaminated by these organisms.

Symptoms

Signs and tests

Tests to diagnose scrofula include:

  • Biopsy of affected tissue
  • Chest x-rays
  • CT scan of the neck
  • Cultures to check for the bacteria in tissue samples taken from the lymph nodes
  • HIV blood test
  • TB tine or PPD test
  • Quantiferon gold blood test

Treatment

When infection is caused by Mycobacterium tuberculosis, treatment usually involves 9 - 12 months of antibiotics. Several antibiotics need to be used at once. Common antibiotics for scrofula include:

  • Ethambutol
  • Isoniazid (INH)
  • Pyrazinamide
  • Rifampin

When infection is caused by another type of bacteria (which often occurs in children), therapy usually involves antibiotics such as rifampin, ethambutol, and clarithromycin.

Surgery is sometimes used as initial treatment, depending on circumstances. It may also be used if medications are not working on the infection.

Expectations (prognosis)

With treatment, patients usually make a complete recovery.

Complications

  • Draining sore in the neck
  • Scarring

Calling your health care provider

Call your health care provider if your child has a swelling or group of swellings in the neck. Scrofula can occur in children who have not been exposed to someone with tuberculosis.

Prevention

People who have been exposed to someone with tuberculosis of the lungs should have a PPD test.

References

Pasternack MS, Swartz MN. Lymphadenitis and lymphangitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 92.


Review Date: 9/15/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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