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Lymph node tuberculosis
Nonacute, painless cold enlargement of lymph nodes, usually matted, localized in one region. May have draining sinuses. Response to standard anti-TB treatment in one month.

Lymphadenitis is the most frequent form of extrapulmonary tuberculosis. The degree of severity depends on the level of immunosuppression of HIV-infected children. In immunocompetent children, it is usually unilateral and cervical in location. It presents as a painless, red, firm, usually matted mass, localized in one region (A). Fine-needle aspiration demonstrates cytologic evidence of granuloma, but smears or cultures are usually negative. Tuberculin skin test is almost always positive.

Conversely, in HIV-infected children with progression of immunosuppression, peripheral tuberculous lymphadenitis is almost always multifocal (B) and associated with major systemic symptoms such as fever, weight loss, and some may have evidence of tuberculosis in the lungs or elsewhere. Fluid or tissue culture is often required for diagnosis, because acid-fast bacilli seen by Ziehl Neelsen stain can be both M. tuberculosis or other mycobacteria, in which specific treatments are different.
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