Primary tubercular sialadenitis – A diagnostic dilemma

Document Type : Original

Authors

1 Department of Otorhinolaryngology and Head-Neck Surgery, Dr. Baba Saheb Ambedkar Hospital, Delhi, India

2 Department of Otorhinolaryngology and Head-Neck Surgery, Seth G.S Medical College and KEM Hospital

Abstract

Introduction:
Involvement of the salivary glands in tuberculosis is rare, even in countries where tuberculosis is endemic. It can occur by systemic dissemination from a distant focus or, less commonly, as primary involvement. This article focuses on its myriad clinical presentations that pose a diagnostic challenge to the clinician. We discuss the schema of investigations required to confirm the diagnosis and the limitations faced in the low-cost setting of a developing country.
 
Materials and Methods:
Medical records, including history, physical examination and imaging findings, and the results of cytological, microbiological and histopathological studies of patients diagnosed with primary tubercular sialadenitis were retrieved and analyzed.
Results:
Seven patients were treated over a 2-year period. The most common mode of presentation was a painless mass of the involved gland in four patients. One patient each presented with chronic non-obstructive sialadenitis, sialolithiasis, and acute suppurative sialadenitis. Fine needle aspiration cytology was diagnostic in five out of seven cases (71.4%), while mycobacterial culture was positive in two patients (28.6%). In one patient, a diagnosis could only be reached on histopathological examination of the resected gland.
Conclusion:
We recommend cytology studies, acid-fast bacilli staining, and mycobacterial culture as the initial investigation on the aspirate in suspected patients, while polymerase chain reaction should be reserved for negative cases. A high index of suspicion, early diagnosis, and timely institution of anti-tuberculosis treatment is essential for establishing cure. The role of surgery in diagnosed cases of tuberculosis is limited.

Keywords

Main Subjects

References

1. World Health Organization. Global tuberculosis report 2015. Available from: http://apps.who.int/iris/
bitstream/10665/191102/1/9789241565059_eng.pdf?ua=1. Accessed: October 2015.
2. Kumar SP, Rajesh Kumar P. Primary Tuberculosis of Submandibular Gland Presenting as Dental Abscess. J Otol Rhinol. 2013;2:2.
3. Gupta KB, Yadav SPS, Sarita, Manchanda M. Primary pharyngeal tuberculosis. Lung India 2005; 22:127–9.
4.Khan AK, Khan NA, Maqbool M. Otorhinolaryngological manifestation of tuberculosis. JK Sci J Med Ed Res. 2002; 4(3):
115-18.
5. Kasim KS, Namavar E, Yunus MRM. A rare case of primary tuberculosis of the submandibular gland. Egypt J Ear Nose Throat Allied Sci. 2015; 16:87–9.
6. Som PM, Brandwein MS. Salivary Glands. In: Som PM, Curtin HD, editors. Head and neck imaging. 3rd ed. Vol. 2. St. Louis, MO: Mosby-Year Book, Inc.; 1996. p. 823–914.
7. Nachlas NE, Johns ME. Physiology of the Salivary Glands. In: Paparella MM, Shumrick DA, Gluckman JL, et al., editors. Otolaryngology. 3rd ed.Vol.1.Philadelphia:Saunders; 1991. pp.391–405.
8. Thakur J, Thakur A, Mohindroo N, Mohindroo S, Sharma D. Bilateral Parotid Tuberculosis. J Global Infect Dis. 2011;3(3):296–9.
9. Prasad KC, Sreedharan S, Chakravarthy Y, Prasad SC. Tuberculosis in the head and neck: Experience in India. J Laryngol Otol. 2007; 121: 979–85.
10. Erkan AN, Cakmak O, Kayaselcuk F, Koksal F, Ozluoglu L. Bilateral parotid gland tuberculosis. Eur Arch Otorhinolaryngol. 2006;263:487–9.
11. Janmeja AK, Das SK, Kochhar S, Handa U.Tuberculosis of the parotid gland. Indian J Chest Dis Allied Sci. 2003;45:67–9.
12. Lee IK, Liu JW. Tuberculous parotitis: case report and literature review. Ann Otol Rhinol Laryngol. 2005;114:547–51.
13. Aygenc E, Albayrak L, Ensari S. Tuberculous parotitis. Inf Dis Clin Prac. 2002;11:555–7.
14. Holmes S, Gleeson MJ, Cawson RA. Mycobacterial disease of the parotid gland. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 90:292–8.
15. Iseri M, Aydýner O, Celik L, Peker O. Tuberculosis of the parotid gland. J Laryngol Otol. 2005;119:311–13.
16. Makeshkumar V, Madhavan R, Narayanan S. Polymerase chain reaction targeting insertion sequence for the diagnosis of extrapulmonary tuberculosis. Ind J Med Res. 2014;139(1):161–6.
17. Singh KK, Muralidhar M, Kumar A, Chattopadhyaya TK, Kapila K, Singh MK, 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(5):355-61.
Iranian Journal of Otorhinolaryngology
Volume 31, Issue 1
January and February 2019
Pages 45-50

Files

Share

How to cite

Statistics