Scrofula

• Alternative Names

  Tuberculous adenitis

• Causes, incidence, and risk factors

  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.

• Symptoms
  • Chills
  • Fevers (rare)
  • Painless swelling of lymph nodes in the neck and elsewhere in body
  • Sores (ulceration -- rare)
  • Sweats
  • Weight loss
• Signs and tests

  Tests to diagnose scrofula include:

  • Examination of tissue sample under a microscope (histology)
  • Chest x-rays
  • Cultures to check for the bacteria in tissue samples taken from the lymph nodes
  • TB tine or PPD 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
  • 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 not usually needed. It is only done when medicines do not work well.

• Expectations (prognosis)

  With treatment, patients usually make a complete recovery.

• Complications
  • Draining fistula in the neck
  • Ulcerated lymph nodes that produce draining sores
  • 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 or Tine test.

  Many occupations, such as nursing and medicine, require practitioners to get regular skin tests. People who immigrate to the United States from areas of the world where tuberculosis is common are also screened with such skin tests.

• References

  Pastermack MS, Swartz MN. Lymphadenitis and lymphangitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Disease. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005: chap 88.

  Starke JR, Munoz FM. Tuberculosis (mycobacterium tuberculosis). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 212.

  Powell DA. Nontuberculous mycobacteria. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 214.

Review Date: 9/28/2008

Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Jatin M. Vyas, MD, PhD, Instructor of Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.