PMID- 37789748
OWN - NLM
STAT- Publisher
LR  - 20231004
IS  - 1122-0643 (Print)
IS  - 1122-0643 (Linking)
DP  - 2023 Oct 3
TI  - Paradoxical reaction in peripheral lymph node tuberculosis: a review for its 
      prevalence, clinical characteristics, and possible treatment.
LID - 10.4081/monaldi.2023.2625 [doi]
AB  - The paradoxical reaction (PR) is a transient worsening following tuberculosis 
      treatment and it is not uncommon in lymph node tuberculosis (LNTB). PR in LNTB 
      maybe  wrongly considered as treatment failure or relapse. This review was 
      undertaken to address various aspects of PR associated with lymph node 
      tuberculosis prevalence, underlying mechanism, clinical pattern, predictors, and 
      possible treatment in an immunocompetent individual. A literature review was 
      performed using various databases (PubMed, Scopus, Science Direct, and Google 
      Scholar) to identify relevant articles for review. The prevalence of paradoxical 
      reactions associated with LNTB varies from as low as 13.3% to as high as 35.3%  
      PR may occur during antitubercular treatment or be reported even after completion 
      of treatment called post-therapy PR. An onset of PR may occur within a month of 
      therapy to even 12 months from the initiation of an anti-tubercular drug. Delayed 
      hypersensitivity reaction and reduction in immune suppression is believed to be 
      possible mechanism leading to a paradoxical reaction. PR in LNTB is characterized 
      by either progression of pre-existing nodal enlargement or formation of abscess, 
      sinus formation, or appearance of new nodal enlargement or rarely extra-nodal 
      involvement. PR is a diagnosis of exclusion and may show granuloma, positive AFB 
      smear, or positive GeneXpert but AFB culture is always negative. Younger age, 
      lymph node size of equal to or more than 3 cm, female gender, unilateral 
      lymphadenopathy, and those with positive AFB on initial examination are 
      predictors for PR in peripheral LNTB. The majority of PR in LNTB have a mild 
      course and are generally self-limited.
FAU - Rai, Deependra Kumar
AU  - Rai DK
AD  - Department of Pulmonary Medicine, All India Institute of Medical Sciences, Patna. 
      deependra78@gmail.com.
FAU - Kant, Surya
AU  - Kant S
AD  - Department of Respiratory Medicine, King George Medical University, Lucknow. 
      skantpulmed@gmail.com.
FAU - Gupta, Vatsal Bhushan
AU  - Gupta VB
AD  - Department of Pulmonary Medicine, All India Institute of Medical Sciences, Patna. 
      vatsalgupta.gkp@gmail.com.
LA  - eng
PT  - Journal Article
DEP - 20231003
PL  - Italy
TA  - Monaldi Arch Chest Dis
JT  - Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace
JID - 9307314
SB  - IM
EDAT- 2023/10/04 06:43
MHDA- 2023/10/04 06:43
CRDT- 2023/10/04 03:23
PHST- 2023/05/05 00:00 [received]
PHST- 2023/09/27 00:00 [accepted]
PHST- 2023/10/04 06:43 [medline]
PHST- 2023/10/04 06:43 [pubmed]
PHST- 2023/10/04 03:23 [entrez]
AID - 10.4081/monaldi.2023.2625 [doi]
PST - aheadofprint
SO  - Monaldi Arch Chest Dis. 2023 Oct 3. doi: 10.4081/monaldi.2023.2625.