Scrofula

Definition

Scrofula is a tuberculous infection of the skin on the neck.

Alternative Names

Causes

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. The bacteria spreads throughout the body, and may cause swelling the lymph nodes in the neck and other parts of the body. If left untreated, the lymph nodes may become ulcerated, producing draining sores.

Symptoms

• Painless swelling of lymph nodes in neck and elsewhere in body
• Ulceration (rare)
• Fevers, chills, sweats, and weight loss can occur in 20% of patients

Exams and Tests

Tests to diagnose scrofula include:

• Histology (examination of tissue sample under a microscope)
• Cultures to check for the bacteria in tissue samples taken from the lymph nodes
• TB tine or PPD tests (usually positive)
• Chest x-rays (may be abnormal)

Treatment

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

• INH
• Rifampin
• Pyrazinamide
• Ethambutol

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

Surgery is not usually needed, and only done when medicines do not work well.

Outlook (Prognosis)

With treatment, patients usually make a complete recovery.

Possible Complications

• Scarring
• Formation of a draining fistula in the neck

When to Contact a Medical Professional

Call your provider if your child has a swelling or group of swellings in the neck. Scrofula can occur in children without exposure to someone with tuberculosis.

Prevention

Prevention of tuberculosis requires identification of individuals with inactive or latent infection. This is done with a PPD or Tine test. Individuals who have been exposed to someone with tuberculosis of the lungs should have such a skin test performed.

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

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