Clinical profile and treatment outcomes of mediastinal lymph node TB: A prospective cohort study

Introduction: Diagnosis of Mediastinal lymph node tuberculosis (TB), a frequent presentation of extrapulmonary TB, is challenging. Scant literature is available on the clinical profile of patients with mediastinal TB. Aims: To study the clinical profile and treatment outcomes of mediastinal TB. Methods: Ethical approval was obtained for a prospective cohort study. Data on clinical profile, diagnostic investigations, and treatment were collected. The diagnostic approach included endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in most subjects. Enrolled subjects were followed for treatment response. Results: We enrolled in 115 subjects with mediastinal TB. The mean age was 35.3 ± 1.4 years (males 58.3%). Symptom duration was 114 ± 11 days. Most common symptoms were fatigue (51.3%), cough (46.1%), weight loss (43.5%), fever (38.3%) and ocular symptoms (17.3%). 9 (7.8%) subjects were asymptomatic. The Tuberculin-skin test positivity rate was 78%. CT scan showed necrotic lymph nodes in 57.4% subjects. The most common lymph nodes involved were subcarinal and right lower paratracheal. Extra-mediastinal involvement was present in 42.6%. EBUS-TBNA provided a diagnosis in 90 subjects (83.3%). The diagnosis was microbiologically confirmed in 43.5%. A complete or partial composite treatment response was observed in 101/115 (88%) at the last follow up. Follow up CT scan showed residual lymph nodes in 17.8% subjects. Conclusion: A definitive diagnosis can be achieved using EBUS-TBNA, in the majority of patients with suspected mediastinal TB. Clinical improvement occurs in a majority of subjects that may not be accompanied by a complete radiological resolution.