Have you ever noticed that some people have a small lump on one side of their neck? Sometimes it can be large, like a bunch of lumps stuck together. Most of the time it is painless, or there is only a slight pain. Sometimes it can be purple or even the same color as the skin. That is the condition we are going to talk about today, and that is scrofula.
What is Scrofula? Simply put...
Simply put, scrofula is when the lymph nodes in your neck, which we call nodes , become swollen due to a bacterial infection. What happens is that one or more nodes join together and form a large, flat mass in your neck.
In the past, it was called the "king's evil" because people thought the king could cure it. But now doctors call it mycobacterial cervical lymphadenitis . A bit of a long name, isn't it? But that's exactly what this condition is called.
Actually, Scrofula is a form of Tuberculosis . However, it is not limited to the lungs, but also affects the glands in the neck.
How common is scrofula?
To be honest, scrofula is a very rare condition. Only about 5% of people who show symptoms of tuberculosis are diagnosed with scrofula. Therefore, you don't hear about it often.
What are the symptoms of Scrofula?
For many people, the main symptom of scrofula is a lump in the neck, which can feel like a lump on one or both sides of the neck. However, some people may also experience symptoms typical of a bacterial infection, such as:
- Fever.
- Sweating at night.
- Unintentional weight loss.
- Feeling tired all the time. (Fatigue)
Imagine, one day, Nilanthi Akka developed a small lump on her neck. At first, she thought it was normal. But after a while, it got bigger, and she started getting fevers at night. That's when she went to see a doctor.
What causes scrofula?
The main cause of scrofula in adults is a bacterium called Mycobacterium tuberculosis . This is the bacterium that causes tuberculosis (TB). When you breathe in this bacteria, it enters your lungs and travels to the glands in your neck, causing the condition.
However, other types of Mycobacterium infections can also cause scrofula in young children, so the cause may be slightly different in children.
Who is most at risk for this?
The main risk factor for developing scrofula is living with HIV, because HIV weakens the body's immune system.
In addition:
- Malnutrition
- Other conditions that weaken your immune system (for example, using immunosuppressive medications, having certain autoimmune conditions, or having certain cancers) can increase this risk.
Simply put, if your body's ability to fight disease is reduced, you are more likely to be susceptible to these types of infections.
What are the possible complications of scrofula?
Sometimes, the swelling caused by scrofula can burst and ooze pus. This can cause a sinus , or tunnel, to form in your skin. This injury can also cause scarring . The scarring may be permanent.
How to diagnose scrofula?
Because there are many other possible causes of swollen neck glands, your doctor may perform or recommend several tests to determine if you have scrofula. These are the ones that are usually done:
- Biopsy: In this test , the doctor removes a lump or tissue sample using a needle. The sample is then cultured to see if mycobacteria are present, and a special stain is used to look for the bacteria.
- Blood tests: A sample of your blood can be taken to check for mycobacteria and other infections.
- Imaging tests: Your doctor may do a chest X-ray , CT scan , or ultrasound scan to get clear images of your lungs or neck.
- Tuberculosis tests: A PPD skin test or blood test can tell if you have tuberculosis.
- Acid-fast bacilli test: This involves taking a tissue sample or a sample of mucus from your lungs and looking for mycobacteria.
All these tests are done to confirm the exact nature of the disease.
How is scrofula treated?
Doctors treat scrofula with antibiotic medications (such as macrolides) that are specifically designed for mycobacterial infections. You will usually need to take these medications for several months to a year . Here are some types of antibiotics that are used to treat mycobacterial infections:
- Ethambutol
- Isoniazid (INH)
- Pyrazinamide
- Rifampin
- Clarithromycin
The most important thing is to take this medication exactly as your doctor prescribes, for the full duration of the medication. If you stop taking it halfway, the disease may return.
Sometimes your doctor may recommend surgically removing the infected pus. They may also recommend a method called DOT (Directly Observed Therapy) . This involves someone other than your family member giving you the medication and staying with you until you take it. This way, you don't have to worry about missing your medication.
What can I expect if I have scrofula?
If you take the right treatment , you can completely recover from scrofula. But as the doctor says, it is important to take the medicine exactly for the entire treatment period. Remember, this can take anywhere from a few months to a year. The scars caused by the wounds may be permanent.
Is Scrofula fatal?
Scrofula is rarely fatal if treated. However, it is difficult to give an exact mortality rate because mortality studies usually focus on mycobacterial infections in the lungs. The results can vary greatly.
Can scrofula be prevented?
Yes, to some extent. You can reduce your risk of scrofula by getting tested for latent TB infection . Latent TB is a condition where you don't show any symptoms, but it can spread to other parts of your body and cause an infection like scrofula. If you find out you have a TB infection, you can get treatment before it spreads.
You can also get the Bacillus Calmette-Guérin (BCG) vaccine for tuberculosis, but the BCG vaccine is usually only given in areas where tuberculosis is common.
How do I take care of myself?
The best thing you can do is stay in close contact with your doctor and take your medications exactly as prescribed. While you have tuberculosis (TB) or nontuberculous mycobacteria infection, you can also help prevent the spread of the bacteria by limiting your contact with other people.
What questions should I ask my doctor?
It may be helpful to ask your doctor questions like these:
- How should I take the medicine?
- What do I do if I miss a dose of medication?
- How long will I have to undergo treatment?
- How long will it take for me to recover?
- What new or worsening symptoms should I watch for?
- When should I come see you again?
Finally, remember (Take-Home Message)
Scrofula is a rare but usually curable condition. Treatment can take some time – you may need to be patient for a while until you recover. See your doctor regularly, especially if you have an underlying condition like HIV. Your doctor can monitor your progress, adjust your medication if necessary, and address any problems that arise during treatment. So don't panic, get the treatment you need, and try to stay healthy!
` Scrofula, neck nodules, erysipelas, tuberculosis, mycobacteria, bacterial infection, lymph nodes
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