Relationship among ultrasound features, pus Mycobacterium tuberculosis load, and efficacy of antituberculosis drugs in patients with necrotizing tuberculous lymphadenitis

For patients with necrotizing cervical tuberculous lymphadenitis (CTL) who have formed abscesses and are unwilling to undergo surgery, early and accurate assessment of drug therapy should be performed to guide subsequent clinical adjustments. This study investigated 22 patients with necrotizing CTL who underwent chemotherapy at our hospital from February 2020 to December 2022. They were diagnosed based on the positive results of pathogen detection methods (acid-fast bacillus smear, mycobacteria culture, Gene X-pert, and next-generation sequencing). Based on the 6-month treatment outcomes, the relationship among prechemotherapy ultrasound features, pus Mycobacterium tuberculosis (MTB) load, and treatment efficacy was assessed. In this study, the maximum lymph node (LN) area, maximum necrotic area, and pus MTB load in patients with necrotizing CTL were associated with poor prognosis and showed significant differences between the effective and ineffective groups (P < 0.05). However, no statistical difference was observed in the maximum longitudinal diameter, short diameter, and necrosis rate between the two groups (P > 0.05). The maximum necrotic area of the LNs was not associated with the pus MTB load. Furthermore, maximum LN area, maximum necrotic area, and pus bacterial load may be potential radiological markers for predicting the therapeutic response of CTL.