Scrofula

Image:Scrofula-andre-du-laurens-1609.jpeg Image:Kone med stor struma.jpg Scrofula (Scrophula or Struma) refers to a variety of skin diseases; in particular, a form of tuberculosis, affecting the lymph nodesof the neck. In adults it is caused by Mycobacterium tuberculosis and in children by nontuberculous mycobacteria. The word comes from the Latinscrofulae, meaning brood sow.

History

In the Middle Agesit was believed that royal touch, the touch of the sovereign of Englandor France, could cure the disease. Scrofula was therefore also known as the King's Evil. The kings were thought to have received this power from descent from Edward the Confessor, who, according to some legends, received it from Saint Remigius. The original Book of Common Prayerof the Anglican Churchcontained a ceremony for this, and it was traditional for the monarch(king or queen) to present to the touched person a coin-- usually an Angel, a goldcoin the value of which varied from about 6 shillings to about 10 shillings. King Henry IV of Franceis reported as often touching and healing as many as 1,500 individuals at a time.

Queen Annetouched the Infant Dr. Samuel Johnsonin 1712, but King George Iput an end to the practice as being "too Catholic." The kings of France continued the custom until 1825.

In 1924, the French historian Marc Blochwrote a book on the history of the royal touch: The royal touch: sacred monarchy and scrofula in England and France (original in French).

The disease

Image:Scrofula.jpeg Scrofula is the term used for tuberculosis of the neck, or, more precisely, a cervical tuberculous lymphadenopathy. Scrofula is usually a result of an infection in the lymph nodes, known as lymphadenitisand is most often observed in immunocompromisedpatients (ca. 50% of cervical tuberculous lymphadenopaty). In ca. 95% of the scrofula cases in adults are caused by Mycobacterium tuberculosis, but only 8% in children. The rest are caused by atypical mycobacterium or nontuberculous mycobacterium (NTM). With the stark decrease of tuberculosis in the second half of the 20th century, scrofula became a very rare disease. With the appearance of AIDS, however, it has shown a resurgence, and presently affects ca. 5% of severely immunocompromised patients.

Signs and symptoms

The most usual signs and symptomsare the appearance of a chronic, painless mass in the neck, which is persistent and usually grows with time. The mass is referred to as a "cold abscess", because there is no accompanying local calor or warmth and the overlying skin acquires a violaceous color. NTM infections do not show other notable constitutional symptoms, but scrofula caused by tuberculosis is usually accompanied by other symptoms of the disease, such as fever, chills, malaiseand weight lossin ca. 43% of the patients. As the lesion progresses, skin becomes adhered to the mass and may rupture, forming a sinus and an open wound.

Diagnosis

Diagnosisis usually performed by needle aspiration biopsyor excisional biopsyof the mass and the histological demonstration of stainable acid-fastbacteria in the case of infection by M. tuberculosis (Ziehl-Neelsen stain), or the culture of NTM using specific growth and staining techniques.

Therapy

Treatmentapproaches are highly dependent on the kind of infection. Surgical excision of the scrofula does not work well for M. tuberculosis infections, and has a high rate of recurrenceand formation of fistulae. Furthermore, surgery may spread the disease to other organs. The best approach then is to use conventional treatment of tuberculosiswith antibiotics. Scrofula caused by NTM, on the other hand, responds well to surgery, but is usually resistant to antibiotics. The affected nodes can be removed either by repeated aspiration, curettageor total excision (with the risk in the latter procedure, however, of causing cosmetically negative effects or damage to the facial nerve, or both).

Prognosis

Prognosis: with adequate treatment, clinical remission is practically 100%. In NTM infections, with adequate surgical treatment, clinical remission is greater than 95%. It is recommended that persons in close contact with the diseased person, such as family members, should undergo testing for tuberculosis.

See also

• Tuberculosis diagnosis
• Tuberculosis treatment

External links

• Scrofulafrom eMedicine medical articlede:Skrofulose

fr:Écrouelles wa:Må sint Marcou

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Scrofula Wikipedia article Scrofula.