Tuberculosis in the upper aerodigestive tract and human immunodeficiency virus coinfections

Objective: To describe the clinical manifestations of tuberculosis in the upper aerodigestive tract. Design: Retrospective chart analysis. Setting: Srinagarind Hospital, Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. Methods: A review of medical records of patients diagnosed with mycobacterial infection of the upper aerodigestive tract between January 1991 and December 2000. Main Outcome Measures: Presenting symptoms, clinical findings, pathologic findings, pulmonary involvement, and outcome of treatment. Results: Forty-five patients presented with upper aerodigestive tract tuberculosis. The nasopharynx was involved in 23 patients, the larynx in 16, the tonsils in 6, and the soft palate in 1. One patient had tuberculous infections in both the nasopharynx and tonsils. The mean duration of symptoms before diagnosis was 2.1 months. The pathologic findings included caseous granuloma and/or positive acid-fast bacilli (AFB) in 39 cases and chronic granulomatous inflammation with negative AFB in 6 cases. Pulmonary tuberculosis was found in 19 of the 36 patients who underwent radiography. A positive serologic test for human immunodeficiency virus (HIV) infection was found in 4 of 26 patients. These 26 patients, who received a full course of treatment, responded well. Conclusion: The most common site of tuberculosis in the head and neck involved the cervical lymph nodes and nasopharynx. Upper aerodigestive tract tuberculosis is difficult to differentiate from carcinoma; thus, tissue biopsy is necessary for a definite diagnosis. Chest radiography and screening for HIV infection are recommended in all patients with upper aerodigestive tract tuberculosis.