Scrofula

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Scrofula has been known to afflict people since antiquity, and during the Middle Ages, the king's touch was thought to be curative. In modern times, surgery has played a pivotal role in the diagnosis and treatment of scrofula. Over the past several decades, however, surgical intervention has played a decreasing role because it has been fraught with persistent disease and complications. As in pulmonary TB, antituberculous chemotherapy has become the standard of care for scrofula, and newer diagnostic techniques (eg, fine-needle aspiration) have replaced more invasive methods of tissue harvesting.

Infection with mycobacteria is usually caused by inhaling air contaminated by these organisms. The bacteria spread throughout the body, and may cause rubbery enlargement of the lymph nodes in the neck (cervical lymph nodes) as well as elsewhere. If these are not treated, the lymph nodes may become ulcerated, producing draining sores.

Scrofula may be inherited or it may be acquired. It is most apt to develop in young persons, particularly in the case of children insufficiently nourished or living in dark or damp, unsanitary quarters. Scrofula manifests itself in the inflammation of various joints and of parts of the mucous membrane, but more often in glandular swellings of the neck. These swellings are as irritating as a boil; in fact, the name scrofula means a little sow, the rooter, the digger, the scratcher. The swellings soften and break through the skin into running sores, followed, it may be, by unsightly scars. Sunshine, pure air, bathing in seawater, and wholesome food are corrective. Cod-liver oil is a remedy. Mineral waters containing iodine, iron, and phosphate of lime are considered beneficial. A person having a fair, thin, creamy skin is said to have a scrofulous complexion. Scrofula was known formerly as king's evil.

When infection is caused by Mycobacterium tuberculosis, treatment is usually with 9 to 12 months of antibiotics. Several antibiotics need to be used at once, to avoid the bacterium becoming antibiotic-resistant. Common antibiotics for scrofula include: INH, rifampin, pyrazinamide, ethambutol. When infection is caused by mycobacteria other than Mycobacterium tuberculosis, as is often seen in children, therapy usually involves antibiotics, such as rifampin, ethambutol, and clarithromycin. Surgery is seldom necessary, and is reserved for cases where medical therapy is only partially effective.