Q: Can cervical lymphadenopathy alone in the absence of cough and expectoration be extrapulmonary or pulmonary tuberculosis? If extrapulmonary, do the family members need to take chemoprophylaxis.

A:Cervical lymphadenopathy could be caused by tuberculosis without pulmonary involvement. It could also be a sign of pulmonary tuberculosis, even if there are no pulmonary symptoms. Diagnosis is best obtained by biopsy of the involved lymph node with culture. It would not be wise to give chemoprophylaxis without a sure diagnosis because chemoprophylaxis is expensive and may be complicated by side effects. Also there are other causes of lymphadenopathy, such as Hodgkin disease, that should be treated differently. Family needs chemoprophylaxis if tuberculosis bacteria is being shed into the environment; this is most common with active pulmonary tuberculosis but can happen with draining abscesses.