('''Scrophula''' or '''Struma''') refers to a variety of
Skin Disease s; in particular, a form of
Tuberculosis , affecting the
Lymph Node s of the neck. In adults it is caused by ''
Mycobacterium Tuberculosis '' and in children by
Nontuberculous Mycobacteria . The word comes from the
Latin ''scrofulae'', meaning ''brood
Sow ''.
In the
Middle Age s it was believed that , the touch of the sovereign of
England or
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 Prayer of the
Anglican Church contained 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
Gold coin the value of which varied from about 6 shillings to about 10 shillings. King
Henry IV Of France is reported as often touching and healing as many as 1,500 individuals at a time.
Queen Anne touched the Infant Dr.
Samuel Johnson in
1712 , but
King George I put an end to the practice as being "too
Catholic ." The kings of France continued the custom until
1825 .
In
1924 , the French historian
Marc Bloch wrote a book on the history of the royal touch: ''The royal touch: sacred monarchy and scrofula in England and France'' (original in French).
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
Lymphadenitis and is most often observed in
Immunocompromised patients (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.
The most usual signs and
Symptom s are 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 ,
Chill s,
Malaise and
Weight Loss in 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 is usually performed by
Needle Aspiration Biopsy or excisional
Biopsy of the mass and the histological demonstration of stainable
Acid-fast bacteria in the case of infection by ''M. tuberculosis'' (
Ziehl-Neelsen Stain ), or the culture of NTM using specific growth and staining techniques.
Treatment approaches 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
Recurrence and formation of
Fistula e. Furthermore, surgery may spread the disease to other organs. The best approach then is to use conventional
Treatment Of Tuberculosis with
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,
Curettage or total excision (with the risk in the latter procedure, however, of causing cosmetically negative effects or damage to the
Facial Nerve , or both).
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.
