Cervical Lymphadenopathy

Cervical Lymphadenopathy

Cervical Lymphadenopathy Management

• In a situation, where a self-limited infection is thought to be the etiology ofacute cervical lymphadenitis, it is reasonable to observe and provide reassurance.
• Unilateral lymphadenopathy that has a history of a rapid onset and overlying erythema of the skin and is accompanied by a fever suggests a bacterial infection. In this case, oral antibiotic therapy for 10–14 days and close follow-up is the appropriate management.

“Treatment Options For Cervical Lymphadenopathy“

• An ultrasound may be indicated to evaluate for the presence and extent of suppuration.If confirmed, surgical drainage is required with the presence of a flctuant mass, suggesting an abscess.
• On follow-up of adenopathy, further evaluation should be considered, if there is not a decrease in size after 2 weeks.

“Role Of Tuberculosis In Cervical Lymphadenopathy”

• Laboratory evaluation may include the following: CBC with differential, ESR, titers for Ebstein-Barr virus/cytomegalovirus/toxoplasmosis/cat-scratch disease,antistreptolysin O or anti-DNAase serologic tests, PPD,and chest radiograph.
• Non-infectious causes of cervical lymphadenopathy include Kawasaki Disease, PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervicaladenitis), and Sarcoidosis. Cervical lymphadenopathy is accompanied by a number of other signs and symptoms in each of these non-infectious disorders, and evaluation and management is individualized based on the disease.

Chronic Cervical Lymphadenopathy

• Laboratory evaluation includes CBC, ESR, PPD, B henselae serology, and titers for Ebstein-Barr virus/cytomegalovirus/toxoplasma among other tests based on history and physical examination.
• Children who have chronic cervical lymphadenopathy often undergo extensive diagnostic evaluation before an etiology is determined.
• Special attntion should be given to the possibility of TB and HIV disease; the hematologic and serologic testing noted previously can be helpful.

“Surgical Management Of Cervical Lymphadenopathy”

• Urine antigen tests for Histoplasma capsulatum occasionally can be helpful.
• If there is an increase in lymph node size over 2 weeks,lack of decrease in size over 4–6 weeks, lack of regression to normal within 8–12 weeks, or the presence of persistent fever, weight loss, fatigue, night sweats, hard nodes, or fiation of nodes to surrounding tissues, a biopsy should be performed for further evaluation.
• Biopsy can be in the form of open biopsy or fie needle aspiration to further investigate for certain pathology,including infectious and non-infectious causes, specifically malignancy. Because lymphadenitis caused by nontuberculous Mycobacterium (NTM) evolves to draining skin fitulas associated with scarring, the safety of needle aspiration when this infection is suspected has been questioned.

“Painful Vs Painless Cervical Lymphadenopathy”

• Needle aspiration may not lead to increased risk for this complication because the treatment of a node found to be infected with NTM is surgical excision-a cure for skin fistulas.
• NTM and Bartonella infection are diagnosed best using material obtained from a suppurative lymph node, which can be stained and cultured for acid-fast organisms and sent for polymerase chain reaction (PCR) examination to detect B henselae infection.
  Importantly, PCR analysis for Bartonella can be performed on material that was obtained recently and preserved by freezing.
  It is sensible to freeze extra material obtained by needle aspiration so PCR studies can be performed if bacterial studies are unexpectedly negative.