Lymphadenitis: Difference between revisions
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''Not to be confused with [[lymphangitis]]. | |||
==Background== | ==Background== | ||
*Lymphadenitis = inflammation of lymph node | *Lymphadenitis = inflammation of lymph node | ||
*Can be single or multiple | *Can be single or multiple | ||
*Most commonly due to viral or bacterial (usually staph or strep) infection local to region draining lymph to that node | *Most commonly due to [[viral illness|viral]] or [[bacterial disease]] (usually [[staph]] or [[strep]]) infection local to region draining lymph to that node | ||
*Pyogenic organisms may cause suppurative infection/abscess | *Pyogenic organisms may cause suppurative infection/abscess | ||
*Not to be confused with [[lymphangitis]] | *Not to be confused with [[lymphangitis]] | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:PMC4295467 JIOH-6-96-g001.png|thumb|[[Tuberculosis]] lymphadenitis: diffuse swelling in left submandibular region.]] | |||
*Pain | *Pain | ||
*Erythema | *[[rash|Erythema]] | ||
*Enlargement over time | *Enlargement over time | ||
*Associated symptoms: | *Associated symptoms: | ||
**Fever | **[[Fever]] | ||
**Local signs of infection depending on location of lymph node | **Local signs of infection depending on location of lymph node | ||
***Cervical | ***Cervical | ||
****URI symptoms | ****[[URI]] symptoms | ||
****Conjunctivitis | ****[[Conjunctivitis]] | ||
****Mouth sores, dental infection | ****Mouth sores, dental infection | ||
***Axillary | ***Axillary | ||
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****Upper-limb infections | ****Upper-limb infections | ||
***Mesenteric | ***Mesenteric | ||
****Abdominal pain, nausea/vomiting | ****[[Abdominal pain]], [[nausea/vomiting]] | ||
***Inguinal | ***Inguinal | ||
****GU infections | ****GU infections | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Lymphadenitis DDX}} | |||
{{Cervical lymphadenopathy DDX}} | |||
==Evaluation== | ==Evaluation== | ||
*Usually clinical diagnosis | *Usually clinical diagnosis | ||
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*Generally can be discharged with outpatient follow-up/treatment if mild/moderate symptoms | *Generally can be discharged with outpatient follow-up/treatment if mild/moderate symptoms | ||
*Admit for: | *Admit for: | ||
**Sepsis/Severe symptoms requiring I&D or IV antibiotics | **[[Sepsis]]/Severe symptoms requiring I&D or IV antibiotics | ||
**Failure of outpatient treatment | **Failure of outpatient treatment | ||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
*Dulin MF, Kennard TP, Leach L, Williams R. Management of cervical lymphadenitis in children. Am Fam Physician 2008; 78:1097. | |||
<references/> | <references/> | ||
[[Category:Dermatology]] [[Category:ID]] | [[Category:Dermatology]] [[Category:ID]] | ||
Latest revision as of 21:45, 9 September 2020
Not to be confused with lymphangitis.
Background
- Lymphadenitis = inflammation of lymph node
- Can be single or multiple
- Most commonly due to viral or bacterial disease (usually staph or strep) infection local to region draining lymph to that node
- Pyogenic organisms may cause suppurative infection/abscess
- Not to be confused with lymphangitis
Clinical Features
Tuberculosis lymphadenitis: diffuse swelling in left submandibular region.
- Pain
- Erythema
- Enlargement over time
- Associated symptoms:
- Fever
- Local signs of infection depending on location of lymph node
- Cervical
- URI symptoms
- Conjunctivitis
- Mouth sores, dental infection
- Axillary
- Breast infections
- Upper-limb infections
- Mesenteric
- Inguinal
- GU infections
- Lower-limb infections
- Cervical
Differential Diagnosis
Lymphadenitis
Infectious
- Reactive adenitis
- Bacterial lymphadenitis
- Tuberculous lymphadenitis
- Cellulitis
- Cat-scratch disease
- Parotitis
- Lymphangitis
- Toxoplasmosis
- Tularemia
- Viral disease
- Fungal disease
- Reactive adenitis
Non-Infectious
- Malignancy
- Lymphoma
- Metastatic cancer
- Rheumatologic Disease
- Kawasaki Disease
- Systemic lupus erythematosus
- Sarcoidosis
- Juvenile Idiopathic Arthritis
- Langerhans Cell Histiocytosis
- Cutaneous Lesions:
- Bacillary angiomatosis
- Purpura
- Hematomas
- Angiomas
- Dermatofibromas
- Nevi
- Drug reaction
- Postvaccination
- Sarcoidosis
- Salivary gland diagnoses
Cervical Lymphadenopathy
- Hodgkin's lymphoma
- Non-Hodgkin's lymphoma
- Mononucleosis
- Toxoplasmosis
- Branchial cleft lesions
- Cat scratch disease
- Mycobacterial adenitis
Evaluation
- Usually clinical diagnosis
- If associated exudative pharyngitis, consider Rapid GAS testing
- If severe symptoms (ill-appearing, high fever), consider:
- Basic labs (CBC, BMP)
- Blood cultures
- ESR/CRP may be helpful for monitoring course of infection/response to treatment
- Ultrasound to evaluate for associate abscess or deep locations
- If subacute/chronic, consider:
- CBC, BMP, ESR/CRP
- Uric acid, LDH
- Tuberculin skin test
Management
- Mild symptoms (well appearing, absent/low-grade fever, minimal tenderness)
- Serial exams, PMD follow-up
- PO Antibiotic treatment if associated GAS pharyngitis found
- Moderate symptoms (fever, tenderness without fluctuance)
- Empiric PO Antibiotic therapy that covers S. Aureus and GAS
- Cephalexin 500 mg PO QID x 10 days
- Amoxicillin-Clavulanate 875 mg PO BID x 10 days
- Clindamycin 300-450 mg PO TID x 10 days
- Consider anaerobic coverage if found to have poor dentition or evidence of periodontal disease
- Empiric PO Antibiotic therapy that covers S. Aureus and GAS
- Severe symptoms (ill-appearing, fever, fluctuance or overlying cellulitis)
- Incision & Drainage or Needle Aspiration
- IV Antibiotics
Disposition
- Generally can be discharged with outpatient follow-up/treatment if mild/moderate symptoms
- Admit for:
- Sepsis/Severe symptoms requiring I&D or IV antibiotics
- Failure of outpatient treatment
External Links
References
- Dulin MF, Kennard TP, Leach L, Williams R. Management of cervical lymphadenitis in children. Am Fam Physician 2008; 78:1097.