Lymphadenitis: Difference between revisions

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''Not to be confused with [[lymphangitis]].
==Background==
==Background==
Lymphadenitis is any inflammation or enlargement of a lymph node. It can occur as an enlargement of a single or multiple node, and is typically caused by local skin or soft tissue bacterial infection (usually staph or strep). Lymphadenitis is not to be confused with [[lymphangitis]], which is an inflammation of the lymphatic ''channels''. Lymphadenitis usually presents with fever and tender lymphadenopathy.
*Lymphadenitis = inflammation of lymph node
*Can be single or multiple
*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
*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
*[[rash|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
****[[Abdominal pain]], [[nausea/vomiting]]
***Inguinal
****GU infections
****Lower-limb infections


==Differential Diagnosis==
==Differential Diagnosis==
 
{{Lymphadenitis DDX}}
{{Cervical lymphadenopathy DDX}}


==Evaluation==
==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==
==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
*Severe symptoms (ill-appearing, fever, fluctuance or overlying cellulitis)
**Incision & Drainage or Needle Aspiration
**IV Antibiotics


==Disposition==
==Disposition==
 
*Generally can be discharged with outpatient follow-up/treatment if mild/moderate symptoms
 
*Admit for:
==See Also==
**[[Sepsis]]/Severe symptoms requiring I&D or IV antibiotics
 
**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: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

Differential Diagnosis

Lymphadenitis

Infectious

Non-Infectious

Cervical Lymphadenopathy

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
    • Consider anaerobic coverage if found to have poor dentition or evidence of periodontal disease
  • 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.
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