Chapter 47 Lymphadenopathy and Lymphadenitis
ETIOLOGY
Do Lymphadenopathy and Lymphadenitis Differ?
Parents often express concern when a child has visible or palpable lymph nodes, especially if they are large, tender, or persistent. Small, nontender (“shotty”) lymph nodes are commonly palpable in the anterior cervical chain of healthy, immunologically intact children and generally do not represent a concerning finding. Lymphadenopathy refers to nontender swelling of the lymph node, usually to greater than 10 mm in size. Lymphadenitis implies enlargement and inflammation of a lymph node, often accompanied by tenderness. In many patients, the distinction between the two may be blurred.
What Causes Lymphadenopathy?
Viral infection commonly causes bilateral enlarged, minimally tender, mobile anterior cervical nodes without other lymph node involvement. Systemic viral infections, such as Epstein-Barr virus, usually cause more diffuse involvement of lymphoid tissue that includes nodes in the anterior and posterior cervical chains, and axilla, plus the spleen. Malignancy such as leukemia may cause lymphadenopathy (see Chapter 63).
What Causes Lymphadenitis?
Acute bacterial lymphadenitis is usually caused by infections with Staphylococcus aureus or Streptococcus pyogenes. Chronic cervical lymphadenitis may be caused by anaerobic bacteria in patients with poor oral hygiene, Bartonella henselae (the agent of cat scratch disease), or nontuberculous mycobacteria. Children with Kawasaki disease may have cervical node enlargement, along with fever and other manifestations of the disease.
EVALUATION
What Findings Accompany Acute Lymphadenitis?
A child with acute staphylococcal or streptococcal lymphadenitis typically has had several days of fever and an increasingly tender, swollen lymph node by the time medical attention is sought. Examination typically demonstrates a unilateral, enlarged, tender, warm, and red, solitary node or tightly matted group of lymph nodes. Although treatment is often started empirically, aspiration of a suppurative node for Gram staining and culture confirms the microbiologic diagnosis and can identify methicillin-resistant S. aureus, which has become prevalent. Occasionally, Kawasaki disease with cervical lymphadenitis may cause diagnostic confusion, but these patients do not respond to antibiotic treatment, continue to have persistent fever, and develop additional findings, including eye, mucous membrane, and extremity changes. Children with cat scratch disease or nontuberculous mycobacterial infection may be difficult to distinguish from patients with staphylococcal or streptococcal infection early in the disease course.
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