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Lymphadenitis

Lymphadenitis is a topic covered in the 5-Minute Emergency Consult.

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Emergency Central

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Basics

Description

  • Lymph nodes may be swollen and tender as part of the systemic response to infection:
    • Become engorged with lymphocytes and macrophages
    • May be primarily infected
    • Infection in distal extremity may result in painful tender adenopathy proximally
  • Acute suppurative lymphadenitis may occur after pharyngeal or skin infection

Etiology

  • Most frequently caused by bacterial infection
  • Most common organisms in pyogenic lymphadenitis:
    • Staphylococcus aureus—including resistant strains such as community-associated methicillin-resistant S. aureus (CA-MRSA):
      • CA-MRSA risk factors include prior MRSA infection, household contact of CA-MRSA patient, military personnel, incarcerated persons, athletes in contact sports, IV drug users, men who have sex with men
      • Different antibiotic susceptibility than nosocomial MRSA
      • CA-MRSA now sufficiently prevalent to warrant coverage in empiric treatment
      • Suspect CA-MRSA in unresponsive infections
    • Group A β-hemolytic Streptococcus
  • Cervical lymphadenitis:
    • Usually pharyngeal or periodontal process
    • Streptococcus and anaerobes
  • Axillary lymphadenitis:
    • Streptococcus pyogenes (group A β-hemolytic Streptococcus)
  • Nosocomial MRSA:
    • Risk factors: Recent hospital or long-term care admission, surgery, injection drug use, vascular catheter, dialysis, recent antibiotic use, unresponsive infection
    • Resistant to most antibiotics (see “Treatment”)

Pediatric Considerations
  • Acute unilateral cervical suppurative lymphadenitis:
    • Most common at age <6 yr
    • Group A Streptococcus, S. aureus, and anaerobes are most common causes

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Citation

Rosen, Peter, et al., editors. "Lymphadenitis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307233/all/Lymphadenitis.
Lymphadenitis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307233/all/Lymphadenitis. Accessed April 26, 2019.
Lymphadenitis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307233/all/Lymphadenitis
Lymphadenitis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307233/all/Lymphadenitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Lymphadenitis ID - 307233 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307233/all/Lymphadenitis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -