Cervical Adenitis

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

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  • Acute bacterial infection of a cervical lymph node
    • Often arising after a prior bacterial infection of the head or neck area
  • Primarily a pediatric disease:
    • Becoming more common in adults owing to immunocompromised disease states (HIV, cancer, transplant patients)
  • Any cervical node can become infected:
    • >80% of childhood cervical lymphadenitis involves the submandibular or deep cervical nodes
    • Jugulodigastric node located just below the angle of the mandible is common site
    • Cervical nodes act as the final common pathway for lymphatic drainage of all areas of the head and neck
    • Initial lymphadenopathy results after bacterial invasion of regional areas of the head and neck
    • Local lymph nodes swell secondary to hyperplasia of sinusoidal cells and infiltration of lymphocytes
    • If the infection is not contained, the bacteria enter the lymph system and proliferate (lymphadenitis)
    • Pus forms when neutrophils are incited, and an abscess develops when host defenses are unable to clear infection
    • Clinically manifests as warm, tender, swollen, erythematous node


  • ∼70% of cases are a result of group A β-hemolytic Streptococcal infection
    • 20% Staphylococcal infection
    • 10% related to viral infection or other bacteria
  • Infections secondary to community-acquired MRSA (CA-MRSA) have increased in frequency
  • Children have one of the highest rate of CA-MRSA colonization and invasive disease
  • Mycobacteria TB:
    • Scrofula or tuberculous lymphadenitis
    • Rarely seen
    • Usually a chronic lymphadenitis in the posterior cervical nodes
    • Purified protein derivative (PPD) is usually strongly reactive
    • Treatment is nonsurgical
  • Atypical mycobacteria (nontuberculous) Mycobacterium avium complex:
    • More commonly seen
    • Usually a chronic lymphadenitis in the submandibular or anterior cervical nodes
    • PPD test results are unreliable
    • Treatment is primarily surgical
  • Bartonella henselae (catscratch disease):
    • Subacute lymphadenitis
    • Fever and mild systemic symptoms occur in only ∼3% of patients
    • Has indolent course but usually spontaneously resolves after 4–6 wk
  • Anaerobes:
    • Consider when associated with infections of the teeth or gingiva
  • Rare organisms:
    • Gram-negative bacilli
    • Yersinia pestis
    • Group B streptococcus
    • Francisella tularensis
    • Alpha-streptococcus
    • Anthrax

Pediatric Considerations
  • One of the most common causes of a neck mass in a child
  • Overall, group A Streptococcus and Staphylococcus aureus most common causes
  • In neonates, group B Streptococcus and S. aureus most common
  • Group B Streptococcal cellulitisadenitis syndrome:
    • Infants are usually 3–7 wk of age, male, febrile, with submandibular or facial cellulitis, and an ipsilateral otitis media
    • 94% incidence of concurrent bacteremia
  • S. aureus associated with more indolent course and higher frequency of suppuration
  • Viral infections generally result in bilateral lymphadenopathy

Geriatric Considerations
  • Consider malignancy over infection in this population, especially in the absence of fever, leukocytosis, etc.
  • Fixed, nontender, hard node most likely not cervical adenitis

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