Cervical Adenitis

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

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Basics

Description

  • 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:
    • >50% of cases involve a submandibular node
    • Clinically manifests as warm, tender, swollen, erythematous node 3–6 cm in diameter
    • Nodes are usually mobile

Etiology

  • 40–89% of cases are caused by Staphylococcus aureus (increasingly CA-MRSA) or group A β-hemolytic streptococcal (GAS) infection
  • Group B streptococcus (GBS) can manifest as cellulitis/adenitis in infants
  • Anaerobes:
    • Consider when associated with infections of the teeth or gingiva
  • Tularemia (Francisella tularensis)
    • Febrile illness that occurs following contact with infected animals (rabbit, hamster, rodent)
    • Most cases in the U.S. occur in south-central region
    • Ulceroglandular syndrome (papular lesion in the drainage field of the inflamed lymph node)
  • Cat-scratch disease (Bartonella henselae)
    • Symptoms begin within 1–4 wk following inoculation from bite or scratch
    • Fever and mild systemic symptoms occur in ∼30% of patients
    • Axillary nodes most commonly affected but 1 in 4 children may have isolated cervical nodes
    • Has indolent course but usually spontaneously resolves after 4–6 wk
  • Nontuberculous mycobacteria (NTM)
    • Mycobacterium avium complex (MAC) most common cause
    • Usually presents as unilateral firm, nontender node that slowly enlarges over weeks (<4 cm)
    • Submandibular, jugulodigastric, parotid nodes most commonly affected
    • Typically seen in young children (<5 yr). Child may have a history of pica
  • Tuberculosis
    • Uncommon in the U.S. but significant cause of cervical adenitis in other parts of the world
    • Suspect in patient with clinical symptoms compatible with TB, abnormal CXR, history of travel to endemic area
  • Rare infectious causes
    • Yersinia pestis
    • Gram-negative bacilli
    • Anthrax
    • Pasteurella
  • Noninfectious causes
    • Connective tissues disorders (consider if associated fever, rash, arthralgia)
    • Neoplasm (persistent or progressive symptoms, nontender node, weight loss, fever, fatigue)
    • Kawasaki disease (associated with fever for ≥5 d, rash, conjunctivitis, mucositis, edema of hands and feet)

Pediatric Considerations
  • One of the most common causes of a neck mass in a child
  • Overall, GAS and S. aureus most common causes
  • In neonates, GBS and S. aureus most common
  • GBS cellulitis–adenitis 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 a 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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Basics

Description

  • 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:
    • >50% of cases involve a submandibular node
    • Clinically manifests as warm, tender, swollen, erythematous node 3–6 cm in diameter
    • Nodes are usually mobile

Etiology

  • 40–89% of cases are caused by Staphylococcus aureus (increasingly CA-MRSA) or group A β-hemolytic streptococcal (GAS) infection
  • Group B streptococcus (GBS) can manifest as cellulitis/adenitis in infants
  • Anaerobes:
    • Consider when associated with infections of the teeth or gingiva
  • Tularemia (Francisella tularensis)
    • Febrile illness that occurs following contact with infected animals (rabbit, hamster, rodent)
    • Most cases in the U.S. occur in south-central region
    • Ulceroglandular syndrome (papular lesion in the drainage field of the inflamed lymph node)
  • Cat-scratch disease (Bartonella henselae)
    • Symptoms begin within 1–4 wk following inoculation from bite or scratch
    • Fever and mild systemic symptoms occur in ∼30% of patients
    • Axillary nodes most commonly affected but 1 in 4 children may have isolated cervical nodes
    • Has indolent course but usually spontaneously resolves after 4–6 wk
  • Nontuberculous mycobacteria (NTM)
    • Mycobacterium avium complex (MAC) most common cause
    • Usually presents as unilateral firm, nontender node that slowly enlarges over weeks (<4 cm)
    • Submandibular, jugulodigastric, parotid nodes most commonly affected
    • Typically seen in young children (<5 yr). Child may have a history of pica
  • Tuberculosis
    • Uncommon in the U.S. but significant cause of cervical adenitis in other parts of the world
    • Suspect in patient with clinical symptoms compatible with TB, abnormal CXR, history of travel to endemic area
  • Rare infectious causes
    • Yersinia pestis
    • Gram-negative bacilli
    • Anthrax
    • Pasteurella
  • Noninfectious causes
    • Connective tissues disorders (consider if associated fever, rash, arthralgia)
    • Neoplasm (persistent or progressive symptoms, nontender node, weight loss, fever, fatigue)
    • Kawasaki disease (associated with fever for ≥5 d, rash, conjunctivitis, mucositis, edema of hands and feet)

Pediatric Considerations
  • One of the most common causes of a neck mass in a child
  • Overall, GAS and S. aureus most common causes
  • In neonates, GBS and S. aureus most common
  • GBS cellulitis–adenitis 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 a 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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