Cervical Adenitis
Cervical Adenitis is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
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:
- >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
Etiology
Etiology
- ∼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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Citation
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TY - ELEC
T1 - Cervical Adenitis
ID - 307553
ED - Barkin,Adam Z,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Shayne,Philip,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307553/all/Cervical_Adenitis
PB - Lippincott Williams & Wilkins
ET - 5
DB - Emergency Central
DP - Unbound Medicine
ER -