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Lymphadenitis

by A. Damian Dhar, MD, JD

(See Lymphangitis.)

Lymphadenitis is an acute infection of one or more lymph nodes.

Lymphadenitis is a feature of many bacterial, viral, fungal, and protozoal infections. Focal lymphadenitis is prominent in streptococcal infection, TB or nontuberculous mycobacterial infection, tularemia, plague, cat-scratch disease, primary syphilis, lymphogranuloma venereum, chancroid, and genital herpes simplex. Multifocal lymphadenitis is common in infectious mononucleosis, cytomegalovirus infection, toxoplasmosis, brucellosis, secondary syphilis, and disseminated histoplasmosis.

Symptoms and Signs

Lymphadenitis typically causes pain, tenderness, and lymph node enlargement. Pain and tenderness typically distinguish lymphadenitis from lymphadenopathy. With some infections, the overlying skin is inflamed, occasionally with cellulitis. Abscesses may form, and penetration to the skin produces draining sinuses. Fever is common.

Diagnosis

The underlying disorder is usually suggested by history and examination. If not, aspiration and culture or excisional biopsy is indicated.

Treatment

  • Treatment of cause

Treatment is directed at the cause and is usually empiric. Options include IV antibiotics, antifungals, and antiparasitics depending upon etiology or clinical suspicion. Many patients with lymphadenitis may respond to outpatient therapy with oral antibiotics. However, many also go on to form abscesses, which require surgical drainage; an extensive procedure is done with accompanying IV antibiotics. In children, IV antibiotics are commonly needed. Hot, wet compresses may relieve some pain. Lymphadenitis usually resolves with timely treatment, although residual, persistent, nontender lymphadenopathy is common.

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