Suppurative lymphadenitis

Article

Abstract

Suppurative lymphadenitis is an important and common form of soft tissue infection. Most acute cases of suppurative lymphadenitis are caused by Staphylococcus aureus or by Streptococcus pyogenes. Empiric antibiotic therapy is frequently successful in the early stages of the disease process, but increasing prevalence of methicillin-resistant S. aureus in particular has necessitated a shift in antibiotic choice that is dictated primarily by specific local resistance patterns. Several other organisms and noninfectious inflammatory processes may give rise to a clinical syndrome suggestive of suppurative lymphadenitis. Failure to respond to empiric antibiotics should trigger a diagnostic re-evaluation to determine the need for surgical intervention and/or the possibility of alternative microbiologic diagnoses.

References and Recommended Reading

  1. 1.
    Junt T, Scandella E, Ludewig B: Form follows function: lymphoid tissue microarchitecture in antimicrobial immune defence. Nature Rev Immunol 2008, 8:764–773.CrossRefGoogle Scholar
  2. 2.
    Darville T, Jacobs RF: Lymphadenopathy, lymphadenitis, and lymphangitis. In Pediatric Infectious Diseases, Principles and Practice. Edited by Jenson HB, Baltimore RS. Norwalk, CT: Appleton & Lange; 1995:751–780.Google Scholar
  3. 3.
    Tanir G, Tonbul A, Tuygun N, et al.: Soft tissue infections in children: a retrospective analysis of 242 hospitalized patients. Jpn J Infect Dis 2006, 59:258–260.PubMedGoogle Scholar
  4. 4.
    Al-Dajani N, Wootton SH: Cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts. Infect Dis Clin North Am 2007, 21:523–541.PubMedCrossRefGoogle Scholar
  5. 5.
    Shefelbine SE, Mancuso AA, Gajewski BJ, et al.: Pediatric retropharyngeal lymphadenitis: differentiation from retropharyngeal abscess and treatment implications. Otolaryngol Head Neck Surg 2007, 136:182–188.PubMedCrossRefGoogle Scholar
  6. 6.
    Scobie WG: Acute suppurative adenitis in children: a review of 964 cases. Scott Med J 1969, 14:352–354.PubMedGoogle Scholar
  7. 7.
    Ahonkhai VI, Omokoku B, Rao M: Acute cervical lymphadenitis in hospitalized pediatric patients: predominance of Staphylococcus aureus in infancy. J Natl Med Assoc 1984, 76:367–369.PubMedGoogle Scholar
  8. 8.
    Luu TM, Chevalier I, Gauthier M, et al.: Acute adenitis in children: clinical course and factors predictive of surgical drainage. J Paediatr Child Health 2005, 41:273–277.PubMedCrossRefGoogle Scholar
  9. 9.
    Simo R, Hartley C, Rapado F, et al.: Microbiology and antibiotic treatment of head and neck abscesses in children. Clin Otolaryngol 1998, 23:164–168.PubMedCrossRefGoogle Scholar
  10. 10.
    Guss J, Kazahaya K: Antibiotic-resistant Staphylococcus aureus in community-acquired pediatric neck abscesses. Int J Pediatr Otorhinolaryngol 2007, 71:943–948.PubMedCrossRefGoogle Scholar
  11. 11.
    Rigante D, Spanu T, Nanni L, et al.: Deep neck infection complicating lymphadenitis caused by Streptococcus intermedius in an immunocompetent child. BMC Infect Dis 2006, 6:61.PubMedCrossRefGoogle Scholar
  12. 12.
    Kristensen LH, Prag J: Localized Fusobacterium necrophorum infections: a prospective laboratory-based Danish study. Eur J Clin Microbiol Infect Dis 2008, 27:733–739.CrossRefGoogle Scholar
  13. 13.
    Fluegge K, Greiner P, Berner R: Late onset group B streptococcal disease manifested by isolated cervical lymphadenitis. Arch Dis Child 2003, 88:1019–1020.PubMedCrossRefGoogle Scholar
  14. 14.
    Herold BC, Immergluck LC, Maranan MC, et al.: Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. J Am Med Assoc 1998, 279:593–598.CrossRefGoogle Scholar
  15. 15.
    Inman JC, Rowe M, Ghostine M, Fleck T: Pediatric neck abscesses: changing organisms and empiric therapies. Laryngoscope 2008, 118:2111–2114.PubMedCrossRefGoogle Scholar
  16. 16.
    Ma XX, Ito T, Tiensasitorn C, et al.: Novel type of staphylococcal cassette chromosome mec identified in community-acquired methicillin-resistant Staphylococcus aureus strains. Antimicrob Agents Chemother 2002, 46:1147–1152.PubMedCrossRefGoogle Scholar
  17. 17.
    Boyle-Vavra S, Daum RS: Community-acquired methicillin-resistant Staphylococcus aureus: the role of Panton-Valentine leukocidin. Lab Invest 2007, 87:3–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Kaplan SL: Community-acquired methicillin-resistant Staphylococcus aureus infections in children. Semins Pediatr Infect Dis 2006, 17:113–119.CrossRefGoogle Scholar
  19. 19.
    Hazra R, Robson CD, Perez-Atayde AR, Husson RH: Lymphadenitis due to nontuberculous mycobacteria in children: presentation and response to therapy. Clin Infect Dis 1999, 28:123–129.PubMedCrossRefGoogle Scholar
  20. 20.
    Robson CD, Hazra R, Barnes PD, et al.: Nontuberculous mycobacterial infection of the head and neck in immunocompetent children: CT and MR findings. Am J Neuroradiol 1999, 20:1829–1835.PubMedGoogle Scholar
  21. 21.
    Berger C, Pfyffer GE, Nadal D: Treatment of nontuberculous mycobacterial lymphadenitis with clarithromycin plus rifabutin. J Pediatr 1996, 128:383–386.PubMedCrossRefGoogle Scholar
  22. 22.
    Lindeboom JA, Kuijper EJ, Bruijnesteijn van Coppenraet ES, et al.: Surgical excision versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children: a multicenter, randomized, controlled trial. Clin Infect Dis 2007, 44:1057–1064.PubMedCrossRefGoogle Scholar
  23. 23.
    Ridder-Schröter R, Marx A, Beer M, et al.: Abscess-forming lymphadenopathy and osteomyelitis in children with Bartonella henselae infection. J Med Microbiol 2008, 57:519–524.PubMedCrossRefGoogle Scholar
  24. 24.
    Ridder GJ, Boedeker CC, Technau-Ihling K, et al.: Role of cat scratch disease in lymphadenopathy in the head and neck. Clin Infect Dis 2002, 35:643–649.PubMedCrossRefGoogle Scholar
  25. 25.
    Rolain JM, Brouqui P, Koehler JE, et al.: Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemother 2004, 48:1921–1933.PubMedCrossRefGoogle Scholar
  26. 26.
    Guffey MB, Dalzell A, Kelly DR, Cassady KA: Ulceroglandular tularemia in a nonendemic area. South Med J 2007, 100:304–308.PubMedGoogle Scholar
  27. 27.
    Meric M, Willke A, Finke E-J, et al.: Evaluation of clinical, laboratory and therapeutic features of 145 tularemia cases: the role of quinolones in oropharyngeal tularemia. APMIS 2008, 116:66–73.PubMedCrossRefGoogle Scholar
  28. 28.
    Khan R, Harris SH, Verma AK, Syed A: Cervical lymphadenopathy: scrofula revisited. J Laryngol Otol 2008, 10:1–4.Google Scholar
  29. 29.
    Prentice MB, Rahalison L: Plague. Lancet 2007, 369:1196–1207.PubMedCrossRefGoogle Scholar
  30. 30.
    Zimmerman RS, Hamilton JD: Yersinia enterocolitica inguinal lymphadenitis. Diagn Microbiol Infect Dis 1986, 5:265–268.PubMedCrossRefGoogle Scholar
  31. 31.
    Lee WS, Hafeez A, Hassan H, et al.: Focal non-typhoidal Salmonella infections from a single center in Malaysia. Southeast Asian J Trop Med Public Health 2005, 36:678–682.PubMedGoogle Scholar
  32. 32.
    Choi P, Qin X, Chen EY, et al.: Polymerase chain reaction for pathogen identification in persistent pediatric cervical lymphadenitis. Arch Otolaryngol Head Neck Surg 2009, 135:243–248.PubMedCrossRefGoogle Scholar
  33. 33.
    van Crevel R, Grefte JM, van Doorninck D, Sturm P: Syphilis presenting as isolated cervical lymphadenopathy: two related cases. J Infect 2009, 58:76–78.PubMedCrossRefGoogle Scholar
  34. 34.
    Lewis DA: Chancroid: clinical manifestations, diagnosis, and management. Sex Transm Infect 2003, 79:68–71.PubMedCrossRefGoogle Scholar
  35. 35.
    Kapoor S: Re-emergence of lymphogranuloma venereum. J Eur Acad Dermatol Venereol 2008, 22:409–416.PubMedCrossRefGoogle Scholar
  36. 36.
    Santana A, Lessa B, Galrão L, et al.: Kikuchi-Fujimoto’s disease associated with systemic lupus erythematosus: case report and review of the literature. Clin Rheumatol 2005, 24:60–63.PubMedCrossRefGoogle Scholar
  37. 37.
    Padeh S, Brezniak N, Zemer D, et al.: Periodic fever, aphthous stomatitis, pharyngitis, and adenopathy syndrome: clinical characteristics and outcome. J Pediatr 1999, 135:98–101.PubMedCrossRefGoogle Scholar
  38. 38.
    Pinna GS, Kafetzis DA, Tselkas OI, Skevaki CL: Kawasaki disease: an overview. Curr Opin Infect Dis 2008, 21:263–270.PubMedCrossRefGoogle Scholar
  39. 39.
    Winkelstein JA, Marino MC, Johnston RB Jr, et al.: Chronic granulomatous disease. Report on a national registry of 368 patients. Medicine (Baltimore) 2000, 79:155–169.CrossRefGoogle Scholar
  40. 40.
    van den Berg JM, van Koppen E, Ahlin A, et al.: Chronic granulomatous disease: the European experience. PLoS ONE 2009, 4:e5234.PubMedCrossRefGoogle Scholar
  41. 41.
    Lee PP, Chan KW, Jiang L, et al.: Susceptibility to mycobacterial infections in children with X-linked chronic granulomatous disease: a review of 17 patients living in a region endemic for tuberculosis. Pediatr Infect Dis J 2008, 27:224–230.PubMedCrossRefGoogle Scholar
  42. 42.
    Greenberg DE, Ding L, Zelazny AM, et al.: A novel bacterium associated with lymphadenitis in a patient with chronic granulomatous disease. PLoS Pathog 2006, 2:e28.PubMedCrossRefGoogle Scholar
  43. 43.
    Altare F, Lammas D, Revy P, et al.: Inherited interleukin 12 deficiency in a child with Bacille Calmette-Guérin and Salmonella enteritidis disseminated infection. J Clin Invest 1998, 102:2035–2040.PubMedCrossRefGoogle Scholar
  44. 44.
    Asilsoy S, Bilgili G, Turul T, et al.: Interleukin-12/-23 receptor beta 1 deficiency in an infant with draining BCG lymphadenitis. Pediatr Int 2009, 51:310–312.PubMedCrossRefGoogle Scholar
  45. 45.
    Döffinger R, Jouanguy E, Dupuis S, et al.: Partial interferon-gamma receptor signaling chain deficiency in a patient with Bacille Calmette-Guérin and Mycobacterium abscessus infection. J Infect Dis 2000, 181:379–384.PubMedCrossRefGoogle Scholar
  46. 46.
    Comeau JL, Lin TJ, Macken MB, et al.: Staphylococcal pericarditis, and liver and paratracheal abscesses as presentations in two new cases of interleukin-1 receptor associated kinase 4 deficiency. Pediatr Infect Dis J 2008, 27:170–174.PubMedGoogle Scholar
  47. 47.
    Serour F, Gorenstein A, Somekh E: Needle aspiration for suppurative cervical lymphadenitis. Clin Pediatr (Phila) 2002, 41:471–474.CrossRefGoogle Scholar
  48. 48.
    Gosche JR, Vick L: Acute, subacute, and chronic cervical lymphadenitis in children. Semin Pediatr Surg 2006, 15:99–106.PubMedCrossRefGoogle Scholar
  49. 49.
    Magarelli N, Guglielmi G, Savastano M, et al.: Superficial inflammatory and primary neoplastic lymphadenopathy: diagnostic accuracy of power-doppler sonography. Eur J Radiol 2004, 52:257–263.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.Clinical PharmacologyMerck Research LaboratoriesRahwayUSA

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