Transcript Lymphadenopathy in Children

Lymphadenopathy
DR.FAROOQ
ALAM
M.B.B.S-M.phil
Definition
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Palpable lymph nodes are normal in anterior cervical,
axillary and inguinal regions in healthy person.
Lymphadenopathy is enlargement of the lymph nodes
beyond this normal state. Practically this is any node >1.0
cm in greatest diameter
Certain nodes should be considered enlarged at different
sizes (i.e. epitrochlear nodes > 0.5 cm, inguinal nodes > 1.5
cm, submandibular nodes > 1.5 cm)
Generalized adenopathy has been
defined as
involvement of three or more 
noncontiguous lymph node areas.
generalized lymphadenopathy is 
frequently associated with
nonmalignant disorders
Etiology of Lymphadenopathy
 Acute
Infectious
 Subacute/Chronic Infectious
 Malignancy
 Systemic
disease/Noninfectious
Differential Diagnosis of
Generalized Lymphadenopathy
Infectious
 Bacterial - Staphylococcus, Streptococcus, Cat
Scratch Disease, Toxoplasmosis, Syphilis,
Tuberculosis,
Atypical
mycobacterium,
Brucellosis, Tularemia, Leptospirosis
 Viral - Epstein Barr Virus, Cytomegalovirus,
HIV, Rubella, Hepatitis B
 Fungal
Aspergillosis,
Candida,
Histoplasmosis
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Cont. Differential Diagnosis of
Generalized Lymphadenopathy
 Malignant
- Leukemia, Lymphoma,
Metastatic
 Autoimmune - Rheumatoid arthritis,
Systemic Lupus Erythematosis, Serum
Sickness, Sarcoidosis
 Immunodeficiency – HIV
 Other
benign/pathologic processes Storage diseases, Embryological cysts
Medications That May Cause
Lymphadenopathy

Allopurinol
(Zyloprim)
Atenolol (Tenormin)
Captopril (Capozide)
Carbamazepine
(Tegretol)
Cephalosporins
Gold
Hydralazine
(Apresoline)
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Penicillin
Phenytoin (Dilantin)
Primidone
(Mysoline)
Pyrimethamine
(Daraprim)
Quinidine
Sulfonamides
Sulindac (Clinoril)
Immunizations
Smallpox (historically)
Live attenuated
MMR(Measles,Mums,Rubella),(Diptheria,Polio,Tetanus)DPT
Poliomyelitis
Typhoid fever
**Usually self limited and resolves with cessation
of medication or with time in the case of
immunization induced LAD(Lymph adenopathy
disease)
Approach to Lymphadenopathy
Reassure Family
No
Lymphadenopathy
Yes
Significant Physical Signs or Symptoms?
Yes
e.g. Weight loss, Hepatosplenomegaly …
No
Node(s) Resolving
Observe :
2-3 Weeks
Node(s) :
Increase in size
Not Resolving
Observe & Follow
Investigate :
(CBC, ESR …)
Follow-up and Treatment
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There is no specific treatment of swollen
lymph nodes.Generally the underlying cause
needs to be treated,which may result in the
resolution of the swollen lymph node.So first
Identify underlying cause and treat as
appropriate – confirmatory tests. If the patient
have a known illness that causes
lymphadenopathy?Treat and monitor for
resolution.
Follow-up and Treatment
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Generalized adenopathy – usually has identifiable
cause.
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Localized adenopathy . Is there an obvious infection
to explain the lymphadenopathy (e.g., infectious
mononucleosis)?Treat and monitor for resolution.
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3-4 week observation period for benign causes.If
resolution not occur then high clinical suspicion for
malignancy
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Biopsy if risk for malignancy - excisional
Antibiotics are given only if there is strong
evidence of an Infections.Antibiotic therapy
is indicated to rapidly decrease node size within
the first 30 days.
Antibiotic therapy should be considered in all
patients, especially those who are immunocompromised and at increased risk for
disseminated disease.
DO NOT USE GLUCOCORTICOIDS-•
might obscure diagnosis or delay healing in
cases of infection (EXCEPTION: lifethreatening pharyngeal obstruction by
enlarged lymph tissue in Waldeyer’s ring
caused by Infectious mononucleosis( IM.)
Specific Causes of
Lymphadenopathy
Lymphadenitis
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Lymphadenitis – enlarged, inflamed, tender lymph
nodes
Organisms:
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Staph aureus, GAS (80%)
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Usually submandibular
Southwest US
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Yersinia pestis(Gram negative rod shape coccobacillus) =
Bubonic plague(OTHER 2 VARIETY ARE PNEUMONIC &
SEPTICEMIC)
Bartonella henselae = cat scratch
 TB and atypical mycobacteria (M. avium and M.
scrofulaceum)
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 Management
 Culture
drainage or of pharyngeal
exudate
 Treatment
1st/2nd
generation cephalosporin or
dicloxacillin
Clindamycin or Augmentin if anaerobe
suspected (oral)
 Ultrasound
to determine if abscess
 I&D indicated if abscess present
Suppurative Bacterial
Lymphadenitis
Staphylococcus aureus and Group A
Streptococcus
 Management is initially with oral or IV
antibiotics depending on severity of
infection
 If not resolving or getting worse
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 CT
with contrast and/or Ultrasound to evaluate
for phlegmon/abscess/infiltrate
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FNA vs Surgical I&D vs Surgical Excision
if abscess is identified
Cat Scratch Disease
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Species involved:
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Bartonella Henselae
Antibiotics always given to immunocompromised
patients to prevent disseminated disease
Toxoplasmosis
 Toxoplasma
gondii:
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90% have cervical lymphadenitis
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Treatment
with
sulfonamides
pyrimethamine
or