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Cervical Adenopathy

Cervical lymph gland enlargement commonly occurs in children. In most cases the enlargement is a transient response to a benign local or generalized viral infection, and almost all children have small palpable cervical, axillary, and inguinal nodes. About 5% have small palpable suboccipital nodes. Distinctly uncommon are palpable postauricular, supraclavicular, epitrochlear, or popliteal nodes, swollen lymph nodes.

Often the cause of the adenopathy is obvious, such as with lymph glands draining an obvious source of infection. Malignancy is suggested by painless adenopathy in the posterior or lower cervical chains, particularly in older children. Almost all adenopathy in the anterior cervical triangle (anterior to the sternomastoid muscle) is benign. Fifty percent of masses in the posterior triangle are malignant.

Etiology and epidemiology

Infection is the most common cause of cervical adenopathy.

Viral agents are the most common infectious agents causing cervical adenopathy. Human herpesvirus 6, adenoviruses, herpes simplex virus, rubella, mumps virus, Epstein_Barr, cytomegalovirus, varicella, human immunodeficiency virus.

Bacterial infection may be caused by oropharyngeal flora (anaerobes, group B streptococci, Staphylococcus aureus.

Staphylococcus aureus and group A beta-hemolytic streptococci account for 65-89% of acute unilateral infectious cervical adenitis.

Contact with domestic or wild animals or with feeding insects may result in lymphadenitis due to Toxoplasma gondii, Francisella tularensis, Yersinia pestis, Rochalimaea henselae, or Pasteurella multocida.

Cat_scratch disease ( Bartonella henselae) most often occurs after a lick or scratch from a cat or dog, or inoculation by a wood splinter, pin, fish hook, cactus spike, or porcupine quill.

Toxoplasma gondii may result from contact with cat feces, undercooked meat, or contaminated vegetables.

Francisella tularensis may be transmitted by direct contact with infected animals or their carcasses, by ingestion of water contaminated by animals, or by bites of ticks, deer flies, mosquitoes.

Brucellosis may result from contact with or ingestion of contaminated meat or dairy products, which can include those from cattle, swine, goats, dogs, or sheep.

Leptospirosis results most often from contact with water or soil contaminated by cats, dogs, rodents, or livestock.

Pasteurella multocida is an aerobic coccobacillus found in the normal flora of the mouth of many animals and occasionally of humans. Cellulitis and regional adenopathy most often occurs.

Atypical mycobacterial infections occur typically in rural Caucasian children, 1 to 4 years of age, who have no 

Mycobacterium tuberculosis generally causes tubercular cervical adenitis in children who are urban and black, have a history of exposure to tuberculosis, have an abnormal chest radiograph, unilateral.

Kawasaki syndrome may cause unilateral cervical lymphadenopathy in infants.

Treatment of acute pyogenic bacterial lymphadenitis