ADMISSIONS FOR CERVICAL LYMPHADENITIS IN A GENERAL PAEDIATRICS UNIT

Abstract

Introduction: Cervical lymphadenitis (CL) is a common condition in children. Acute bilateral CL is the most frequent presentation, usually self-limited and caused by virus. Acute unilateral CL is commonly bacterial, most frequently caused by Streptococcus pyogenes and Staphylococcus aureus. Bartonella, Mycobacteria and Toxoplasma must be considered when the CL is subacute/chronic.

Objective: Characterization of children with CL hospitalized in a paediatric unit. Population and methods: Retrospective comparative study of a convenience sample that includes inpatient children, between March 1999 and February 2010.

Results and Discussion: Sixty-one patients were identified, 88,5% female. All CL were infectious. Acute CL was observed in 88,5% of cases (57,4% unilateral and 31,1% bilateral). Subacute/chronic CL occurred in 11,5%. The average age in acute cases was significantly lower than in subacute /chronic ones (p=0,034). Bacterial CL occurred in 96,7% and the remaining cases included infectious mononucleosis (n=1) and ganglionar toxoplasmosis (n=1). S. aureus and S. pyogenes were isolated in 66,6% of the patients. In addition, Mycobacterium tuberculosis was identified in three cases, Bartonella henselae in two and Ricketsia conorii in two. Previous head and neck infections were found in 27 patients (44,3%) with CL. Preceding viral infections were found in five cases. Cervical and submandibular nodes were the most frequent involved, 47,5% and 44,3% respectively. Fever was present in 85,2% and regional complaints (torticollis and trismus) in 45%. In 29%, the nodes developed fluctuation and 24,6% needed surgical drainage. Six (9,8%) patients underwent fine -needle aspiration and 45 had image studies performed. Leukocyte count > 15000/μL and positive C Reactive Protein (>3 mg/dL) were present in 83,6% and 65,5% respectively. S. pyogenes and S. aureus infections were associated more frequently with skin inflammatory signs and need for surgical drainage (p=0,01). Antibiotics were used in all patients, most commonly amoxicillin -clavulanate (57,3%) and flucloxacillin (19,7%). The outcome was favourable in all patients.

Conclusion: Aetiology identification for CL can be challenging. Although the majority of children with CL can be managed in an outpatient setting, there are cases that require in-hospital diagnostic investigation or intensive care. Since Portugal presents a medium incidence of tuberculosis, clinicians should maintain a high -level of suspicion for the emergence of multiresistant M. tuberculosis.