Mesenteric Lymphadenitis Clinical Presentation
- Author: Jennifer Lynn Bonheur, MD; Chief Editor: Julian Katz, MD more...
The disease may have a variable course, depending on the patient's age and condition and/or the pathogenic properties of the causative organisms. The onset and progression of mesenteric lymphadenitis may be insidious or, sometimes, dramatic.
Clinical features of associated organ involvement, such as enterocolitis or ileitis in Yersinia infection, may be present. Clinical presentations include the following:
- Abdominal pain - Often right lower quadrant (RLQ) but may be more diffuse
- Concomitant or antecedent upper respiratory tract infection
- Nausea and vomiting (which generally precedes abdominal pain, as compared to the sequence in appendicitis)
- History of ingestion of raw pork may be obtained in areas with endemic Yersinia (eg, Belgium).
No set of physical findings is pathognomonic of mesenteric lymphadenitis.
- Fever (38-38.5°C)
- Flushed appearance
- RLQ tenderness - Mild, with or without rebound tenderness
- Voluntary guarding rather than abdominal rigidity
- Rectal tenderness
- Hyperemic pharynx
- Toxic appearance
- Associated peripheral lymphadenopathy (usually cervical) in 20% of cases
See the list below:
- Numerous organisms have been cultured from mesenteric lymph nodes and blood.
- Organisms include beta-hemolytic streptococcus, Staphylococcus species, Escherichia coli, Streptococcus viridans, Yersinia species (responsible for most cases currently), Mycobacterium tuberculosis, Giardia lamblia, and non– Salmonella typhoid.
- Viruses, such as coxsackieviruses (A and B), rubeola virus, and adenovirus serotypes 1, 2, 3, 5, and 7, have been implicated.
- Mesenteric node involvement can also be part of infectious Epstein-Barr virus (EBV), acute human immunodeficiency virus (HIV) infection, and catscratch disease (CSD).
- The frequent association of this condition, especially in children with upper respiratory tract infection, has popularized a theory that swallowed pathogen-laden sputum may be the primary source of infection.
- Fecal-oral transmission occurs in Y enterocolitica infection and may present as a common source outbreak. This infection has also been associated with meat, milk, and water contamination. Rarely, person-to-person or zoonotic contacts with fecal carriers can lead to infection.
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