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Lymphadenitis Treatment & Management

  • Author: Elizabeth Partridge, MD, MPH; Chief Editor: Russell W Steele, MD  more...
 
Updated: May 11, 2015
 

Medical Care

In patients with lymphadenitis, treatment depends on the causative agent and may include expectant management, antimicrobial therapy, or chemotherapy and radiation (for malignancy).[10]

Expectant management is used when lymph nodes are smaller than 3 cm, without overlying erythema, not exquisitely tender, and present for 2 weeks or less.

Antimicrobial therapy is used when nodes are greater than 2-3 cm, are unilateral, have overlying erythema, and are tender. Antibiotics should target common infectious causes of lymphadenopathy, including S aureus and GAS. Owing to the increasing prevalence of community-acquired methicillin-resistant S aureus (MRSA), empiric therapy with clindamycin should be considered.[11] Trimethoprim-sulfamethoxazole is often effective for MRSA infection, but it is not appropriate for GAS infections.

Chemotherapy and radiotherapy are used for treatment of malignancies.

For details on medical therapy, please refer to the Medscape Reference article that discusses the specific diagnosed condition, including the following:

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Consultations

Depending on the suspected etiology, consultations with the following specialists may be appropriate:

  • Infectious diseases specialist
  • Hematologist/oncologist
  • Dermatologist
  • Otolaryngologist
  • Surgeon
  • Interventional radiologist
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Contributor Information and Disclosures
Author

Elizabeth Partridge, MD, MPH Resident Physician, Department of Pediatrics, University of California Davis Children’s Hospital

Elizabeth Partridge, MD, MPH is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Dean A Blumberg, MD Associate Professor of Pediatrics and Chief, Section of Pediatric Infectious Disease, University of California Davis Children's Hospital

Dean A Blumberg, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, California Medical Association, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Sierra Sacramento Valley Medical Society

Disclosure: Received grant/research funds from Novartis for clinical research investigator; Received speaking fees paid to university, not self from Merck for speaking and teaching; Received speaking fees paid to university, not self from sanofi pasteur for speaking and teaching.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Ulfat Shaikh, MD, MPH, to the development and writing of this article.

References
  1. Boldt DH. Lymphadenopathy and Splenomegaly, Internal Medicine, Stein. 5th Ed. 1998. Chapter 81.

  2. Pasternack MS, Marton NS. Lymphadenitis and Lymphangitis, Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. 2010. Chapter 92.

  3. Carvalho AC, Codecasa L, Pinsi G, Ferrarese M, Fornabaio C, Bergamaschi V. Differential diagnosis of cervical mycobacterial lymphadenitis in children. Pediatr Infect Dis J. 2010 Jul. 29(7):629-33. [Medline].

  4. Friedmann AM. Evaluation and management of lymphadenopathy in children. Pediatr Rev. 2008 Feb. 29(2):53-60. [Medline].

  5. Peters TR, Edwards KM. Cervical lymphadenopathy and adenitis. Pediatr Rev. 2000 Dec. 21(12):399-405. [Medline].

  6. Sejben I, Rácz A, Svébis M, Patyi M, Cserni G. Petroleum jelly-induced penile paraffinoma with inguinal lymphadenitis mimicking incarcerated inguinal hernia. Can Urol Assoc J. 2012 Aug. 6(4):E137-9. [Medline]. [Full Text].

  7. Raoot A, Dev G. Assessment of Status of rpoB Gene in FNAC Samples of Tuberculous Lymphadenitis by Real-Time PCR. Tuberc Res Treat. 2012. 2012:834836. [Medline]. [Full Text].

  8. Leung AK, Davies HD. Cervical lymphadenitis: etiology, diagnosis, and management. Curr Infect Dis Rep. 2009 May. 11(3):183-9. [Medline].

  9. Geake J, Hammerschlag G, Nguyen P, Wallbridge P, Jenkin GA, Korman TM, et al. Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: a multicentre Australian experience. J Thorac Dis. 2015 Mar. 7(3):439-48. [Medline]. [Full Text].

  10. Dulin MF, Kennard TP, Leach L, Williams R. Management of cervical lymphadenitis in children. Am Fam Physician. 2008 Nov 1. 78(9):1097-8. [Medline].

  11. Guss J, Kazahaya K. Antibiotic-resistant Staphylococcus aureus in community-acquired pediatric neck abscesses. Int J Pediatr Otorhinolaryngol. 2007 Jun. 71(6):943-8. [Medline].

 
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A lymph node biopsy is performed. Note that a marking pen has been used to outline the node before removal and that a silk suture has been used to provide traction to assist the removal.
 
 
 
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