Lymphadenopathy in children

Cervical lymphadenopathy in childhood is a fairly common problem. In 38 to 45% of healthy children in all respects, the cervical lymph nodes are palpated. Pathology is an increase in the node to a size of more than 1 cm in diameter. As a rule, lymphadenopathy is a short-term response to the infectious process, but it can be a sign of more serious disorders and malignant tumors.

Bilateral acute cervical lymphadenopathy is usually caused by viral infections of the upper respiratory tract or streptococcal pharyngitis. Acute unilateral cervical lymphadenopathy in 40 to 80% of cases is associated with staphylococcal or streptococcal infection. The most common cause of subacute or chronic lymphadenitis is cat scratch disease, infection with mycobacteria or toxoplasma. Generalized lymphadenopathy is often caused by a viral infection, less often by tumors, collagenosis, and medication.

Most children do not need additional testing. Performing a general blood test, determining the ESR, X-ray and ultrasound can help with the diagnosis. According to the indications, a CT scan is carried out, skin tests for the presence of an infection with Mycobacterium tuberculosis and specific reactions are carried out to identify other pathogens (cytomegalovirus, toxoplasmosis, etc.).

If necessary, a puncture biopsy is possible, followed by a cytological examination and an inoculation of the aspirate obtained.

Depends on the etiology of the process. In most cases, lymphadenopathy is prone to self-healing and does not require therapy. The absence of signs of resolution within 4-6 weeks serves as an indication for a diagnostic biopsy.

With bacterial lymphadenopathy, antibiotics are used taking into account the sensitivity of the microorganism. If the pathogen is not known, empirical therapy should be performed taking into account the sensitivity of the most likely pathogens (S. aureus, group A β-hemolytic streptococcus).

When the tuberculosis etiology of the process is detected, the following drugs are indicated: isoniazid, rifampicin, pyrazinamide and ethambutol, streptomycin or another aminoglycoside or ethionamide for 1-2 months, followed by isoniazid and rifampicin for 9-12 months.

Pathogenetic and symptomatic treatment is also carried out. With a pronounced pain symptom, pain relievers are prescribed. In the presence of fluctuations in the lymph node, an autopsy and drainage are performed.