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Tuberculosis is a common occurrence in developing countries. Drug resistance, co-morbidities, and limited availability of new rapid tests such as the GeneXpert/MTB Rif assay make diagnosis and treatment of extrapulmonary tuberculosis burdensome. A cross-sectional study was carried out at Employees' State Insurance Corporation Medical College and Hospital, Faridabad, Haryana of patients treated for tubercular cervical lymphadenopathy from December 2021 to March 2023 in the department of ENT. This study included 58 patients. The clinicopathological profile of patients and the outcome of treatment with antitubercular therapy were noted. The majority of patients had level V (39.6%) involvement. Incidental diagnosis of diabetes mellitus was seen in 2 cases (3.4%). Fever was the commonest constitutional symptom observed in 27.5% of cases. FNAC was suggestive of tubercular abscess in 48.2% and the GeneXpert MTB/RIF assay detected Mycobacterial tuberculosis in all the cases with rifampicin resistance in only one case. 56 cases (96.5%) had complete resolution after completion of antitubercular therapy including patients with rifampicin resistance and patients with diabetes mellitus. In the remaining two cases, treatment was prolonged for a few months before the resolution of the disease was observed. Timely diagnosis, patient compliance to antitubercular therapy, and adequate management of comorbidities lead to successful treatment outcomes in tubercular cervical lymphadenitis. Delayed response to treatment in a few cases needs further research into factors like immune status, nutrition, living conditions, and quality of drugs available to the public. [ABSTRACT FROM AUTHOR]

Suppurative cervical lymphadenitis sometimes resolves with oral antibiotic treatment; however, many children are hospitalized for intravenous treatment due to lack of improvement. When there is no substantial improvement, the possibility of a liquefaction process is considered, and as a result, source control such as needle aspiration or open surgical drainage is recommended. We examined, among pediatric patients hospitalized with suppurative cervical lymphadenitis, clinical and laboratory predictors for invasive intervention that may lead to early imaging and intervention, hasten recovery, and shorten length of hospitalization. We compared laboratory and clinical characteristics of pediatric patients hospitalized with suppurative cervical lymphadenitis during 2010-2017, according to 3 treatments: needle aspiration (N = 54), open surgical drainage (N = 37), and conservative adequate antibiotic treatment only (N = 292). Physical indicators such as local erythema and fluctuation were found as predictors for invasive interventions in hospitalized pediatric patients diagnosed with suppurative cervical lymphadenitis. No significant associations were found between invasive interventions and laboratory parameters assessed in this study. Children who underwent interventions displayed a prolonged average length of hospitalization and received extended antibiotic treatment prior to hospital admission. In hospitalized pediatric patients diagnosed with suppurative cervical lymphadenitis, physical examination findings are the main predictive factors for invasive interventions. Consequently, when such straightforward clinical findings are observed in the context of insufficient improvement during antibiotic treatment, they should prompt consideration of invasive intervention. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis is a specific infectious disease caused by bacteria belonging to the "Mycobacterium tuberculosis complex". It presents a great social and economic problem and is one of the major factors responsible for high morbidity and mortality in India. The incidence of tuberculous cervical lymphadenopathy accounts for two third of extra pulmonary tuberculous lymphadenopathy. Higher proportion of tuberculous origin is because of greater incidence of pulmonary tuberculosis in our country. Perhaps there are many other causes of lymphadenopathy which are usually misdiagnosed as tuberculosis. Thus, it has been a common problem for both the clinicians as well as the pathologists to diagnose tuberculosis. Methods and Materials: The present work is carried out in 100 clinically suspected cases of tuberculous cervical lymphadenitis attending E.N.T., Surgery, Paediatrics and Medicine Department of central India institute as an outdoor/indoor patient during the period of one year. Patients with enlarged cervical lymph nodes with a history suggestive of tuberculosis were included after taking an informed consent. Results: Study was conducted on 100 clinically suspected cases of tuberculous cervical lymphadenitis, Tuberculosis was diagnosed in 57% cases by FNAC, smear and culture together, the maximum incidence of tuberculosis was observed in second and third decades, Females were more affected (64%) than males with the ratio of 1:2.3. FNAC showed accuracy of 42%, 30% cases were AFB smear positive in our study which nearly matches to other authors. The culture studies could diagnose 57 cases as tuberculous and 4 cases as non-tuberculous cervical lymphadenitis. Culture positive was higher in granulomatous necrotic lesions. Sensitivity, specificity and predictive values of culture study were significantly higher than FNAC and smear. These methods of investigation require considerable experience and confidence of the pathologist who perform the procedure for better results. When culture was taken as Gold Standard, cytology was found to be more sensitive than smear. Conclusions: From this study we concluded that Both FNAC and smear are quick, simple, less traumatic and cost-effective methods and are used as routine investigating procedures in OPDs of urban and semi-urban hospitals. Simplicity of these techniques (FNAC & Smear) combined with early availability of results and good diagnostic accuracy warrants their clinical application. Missed cytological diagnosis and isolation of nontuberculous mycobacteria justify the use of culture studies in all suspected tuberculous lymphadenitis cases. [ABSTRACT FROM AUTHOR]

Background: Post-COVID-19 multisystem inflammatory syndrome (MIS) has been increasingly recognized but fever with isolated tender cervical lymphadenitis as the initial presentation has been rarely reported. We present 2 female patients one a child and the other an adolescent. Case presentation: Case 1 was a 13-year-old girl who presented with tender cervical lymphadenopathy and fever 3-weeks post-COVID-19, and then developed features of MIS 5 days later. Case 2, also female, was 18 years old. She had no history of COVID-19 infection or immunization but had a serologic diagnosis of COVID-19. She similarly presented with fever and tender cervical lymphadenopathy, and then progressed rapidly to develop features of MIS. Both patients responded well to treatment with immunosuppressants and intravenous immunoglobulin. Conclusion: Tender cervical lymphadenopathy could be the herald of multi-system inflammatory syndrome following COVID-19 infection among children and adolescents, which the clinicians must have a good suspicion about. [ABSTRACT FROM AUTHOR]

• Mycobacterium avium lymphadenitis may have a risk of using a Janus kinase inhibitor. • M. avium cervical lymphadenitis can occur without lung disease. • Lymph node excision should be done in M. avium cervical lymphadenitis. • The need for antibiotics for M. avium cervical lymphadenitis is unclear. • Immunosuppression during Mycobacterium infection should be discussed with specialists. A woman diagnosed with rheumatoid arthritis and treated with Janus kinase (JAK) inhibitors presented with a gradually enlarging bilateral submandibular lymph nodes swelling that had lasted several weeks. A lymph node biopsy showed epithelioid granulomatous lymphadenitis with caseous necrosis. Mycobacteria grew in acid-fast bacteria culture and were identified as Mycobacterium avium by polymerase chain reaction. The patient was diagnosed with cervical lymphadenitis caused by M. avium. A computed tomography scan showed no evidence of a mass or infection at other sites, including the lungs; therefore, the mass was excised without any antimicrobial treatments. Her neck mass had not recurred at 9 months after the excision. JAK inhibitors have emerged as an important new class of oral therapy for rheumatoid arthritis and other diseases. Physicians should be aware of the relatively rare complications, such as cervical lymphadenitis caused by nontuberculous mycobacteria, when using JAK inhibitors. [ABSTRACT FROM AUTHOR]

Mycobacterium tilburgii , a nonculturable mycobacterium, is an important nontuberculous mycobacterium that occasionally causes serious infections in patients with cellular immune deficiencies. Due to its nonculturable nature, information about its drug susceptibility is not available, and data about its clinical response to antimycobacterial treatment remains insufficient. Here, we report a case of a patient who presented with neck swelling and was finally diagnosed with cervical abscess caused by M. tilburgii carrying anti-interferon gamma autoantibodies using a molecular method. The relevant literature was reviewed in the context of epidemiological and clinical data on M. tilburgii infections. In this report, 15 patients were reported to be infected with M. tilburgii. Almost all patients had a cellular immune deficiency and presented with disseminated infections. Multiple refractory or relapse cases that often required prolonged antimycobacterial treatment have been reported, although a few fatal cases have also been reported. In conclusion, M. tilburgii is an important pathogen in patients with cellular immune deficiency. Physicians should thoroughly investigate cellular immune deficiency, including adult-onset immune deficiency with anti-interferon gamma autoantibodies, in patients with M. tilburgii infection. [ABSTRACT FROM AUTHOR]

Objective: To analyze the role of Fine Needle Aspiration Cytology (FNAC) in the detection of tuberculous cervical lymphadenitis. Methods: A retrospective cross-sectional study was carried out at the Dr. Ruth K. M. Pfau Civil Hospital Karachi's ENT-Head and neck surgery department, from April 2021 till March 2022. Patients with ages between 30-70 years having cervical lymphadenopathy lasting for more than or equal to 3 months and having 1 or more palpable lymph nodes of more than or equal to 1 cm were included in the study. A questionnaire was designed for data collection from the patients. The names, ages, gender of the patients, the duration of disease noted down. The dominating nodes' FNAC and ultrasound neck were done. Inconclusive FNAC were followed by excisional biopsy. The sample size was taken as 50, with analysis done through SPSS version 23. Results: There were 34 (64%) females and 16 (32%) males present. The patients' average age was 52.94 ± 9.43 years; 33 patients were below the age of 55, out of which 25 (75.7%) had positive and 8 (24.2%) had negative FNAC. Of the patients over the age of 55, 11 (64.7%) had positive and 6 (54.5%) had negative FNAC. The illness lasted 5.84 ± 2.63 months on average, 2 months being the minimum duration of disease, while maximum duration was 15 months. The duration of less than or equal to six months was observed in 40 (80%) and the duration of more than 6 months was observed in 10 (20%) of patients. W ith a mean size of 2.5 ± 1.14 cm, 29 patients (58%) had unilateral nodes and 21 (42%) had bilateral nodes. FNAC has a sensitivity of 97% and specificity of 72.2%, meaning that it was positive in 36 individuals and negative in 14. Conclusion: FNAC plays a significant role in the diagnosis of tuberculous cervical lymphadenitis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effecst of Pudilan combined with acupuncture on cervical lymphadenitis in children on the expression of C-reactive protein (CRP). Methods: From August 2017 to June 2019, 84 cases children with cervical lymphadenitis diagnosed and treated in our hospital were selected as the research object. All the cases were divided into the combined group and control group of 42 cases in each groups accorded to the random number table method. The control group were given Pudilland treatment, and the combined group were given Pudilland combined with acupuncture treatment for 14 days. The treatment effects and CRP expression changes were recorded. Results: The total effective rates of the combined group were 97.6 % after treatment, which were significantly higher than 85.7 % of the control group (P<0.05). The local swelling time, local tenderness remission time and fever remission time in the combined group were significantly shorter than those in the control group (P<0.05). The serum CRP value of the two groups after treatment were lower than that before treatment, and the combined group were lower than that of the control group, compared the difference were statistically significant (P<0.05). After treatment, the proportion of CD4+T lymphocytes in both groups were higher than before treatment, and the combined group were higher than the control group, compared the difference between the two groups were statistically significant (P<0.05). There were no significant difference in the proportion of CD8+T lymphocytes between the two groups before and after treatment (P>0.05). Conclusion: Pudilland combined with acupuncture in the treatment of cervical lymphadenitis in children can inhibit the release of CRP and improve the immune function of children, thereby promote the disappearance of clinical symptoms and improve the overall treatment effects. [ABSTRACT FROM AUTHOR]

Since its introduction in 1976, Bacille Calmette-Guerin (BCG) has become the standard of care in high risk non-muscle-invasive bladder cancer. Apart from its efficacy, BCG immunotherapy is also considered to be safe. However, in addition to its common adverse effects, which are mild, it can rarely cause serious adverse effects, which can be life threatening. In this report, the case of an 85-year old male, who developed tuberculous cervical lymphadenitis and abscess after BCG immunotherapy is described. the patient pre- sented with acute renal failure. During his hospitalization he also developed hepatitis because of the anti-tuberculous therapy and eventually passed away, probably by septic emboli originated from his right jugular vein which was infiltrated by his abscess. tubercu- lous cervical lymphadenitis accompanied with abscess is a quite rare complication of BCG immunotherapy, but clinicians should be aware of it, as it can be proved fatal. [ABSTRACT FROM AUTHOR]

Objective: To correlate different cytomorphological presentations of cervical lymphadenitis suspected for Mycobacterium Tuberculosis (MTB) on Fine Needle Aspiration Cytology (FNAC) with Mycobacterium Tuberculosis detection by geneXpert on aspirated material. Study Design: Comparative, cross sectional study. Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology Rawalpindi, Jan 2017 to Nov 2018. Methodology: Fine needle aspirates of total 100 patients with cervical lymphadenitis suspected for Mycobacterium Tuberculosis were included and the cytomorphology was compared with geneXpert. Data was analyzed using SPSS version 23. Results: A total of 100 cases were included. A total of 78 cases were positive for Mycobacterium Tuberculosis while 22 cases were negative when compared with molecular analysis on aspirated material. Positivity for Mycobacterium Tuberculosis by geneXpert was seen in 93% of cases with both caseous necrosis and granulomas, 80% of cases with caseous necrosis only, 80% of cases having granulomas along with neutrophilic abscess, 70% of cases showing granulomas and 14% of cases with neutrophilic abscess (p-value<0.05). Sensitivity of Fine Needle Aspiration Cytology was 97% and specificity was 54%. Positive Predictive Value was 88% and Negative Predictive Value was 85%. Conclusion: Mycobacterium Tuberculosis was detected by GeneXpert in a significant percentage of the Fine Needle Aspiration Cytology samples included in our study. Fine Needle Aspiration Cytology is a rapid, safe, easily available, minimally invasive, outpatient procedure and GeneXpert analysis can be performed on the aspirated material. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a major killer with a majority of 80–100 per lakh and 2–3% of patients attending our hospital are suffering from tuberculosis. Glandular TB appears to be high in our society. Fifty cases of cervical lymph nodes were collected in ENT department and studied. The diagnosis of TB cervical lymph nodes by disease process is only on 'Histopathological ground'.The aim of the present study is to establish the claim of TB cervical lymph node as a disease process. [ABSTRACT FROM AUTHOR]

Paraclostridium bifermentans (current nomenclature of Clostridium bifermentans since 2016) is a gram-positive, spore-forming anaerobic bacterium. Here, we describe two cases associated with this organism. The first, primarily a case of tubercular brain abscess where P. bifermentans was isolated as part of a polymicrobial flora, following a neurosurgical procedure for the same and the second, a case of cervical lymphadenitis from which it was isolated as the sole causative agent. There are only a few reported cases of P. bifermentans in literature and these cases illustrate the widening spectrum of infections related to it. [ABSTRACT FROM AUTHOR]

Lateral neck lumps are very common in children, and are largely benign in nature. The majority of lumps may be diagnosed on history and clinical examination alone, and further investigations are often not required. The most common pathologies in young children include reactive lymphadenopathy, lymphadenitis and atypical mycobacterial infections. A lateral neck lump is an uncommon presentation for malignancy and is largely restricted to older children and adolescents. The paediatric surgeon plays an important role in the assessment and management of lateral neck lumps, often in the form of reassurance to the patients and their carers. [ABSTRACT FROM AUTHOR]

Non-tuberculous mycobacterial (NTM) infection commonly manifests as subacute or chronic cervicofacial lymphadenitis in immunocompetent children. The optimal management of this pathology remains controversial. This international consensus guideline aims to understand the practice patterns for NTM cervicofacial lymphadenitis and to address the primary diagnostic and management challenges. A modified three-iterative Delphi method was used to establish expert recommendations on the diagnostic considerations, expectant or medical management, and operative considerations. The recommendations herein are derived from current expert consensus and critical review of the literature. Multinational, multi-institutional, tertiary pediatric hospitals. Consensus recommendations include diagnostic work-up, goals of treatment and management options including surgery, prolonged antibiotic therapy and observation. The recommendations formulated in this International Pediatric Otolaryngology Group (IPOG) consensus statement on the diagnosis and management of patients with NTM lymphadenitis are aimed at improving patient care and promoting future hypothesis generation. [ABSTRACT FROM AUTHOR]

Objectives: The indications and benefits of surgery in the management of pediatric acute suppurative cervical lymphadenitis (ASCL) remain unclear. We aimed to design a management protocol focusing on the avoidance of unnecessary operation in pediatric ASCL patients. Methods: The study population consisted of 45 pediatric patients with ASCL treated with antibiotics alone and 30 surgically treated patients. The primary outcome was the determination of differences in patient characteristics and radiologic findings in the 2 groups. The secondary outcome, after matching 20 cases with 20 controls, was to determine the benefits of surgery to patients. Results: There were no significant differences between the 2 groups in patient characteristics and radiologic findings at initial presentation. In the matched case-control analysis, intravenous antibiotics alone yielded successful treatment outcomes when compared with surgery, with no significant differences in time to symptom resolution, normalized laboratory test results, and duration of hospitalization (all P > .05). Conclusions: The size and location of suppurated lymph nodes are not absolute determinants for surgical drainage in the stable pediatric ASCL patients. If patients show no clinical improvements despite appropriate second- and third-line antibiotics, patients should be carefully reevaluated and image-guided aspiration considered. [ABSTRACT FROM AUTHOR]

Background Differentiating Kawasaki disease ( KD) from cervical lymphadenitis ( CL) is clinically difficult but essential given that treatment and outcome differ significantly. Research on differentiation between KD and CL using ultrasound ( US) and computed tomography ( CT) is limited. The purpose of this study was to identify cervical US and CT findings that may differentiate KD from CL. Methods We retrospectively reviewed cervical US of 25 KD patients and 25 CL patients, and CT of 14 KD patients, and 14 CL patients. Two radiologists analyzed specific imaging features on US (lymph node size, shape, echogenicity, margins, laterality, necrosis, and presence of normal hilum) and on CT (size and location of enlarged nodes, laterality, perinodal infiltration, and retropharyngeal edema). Results On US, patients with KD more frequently had lymph nodes with a 'cluster of grapes' appearance ( KD vs CL: 64% vs 32%, P < 0.05) and less frequently had poorly circumscribed margins (0% vs 36%, P < 0.01), necrosis (0% vs 32%, P < 0.01), or non-visualization of the hilum (4% vs 36%, P < 0.01). On CT, KD patients more frequently had retropharyngeal edema (100% vs 29%, P < 0.001) and less frequently had level 4 lymphadenopathy (14% vs 79%, P < 0.01) than CL patients. Conclusions Ultrasound is mainly useful for excluding purulent lymphadenopathy while CT is a useful diagnostic tool for differentiating KD from CL, especially in patients with incomplete KD, who present with prominent cervical lymphadenopathy and other equivocal principal findings. [ABSTRACT FROM AUTHOR]

Mycobacterium bovis is a tuberculosis causing bacterium that commonly presents with cervical lymphadenopathy. It is important to differentiate M. bovis from other Mycobacterial pathogens to ensure selection of correct anti-microbial therapy. This may decrease the number of treatment failures, the prevalence of anti-mycobacterial drug resistance patterns, and the need for surgical intervention. M. bovis has universal resistance to pyrazinamide and thus may not respond to typical first line mycobacterial drugs and may require surgical intervention. This case report and review of M. bovis cervical lymphadenitits demonstrates the need for accurate diagnosis as well as combined management with infectious disease and public health specialists. [ABSTRACT FROM AUTHOR]

Atypical mycobacteriosis (AM) is a rare disease, which is caused by an infection with mycobacteria other than tuberculosis (MOTT). In children, the cervical lymph nodes are frequently affected. MOTT are a pathogen or facultative pathogen environmental germs, which can affect otherwise healthy individuals. The diagnostic and therapeutic management is often challenging. Currently, there are only few data published about the systematic investigation and therapy of children with AM. In a retrospective study, 29 children with AM were evaluated. The clinical records of these patients were reviewed and analyzed along with the results of histopathological and microbiological findings. The clinical parameters were correlated to patients' therapy and clinical follow-up. 29 otherwise healthy and immunocompetent children (18 girls, 11 boys, average age of 3.5 years, range 1.5-9.5 years) with AM of the head and neck region have been evaluated. Clinically, all patients were admitted with a swelling of cervical lymph nodes and discoloration of the overlaying skin. In five patients, an abscess formation of the lymph nodes occurred. Ultrasound examinations typically revealed a hypoechoic mass with central necrosis and intralesional septa. Histologically, epithelioid granuloma with caseating necrosis was described in any case. Germ identification by either microbiological culture or PCR was successful in 20 cases, with Mycobacterium avium and Mycobacterium intercellulare being the most frequent germs. In all patients, lymph nodes were surgically removed. In a clinical follow-up of at least 18 months, a recurrence occurred in five cases. Diagnosis of atypical mycobacteriosis is often difficult and challenging, since clinical appearance is unspecific and MOTT can only be identified microbiologically or by PCR in about two-thirds of cases. Therefore, a close cooperation between clinician, pathologist, and microbiologist is required. Therapeutically excision of all affected lymph nodes is recommended. Alternative or concomitant medical treatment with tuberculostatics is indicated in particular cases, i.e., recurrence, persistence or systemically lymph node involvement. [ABSTRACT FROM AUTHOR]

Actinomycetes are Gram-positive bacteria that can be part of the normal human flora of the gastrointestinal, pulmonary, and genital tract. Infections are rare, slowly progressing and most commonly affect the cervicofacial region. Actinomyces israelii is the most frequently isolated species but a number of other species may cause infection.We report the first postnatally acquired case of an actinomycosis caused by A. neuii in a child.We also provide a systematic review of all published cases of A. neuii infections. In children, there is one case report of a premature infant with perinatally acquired A. neuii sepsis. In adults 21 cases have currently been reported and A. neuii infection was associated with endophthalmitis after eye surgery, foreign material-associated infection and abscess formation in the inguinal, axillary, and mammary area. Our case highlights that a A. neuii infection is also a potential differential diagnosis in children with chronic lymphadenitis. [ABSTRACT FROM AUTHOR]

Summary: Background: Over the last two to three decades there has been a marked decrease in certain bacterial infections in Turkey. One of them is tuberculosis. Of note, statistics published by the Turkish Ministry of Health (MoH) show decreasing pulmonary tuberculosis (PTB), but on the other hand, increasing extrapulmonary tuberculosis (EPTB). The most common form of EPTB is tuberculous cervical lymphadenitis (TCL). The increase in the number of TCL cases despite the decline in cases of PTB is seen as a paradoxical issue. In contrast there has been an increase in the number of oropharyngeal tularemia cases in the last decade in Turkey. The aim of this study was to draw attention to the importance of differentiating between TCL and tularemia lymphadenitis, because these diseases may have a similar histopathological appearance. Methods: Thirty-two cases diagnosed as TCL were identified from the archives of a pathology laboratory (Patomer Pathology Laboratory, Bursa, Turkey). PCR tests for Francisella tularensis and Mycobacterium tuberculosis were carried out on the paraffin tissue blocks of these cases. At the same time, statistical data on PTB and EPTB for the period 1996–2010 were retrieved from the MoH and reviewed. Statistics related to tularemia, which has been diagnosed since 1988 and has been increasing in the last 10 years, were obtained from the Department of Zoonoses of the MoH. Results: Six out of 32 (19%) cases who had previously been diagnosed with ‘casseifying granulomatous lymphadenitis consistent with tuberculosis’ were found to be positive for tularemia by PCR test of the cervical lymph nodes. Conclusions: Oropharyngeal tularemia should be kept in mind in the differential diagnosis of cervical lymphadenitis in widespread geographic regions of the Northern Hemisphere, including the Asian continent. In particular, if granulomatous inflammation with necrosis is seen histopathologically, tularemia should be excluded before making the diagnosis of TCL. [ABSTRACT FROM AUTHOR]

Mycobacterium triplex was first described in 1996. This nontuberculous Mycobacterium causes a severe pulmonary disease in immunocompromised patients but it can involve also healthy patients. A literature search was made on the PubMed database and it produced only few cases of children with cervical lymphadenitis due to this Mycobacterium Triplex. We are describing a case of M. triplex cervical lymphadenitis in an immunocompetent child. [ABSTRACT FROM AUTHOR]

Abstract: Background: Acute cervical lymphadenitis is a common condition often times requiring antibiotic therapy and possible surgical drainage. The objective of this study was to describe the clinical characteristics, diagnostic and therapeutic management of children requiring surgical drainage for acute cervical lymphadenitis. Methods: A retrospective, descriptive study was performed at a Midwestern US tertiary-care children's hospital on all immunocompetent children who underwent an incision and drainage procedure of cervical lymphadenitis from January 1999 to July 2009. Results: A total of 277 patients were identified. Males represented 51% and the median age was 28 months (IQR: 13–59). Lymphadenitis was unilateral in 243 (87.7%) cases and bilateral in 19 (6.9%). Median length of hospital stay was 4 days (IQR: 3–5). Aerobic, anaerobic, acid fast bacillus (AFB), and fungal cultures were obtained intraoperatively in 99%, 98%, 82%, and 78% of cases, respectively. However no fungal cultures were positive and only 1% of anaerobic and 2% of AFB cultures were positive. The most common bacterial etiology was Staphylococcus aureus (35.7%) and Streptococcus pyogenes (18.8%). Of all cultures, 32% were negative. Overall, 22% were positive for methicillin susceptible S. aureus (MSSA) and 13.7% for methicillin resistant S. aureus (MRSA), with 96% MSSA and 100% MRSA susceptible to clindamycin. Median duration of discharge antibiotics prescribed was 10 days (IQR: 7–11). Only 12 (4.5%) patients required a repeat incision and drainage within 3 months. Conclusions: A single antibiotic that treats S. pyogenes and S. aureus should be the empiric antibiotic for cervical lymphadenitis requiring incision and drain. We recommend sending only aerobic cultures intraoperatively as a routine practice as other pathogens are rare. [Copyright &y& Elsevier]

Both tuberculosis cervical lymphadenitis ( TCL) and oropharyngeal tularaemia ( OT) have similar signs, symptoms and pathological findings. We aimed to investigate the frequency of tularaemia antibodies in patients diagnosed with TCL. Using data from the Tuberculosis Control Dispensaries between the years of 2008 and 2011 in Turkey, all patients diagnosed with TCL were informed about and included in the study. Control group subjects were selected from healthy blood donors who lived in the same region. After informed consent was obtained, the sera obtained from volunteer TCL patients and the control group were tested with a microagglutination technique for Francisella tularensis. Antibodies to Brucella were also investigated with a tube agglutination test for cross-reactivity in sera that were seropositive for tularaemia. Sera were obtained from a total of 1170 individuals in the TCL group and 596 in the control group from 67 of 81 provinces in Turkey. Francisella tularensis-positive antibodies were found in 79 (6.75%) cases in the TCL group and two (0.33%) cases in the control group with a titre of ≥1:80 (p < 0.01). When the presence of antibody of any titre was considered, the ratio became 8.2% (96/1170) in the TCL group and 0.67% (4/596) in the control group (p < 0.001). For the first time, with this study, tularaemia serology was found to be positive in a significant portion (6.75%) of diagnosed cases of TCL. In tularaemia endemic regions, it was concluded that tularaemia serology should be investigated in patients suspected of having TCL. [ABSTRACT FROM AUTHOR]

Abstract: Samuel Johnson, the acclaimed author of the Dictionary of the English Language, survived childhood scrofula with impaired sight and hearing. The cause of his scrofula has been attributed to bovine tuberculosis, but mycobacterial infection does not satisfactorily account for the peculiar features of Johnson’s eye disorder or his hearing loss. The subject of numerous biographies, Johnson may have the most scrutinized medical history of all time. Medical detectives, hampered by the vagueness of 18th-century diagnosis, suspect that phlyctenular eye disease related to tuberculosis was the reason for his visual impairment. Pediatric brucellosis can also explain childhood scrofula associated with visual and auditory disabilities, but it may be difficult to reconcile any single diagnosis given the uncertainties surrounding Johnson’s medical and ocular histories. [Copyright &y& Elsevier]

Mycobacterium interjectum is a rare causative agent of cervical lymphadenitis. We describe a 2-year-old girl with suspected tuberculous cervical lymphadenitis.Sequencing of the 16S rRNA gene allowed the correct identification of Mycobacterium interjectum. As yet, only nine case reports of infections due to M. interjectum in children have been reported in the literature, and in all of them a correct identification could only be obtained using gene sequencing. [ABSTRACT FROM AUTHOR]

Genetic defects along the interleukin (IL)-12/interferon (IFN)−γ pathway have been found in patients with mendelian susceptibility to mycobacterial disease (MSMD) caused by live BCG vaccine or non-tuberculous Mycobacterium (NTM) species, highlighting the crucial role of this axis in human immunity to Mycobacterium. The aims of this study were to characterize healthy children presenting with cervical lymphadenitis caused by NTM and to investigate their IL-12/IFN- γ pathway. Epidemiological, clinical, laboratory and pathological findings were reviewed retrospectively. Blood samples from five patients and healthy controls were in vitro activated with BCG, BCG + IL-12 and BCG + IFN-γ and levels of IL-12p40 and IFN-γ were measured. Fourteen patients (11 males, median age 24 months, range 12–78 months) were studied. The mean duration of illness before diagnosis was 9.1 weeks. Mycobacterium tuberculosis purified protein derivate (PPD) was positive in all patients (mean 14.5 ± 9.8 mm). Caseous granuloma was found in all ten patients who underwent excision biopsy. However, acid fast stain was positive in only five children and cultures were positive in only three cases. The amplified M. tuberculosis direct test was negative in all tested cases. No significant differences in IL-12p40 and IFN-γ levels were found between patients and controls. In spite of the normal response as measured in the screening test, it is still possible that patients might have a monogenic/mendelian disease for which the genetic defect(s) have yet to be elucidated. Alternatively, some single nucleotide polymorphisms along the IL-12/IFN-γ axis might be associated with an isolated cervical lymph node infection and not a disseminated disease in children. [ABSTRACT FROM AUTHOR]

Objective To investigate the distribution of lymph nodes in the neck during the process of development of tuberculous cervical lymphadenitis (TCL) in patients attending an outpatient clinic over a 1-year period. Material and Methods This was a prospective, cross-sectional, observational study which included 100 cases of histopathologically confirmed TCL of >6 weeks duration. Results Lymph nodes in the posterior triangle (PT) were found to be commonest (51%), followed by those in the upper deep cervical (UDC; 48%) and submandibular (SM; 36%) regions. The supra-clavicular (SC; 3%), submental (Sment; 4%) and lower deep cervical (LDC; 9%) regions were found to be the least frequently affected. Uni- and bilateral disease were observed in 83% and 17% of patients, respectively. A single group of lymph nodes was involved in 68% of patients, 2 groups in 29% and >2 groups in 13% of patients. Conclusions These results indicate that if unilateral, painless, enlarged and mated lymph nodes are found in either the PT or the UDC or SM areas, lymphadenitis of tuberculous origin should be suspected rather than lymphadenitis of any other etiology. [ABSTRACT FROM AUTHOR]

Mycobacterium fortuitumis a rapidly growing mycobacterium found in soil and water throughout the world. It can cause diseases in immunocompetent patients, usually resulting in localized skin and soft tissue infections. Cervical lymphadenitis caused byM. fortuitumis rare. We report a 46-year-old woman in whom skin lesions of cutaneous polyarteritis nodosa, leucocytoclastic vasculitis and Sweet's syndrome had successively developed before the diagnosis of cervical lymphadenitis caused byM. fortuitumwas made. The skin lesions responded to colchicine and systemic corticosteroids but recurred intermittently. After establishment of the diagnosis, she received treatment with clarithromycin and ciprofloxacin. The cervical lymph nodes decreased in size 6 months later and no more new skin lesions were found. [ABSTRACT FROM AUTHOR]

This review describes the microbiology, diagnosis and management of cervical lymphadenitis (CL) in children. The most common bacterial organisms causing acute unilateral infection associated with facial trauma or impetigo are Staphylococcus aureus and group A β-hemolytic streptococci. Other causes include Bartonella henselae, Francisella tularensis, Pasteurella multocida, Yersinia pestis, Actinobacillus actinomycetemcomitans, Burkholderia gladioli, Mycobacterium tuberculosis and nontuberculous mycobacteria. Other rare aerobic pathogens are Streptococcus pneumoniae and gram-negative rods. Studies that utilized methodologies that were adequate for the recovery of anaerobes demonstrated the importance of these organisms in CL. The predominant anaerobes were Peptostreptococcus spp., gram-negative bacilli and Fusobacterium spp. The most common viruses are Epstein-Barr virus, cytomegalovirus, herpes simplex virus, adenovirus, enterovirus, roseola, rubella and the human immunodeficiency virus. Therapy includes administration of antibiotics effective against the causative pathogen(s). Proper selection of therapy can be guided by culture of the lesion. Surgical drainage may be necessary in case of suppuration. [ABSTRACT FROM AUTHOR]

Objective To compare the chromosomal types of Mycobacterium avium strains infecting HIV-negative and AIDS patients in Greece. Methods In total, 41 Mycobacterium avium isolates, 23 from AIDS and 18 from HIV-negative patients, were compared by pulsed-field gel electrophoresis of genomic DNA after XbaI digestion. The majority (87%) of AIDS isolates were from disseminated infection, while the majority (61%) of HIV-negative isolates were from children with cervical lymphadenitis. Results Pulsed-field gel electrophoresis classified strains whose electrophoretic patterns were at least 85% similar into three clusters, A (four isolates), B (12 isolates), and C (15), while 10 isolates remained outside of these clusters. There was no statistically significant correlation of any PFGE cluster with a specific patient group. Within each patient group, no significant correlation of PFGE type with time, place of residence or, in the case of AIDS patients, hospital attended was observed. Conclusions Genotypic similarities between isolates responsible for disseminated infection in AIDS patients and lymphadenitis in HIV-negative children suggest that related strains, possibly from an environmental source, cause both types of infections. [ABSTRACT FROM AUTHOR]

Background Kawasaki disease (KD) can present initially with fever and cervical lymphadenopathy before other characteristic clinical signs appear. It is important to recognize KD at an early stage for appropriate treatment to be started and reduce cardiac complications. We sought to identify variables which distinguish early stage of node first presentation of KD from bacterial cervical lymphadenitis (BCL). Methods We retrospectively reviewed records of patients presenting with cervical lymphadenopathy and fever as primary diagnosis who discharged from the inpatient ward between January 2010 and December 2017. Only the patients who underwent radiologic studies (CT or US) were included. Patients were divided into 3 groups by their final diagnosis; CL with abscess (Group A), CL without abscess (Group B), and Node first presentation of KD (Group C). Initial clinical, laboratory, and imaging characteristics of the 3 groups were compared. Sequential laboratory data performed on the third hospital day was used to calculate their percentage differences. A clinical prediction model for KD in patients with CL was constructed using the decision tree analysis. Results Patients with KD had a longer duration of fever after admission and longer duration of fever prior to final diagnosis compared with BCL patients. Compared with group A or B, group C patients had higher neutrophil counts, neutrophil-lymphocyte ratio, C-reactive protein (CRP), erythrocyte sedimentation rates (ESR), alanine transaminase (ALT), aspartate transaminase (AST). In radiologic studies, no differences were observed in node sizes or palatine tonsil enlargement among the 3 groups. Retropharyngeal edema was more commonly associated with group C than group A and B combined, but was not significantly different between group A and C. By decision tree analysis, factors contributing to classification included presence of abscess, CRP percentage change, and neutrophil percentage change (Figure 1). Strong predictivity of the decision tree was observed in classifying Group C, with an overall accuracy of 87.9% for Group A, 82.6% for Group B, and 91.4% for Group C. Conclusion Decision tree analysis showed that the presence of abscess, CRP percentage change, and neutrophil percentage change could classify KD from BCL with an accuracy of 91.4%. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

The etiology of cervical lymphadenitis may be related to the many different reasons. It is stated that tularemia is a rare cause of cervical lymphadenitis. However, tularemia is seen as endemic in several regions in our country. Tularemia outbreaks have been reported recently. Tokat and surrounding area are the places where tularemia is seen as endemic. In this paper, seven patients with cervical lymphadenitis due to tularemia between 2007 and 2008 are presented. The aim of this paper is to emphasize that tularemia is an increasing cause of cervical lymphadenitis in our region although it is not described as a common reason for cervical lymphadenitis. [ABSTRACT FROM AUTHOR]

Background: Cat-scratch disease is the most common form of Bartonella henselae infection. Although reports have shown that CSD is relatively common, they have not shown the prevalence of seropositivity for Bartonella henselae in cases of cervical lymphadenitis and Kawasaki disease, which are relatively common diseases in children. Methods: We evaluated the presence of immunoglobulin (Ig) G- and IgM-class antibodies against Bartonella henselae in children with cervical lymphadenitis, Kawasaki disease, and infectious diseases without lymphadenopathy in a semi-rural area in Japan. Results: We found that the positivity rate for the IgG antibody against Bartonella henselae in patients with cervical lymphadenitis who owned cats or dogs was significantly higher than that in patients with Kawasaki disease and infectious diseases without lymphadenopathy. However, the average age of children with cervical lymphadenitis did not significantly differ when compared to those with other infectious diseases. Conclusion: Our serological study showed that Bartonella henselae infection may contribute to the etiology of cervical lymphadenitis in children. [ABSTRACT FROM AUTHOR]

Paediatric acute cervical lymphadenitis is a frequent diagnosis in the emergency department. Traditionally, suppurative cervical lymphadenitis (SCL) is associated with a higher need of surgical drainage. However, a great variability in the management of this suppurative infections can be observed. Moreover, the clinical distinction between non-suppurative cervical lymphadenitis (NSCL) and SCL is not an easy task and there are, currently, no guidelines defining which patients are eligible for imaging study. To assess the determinants and benefits in the surgical management of SCL in children. As secondary outcome, to determine differences in epidemiological characteristics, clinical, biochemical and radiological features between NSCL and SCL. A retrospective survey was carried out in a tertiary university hospital between January 2007 and December 2016. Forty-two children with a diagnosis of acute cervical lymphadenitis (ACL) were included and categorized according to the presence of suppuration, resulting in two groups: NSCL and SCL. The latter group was further categorized into surgical and non-surgical groups, according to the need of surgical drainage. No significant differences were found between SCL and NSCL groups in gender, age and previous antibiotics intake (p > 0.05). According to clinical presentation, odynophagia was significantly more frequent in NSCL patients (p = 0.01), with no differences found in other clinical parameters (p > 0.05). Patients presenting acute cervical lymphadenitis involving the submandibular region have 16 times the odds of a suppurative process (p = 0.029). In a SCL subgroup analysis, no association was observed between lymphadenitis size or location and the need for surgical drainage (p > 0.05). Children included in the SCL surgical group presented a trend to an increased in the hospitalization length (p = 0.01), when comparing to those in which treatment was limited to intravenous antibiotics. One death was observed in the SCL non-surgical group. Predictive factors for the need of surgery were not found. Furthermore, surgical drainage was not associated with better outcomes. Surgery could be considered in selected stable patients, when alternative medical treatments do not seem to work, in a case-to-case basis. [ABSTRACT FROM AUTHOR]

Atypical (nontuberculous) mycobacterium is an uncommon cause of cervical lymphadenitis in immunocompetent children. Rarely, this disease progresses to locoregional destruction of the deep structures of the neck including salivary glands. Recent reports suggest medical monotherapy as an effective treatment of this disease. We report three cases of children who experienced progression to locoregional disease while on appropriate antibiotics. We suggest that the patient population to benefit from medical monotherapy has yet to be adequately defined. In our experience, surgical therapy is the only effective treatment for locoregional disease. [ABSTRACT FROM AUTHOR]

Abstract: Cervical lymphadenitis and fever are common in patients presenting to the Emergency Department (ED). Kikuchi’s disease is a rare, self-limited cause of fever and cervical lymphadenitis often misdiagnosed as lymphoma or lupus and inappropriately treated, potentially causing numerous ED visits for unrelieved symptoms. The case described is that of a 29-year-old with persistent fever and cervical lymphadenitis who presented to the ED with a suspected allergic reaction to an antibiotic. The diagnosis of Kikuchi’s disease was made in association with nasopharyngeal carcinoma and partial hydatidiform mole. The case highlights the clinical features, diagnosis, and treatment of Kikuchi’s disease. [Copyright &y& Elsevier]

In this report, we describe a 57-year-old woman with oropharyngeal tularemia who presented with tonsillopharyngitis and cervical lymphadenitis. Clinical and radiological manifestations and histopathological characteristics of this disease are discussed with a review of the world literature. The oropharyngeal form of tularemia should be considered in the differential diagnosis of cases involving tonsillopharyngitis and cervical lymphadenitis, particularly in those not responding to penicillin treatment. [ABSTRACT FROM AUTHOR]

Tuberculosis is one of the biggest health challenges the world is facing. In this study the clinical pattern of patients with cervical lymphadenitis, who presented to the ear, nose, and throat outpatient department of the Government Medical College Hospital, Chandigarh, India between June 1997 and May 1998 is recorded. Tuberculosis accounted for 60 out of 94 cases of cervical lymph node enlargement. The commonest age group affected was 11-20 years. Constitutional symptoms were not present in most of the patients. Multiple matted nodes were seen in 23 patients but a single discrete node was seen in 18 patients. Upper deep jugular nodes were the most commonly affected lymph nodes. Discharging sinus and abscess formation were uncommon. Fine needle aspiration cytology yielded a positive diagnosis in 52 out of 56 patients. Chest lesions on radiography were evident in 16% of the patients. Mantoux test was positive and was more than 15 mm in most of the patients. This study shows that the classical picture of "scrofula" is no longer seen nowadays and can probably be explained by the earlier presentation of the disease. All the patients were treated with short course daily chemotherapy for six months. Surgery was not required in the majority of patients except in four cases where excision biopsy was performed. Patients with abscess formation were managed with wide bore needle aspiration only. With a minimum six month period of follow up, no patient was found to have a recurrence of local or systemic disease. This study emphasises the role of fine needle aspiration cytology in diagnosis and confirms the efficacy of six months short course chemotherapy. [ABSTRACT FROM AUTHOR]

Henoch-Schonlein purpura (HSP) is a multisystem disease and immunoglobulin A-mediated vasculitis with a self-limited course affecting the skin, joints, gastrointestinal tract, and kidneys. Severe renal and central nervous system disease may lead to life-threatening conditions, and immunosuppressive agents and plasmapheresis may be needed. We report successful management of a 6-year-old patient with HSP for drainage of cervical lymphadenitis. [ABSTRACT FROM AUTHOR]

Cervical lymphadenitis is a common finding in young adults in a country like India, where tuberculosis is endemic. We are presenting the case of a young boy who presented with low grade fever, dry cough, weight loss, and a cervical swelling. His chest X-ray showed diffuse reticulonodular infiltrates. Contrast enhanced CT of chest showed bilateral multiple ring shadows. Cervical lymph node fine needle cytology suggested a metastatic thyroid carcinoma. He was evaluated extensively and a final diagnosis of a familial medullary thyroid carcinoma was made. Medullary thyroid carcinoma should be considered in the differential diagnosis of cervical lymphadenitis with lung infiltrates in young adults. It may be sporadic or a part of an inherited autosomal dominant disorder like multiple endocrine neoplasia. Genetic testing should be done for all patients with a diagnosis of medullary thyroid carcinoma. [ABSTRACT FROM AUTHOR]