Related Terms: adenopathy, lymphadenopathy, lymph node enlargement, lymph node inflammation, lymph node infection, postauricular node, supraclavicular node, epitrochlear node, popliteal node, tuberculous lymphadenitis, regional adenopathy, cervical adenopathy , bacteremia, septicemia, gangrene, cellulitis, necrosis, lymphedema
Related conditions: Lymphangitis, lymphadenopathy, Lymph node infection, Lymph gland infection, Localized lymphadenopathy
Lymphadenitis simply defined an inflammation and/or infection of a lymph node. The condition may be specifically localized, or generalized with systemic infections or confined to regional lymph nodes draining a local area of infection (2)
The nodes may be swollen, hard, smooth, or irregular. They may also be painful and warm if near the skin. The location of the lymphadenitis is usually related to the site or origin of the infection.
The most common causes of lymphadenitis are bacterial infections caused by streptococcal and staphylococcal bacterium. Other infections that may be involved include rabbit fever (tularemia), cat scratch disease, lymphogranuloma venerum, chancroid, genital herpes, infected acne, dental abscesses and even bubonic plague.
Regional lymphadenopathy is prominent in streptococcal disease, TB or nontuberculous mycobacterial disease, tularemia, plague, cat-scratch disease, primary syphilis, lymphogranuloma venereum, chancroid, and genital herpes simplex. (2)
Overall body symptoms may include fever, chills, body aches (often flu-like), fatigue and general malaise. Specific symptoms include nodes that are swollen, tender. Also common is a throbbing type pain at the point of infection. They may be either hard or rubbery to the touch. The skin over the node may be reddened and hot.
General diagnosis may be obtained by simple observation and examination. A complete blood workup may also be indicated as well as blood cultures to determine and/or rule out the possibility of a systemic infection as well as to determine the suspect bacteria involved.
Mediastinal lymphadenitis may cause cough, dyspnea, stridor, dysphagia, pleural effusion, and venous congestion in the upper body. Intra-abdominal (mesenteric and retroperitoneal) adenopathy may be manifested as abdominal pain. Iliac lymph node involvement may cause abdominal pain and limping.(3)
Treatment may involve antibiotic therapy. These should be specific to the cause of the infection. Anti-inflammatory medications may be used to decrease localized swelling and inflammation. Pain medication also may be used. If there is a serious abscess is involved, it may need to be surgically drained. Commonly used antibiotics include the penicillins, nafcillin, cephalosporins, and erythromycin.
IIn more severe infections, it may be necessary to surgically drain the affected node.
Treatment may also need to be directed at the specific cause of the lymphadenitis, such as the bacterial infection, lymphomas, toxoplasmosis, sickle cell abemia, Thalassema, Kawasaki disease to mention only a few possible causes.
The expectation of recovery is excellent with prompt diagnosis and treatment. High risk groups however, may be required to undergo antibiotic therapy for an extended period of time and may experience recurrence of the infection.
Prognosis may also be based on any underlying causative disorder.
By far and wide, the leading cause of secondary lymphedema is the removal of lymph nodes for biopsy. I personally also feel it most cases it can be prevented by utilization of modern diagnostic techniques. Radiological tests such as ultrasounds, MRI, CT and PET have become increasingly sensitive in their abilities to assist in the diagnostic process.
Small needle biopsy or aspiration has also become more sophisticated in its ability to provide an accurate diagnosis. Therefore, if your doctor suggest a lymph node biopsy, insist that they use scans and perform a small needle biopsy first.
In 2000, a small needle biopsy was performed in my right inguinal region. Lymphoscintigraphy had already shown that many of my main inguinal nodes were missing, thus, to remove more would have been catastrophic for my lymphedema. We decided on a SMB and were able to achieve a correct diagnosis with it. The biopsy caused no further complication or worsening of my existing leg lymphedema.
Lymphadenitis is the inflammation of a lymph node. It is often a complication of a bacterial infection of a wound, although it can also be caused by viruses or other disease agents. Lymphadenitis may be either generalized, involving a number of lymph nodes; or limited to a few nodes in the area of a localized infection. Lymphadenitis is sometimes accompanied by lymphangitis, which is the inflammation of the lymphatic vessels that connect the lymph nodes.
Lymphadenitis is marked by swollen lymph nodes that are painful, in most cases, when the doctor touches them. If the lymphadenitis is related to an infected wound, the skin over the nodes may be red and warm to the touch. If the lymphatic vessels are also infected, there will be red streaks extending from the wound in the direction of the lymph nodes. In most cases, the infectious organisms are hemolytic Streptococci or Staphylococci. Hemolytic means that the bacteria produce a toxin that destroys red blood cells.
The extensive network of lymphatic vessels throughout the body and their relation to the lymph nodes helps to explain why bacterial infection of the nodes can spread rapidly to or from other parts of the body. Lymphadenitis in children often occurs in the neck area because these lymph nodes are close to the ears and throat, which are frequent locations of bacterial infections in children.
Causes and symptoms
Streptococcal and staphylococcal bacteria are the most common causes of lymphadenitis, although viruses, protozoa, rickettsiae, fungi, and the tuberculosis bacillus can also infect the lymph nodes. Diseases or disorders that involve lymph nodes in specific areas of the body include rabbit fever (tularemia), cat-scratch disease, lymphogranuloma venereum, chancroid, genital herpes, infected acne, dental abscesses, and bubonic plague. In children, tonsillitis or bacterial sore throats are the most common causes of lymphadenitis in the neck area. Diseases that involve lymph nodes throughout the body include mononucleosis, cytomegalovirus infection, toxoplasmosis, and brucellosis.
The early symptoms of lymphadenitis are swelling of the nodes caused by a buildup of tissue fluid and an increased number of white blood cells resulting from the body's response to the infection. Further developments include fever, often as high as 101-102°F (38-39°C) together with chills, loss of appetite, heavy perspiration, a rapid pulse, and general weakness.
The diagnosis of lymphadenitis is usually based on a combination of the patient's history, the external symptoms, and laboratory cultures. The doctor will press (palpate) the affected lymph nodes to see if they are sore or tender. Swollen nodes without soreness are often caused by cat-scratch disease. In children, the doctor will need to rule out mumps, tumors in the neck region, and congenital cysts that resemble swollen lymph nodes.
Although lymphadenitis is usually diagnosed in lymph nodes in the neck, arms, or legs, it can also occur in lymph nodes in the chest or abdomen. If the patient has acutely swollen lymph nodes in the groin, the doctor will need to rule out a hernia in the groin that has failed to reduce (incarcerated inguinal hernia). Hernias occur in 1% of the general population; 85% of patients with hernias are male.
The most significant tests are a white blood cell count (WBC) and a blood culture to identify the organism. A high proportion of immature white blood cells indicates a bacterial infection. Blood cultures may be positive, most often for a species of staphylococcus or streptococcus. In some cases, the doctor may order a biopsy of the lymph node.
The medications given for lymphadenitis vary according to the bacterium or virus that is causing it. If the patient also has lymphangitis, he or she will be treated with antibiotics, usually penicillin G (Pfizerpen, Pentids), nafcillin (Nafcil, Unipen), or cephalosporins. Erythromycin (Eryc, E-Mycin, Erythrocin) is given to patients who are allergic to penicillin.
Supportive care of lymphadenitis includes resting the affected limb and treating the area with hot moist compresses.
Cellulitis associated with lymphadenitis should not be treated surgically because of the risk of spreading the infection. Pus is drained only if there is an abscess and usually after the patient has been started on antibiotic treatment. In some cases, a biopsy of an inflamed lymph node is necessary if no diagnosis has been made and no response to treatment has occurred.
The prognosis for recovery is good if the patient is treated promptly with antibiotics. In most cases, the infection can be brought under control in three or four days. Patients with untreated lymphadenitis may develop blood poisoning (septicemia), which is sometimes fatal.
Prevention of lymphadenitis depends on prompt treatment of bacterial and viral infections.
For Your Information
Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group
The Essay Author is Rebecca J. Frey PhD.
Mesenteric lymphadenitis is an inflammation of the lymph nodes in the fold of membranes that attaches organs, such as your colon, to your abdominal wall (mesentery). Mesenteric lymphadenitis occurs mainly in children and adolescents.
Commonly caused by a viral or bacterial infection, mesenteric lymphadenitis may mimic the signs and symptoms of appendicitis. Unlike appendicitis, however, mesenteric lymphadenitis usually requires no treatment.
Signs and symptoms
Signs and symptoms of mesenteric lymphadenitis may last a few days or as long as a few weeks. They include:
Depending on what's causing the ailment, other signs and symptoms may include:
The most common cause of mesenteric lymphadenitis is a viral infection, such as adenovirus, a common cause of intestinal infection (gastroenteritis) in children. But it can also result from a bacterial infection. The type of bacterium commonly associated with mesenteric lymphadenitis is yersinia, which may come from eating undercooked pork or drinking unpasteurized milk or contaminated water.
Some children may develop an upper respiratory infection before or during their course of mesenteric lymphadenitis. Other conditions associated with inflamed mesenteric nodes include:
The signs and symptoms of mesenteric lymphadenitis usually resolve on their own within a few days to a few weeks. However, it may be important for your child to see a doctor to rule out appendicitis and other possible causes of abdominal pain. Take your child to a doctor if fever, low blood pressure (hypotension), bloody stools or inability to keep fluids down accompany the abdominal pain.
Your doctor is likely to take your child's medical history and ask when and how signs and symptoms developed. In addition, your doctor may request laboratory tests to help pin down the diagnosis, including:
Mesenteric lymphadenitis usually resolves on its own and rarely causes complications. However, if the cause is a bacterial infection and it isn't treated, the infection could spread to the bloodstream, causing an overwhelming infection (sepsis). Sepsis may result in organ failure and death. Treatment of sepsis involves hospitalization and administration of antibiotics through a vein (intravenously).
Mild, uncomplicated cases of mesenteric lymphadenitis and those caused by a virus usually resolve on their own within days or weeks. To help ease discomfort, over-the-counter (OTC) pain relievers and fever reducers may help.
If your child has a bacterial infection that's causing moderate to severe signs and symptoms, your doctor may prescribe antibiotics.
For the pain and fever of mesenteric lymphadenitis, have your child:
Research Abstracts and Articles:
[Article in Japanese]
Department of Respiratory Medicine,
We herein report a case of a 41-year-old female with a 14-year history of Crohn's disease who had been treated with diet and mesalazine. Because of inadequate control, therapy with infliximab was planned. She had a positive result on the interferon-gamma release assay (QuantiFERON TB). After active tuberculosis was ruled out by chest x-ray and computed tomography, she was started on a six-month course of isoniazid 7 weeks prior to starting infliximab. After 10 doses of infliximab (15 months of therapy), she presented with pain of cervical lymphadenopathy. A biopsy of the lymph nodes revealed Langhans giant cells from granulomas and a positive result of polylmerase chain reaction for Mycobacterium tuberculosis. The treatment with infliximab was discontinued and anti-tuberculosis therapy was started. Although treatment for latent tuberculosis infection lowers the risk of reactivation of tuberculosis due to tumor necrosis factor alpha-blockers, it cannot completely inactivate tuberculosis. Despite the completion of chemoprophylaxis, patients receiving such agents should be instructed to watch out for any symptoms associated with pulmonary and extrapulmonary tuberculosis such as fever, cough, malaise, body weight loss, night sweating and lymphadenopathy, and they should also be closely followed up.
Isolated lymphadenitis due to Histoplasma capsulatum diagnosed by fine-needle aspiration biopsy and immunohistochemistry.
Rev Iberoam Micol. 2008 Mar
Department of Infectious Diseases, University of Săo Paulo, Săo Paulo, Brasil. firstname.lastname@example.org.
In the disseminated form of histoplasmosis, isolation and further identification of Histoplasma capsulatum can be performed by several methods, namely, bone marrow aspiration, blood culture, and liver biopsy. Lymph node disease usually is diagnosed by excisional biopsy. Although fungal stains can identify this fungus, detection of specific antigens by immunohistochemistry shows a higher specificity and sensitivity. This approach can use the cell block method when the material is not sent to fungal cultures or fresh staining.
Diagnosing mycobacterial lymphadenitis in children using fine needle aspiration biopsy: Cytomorphology, ZN staining and autofluorescence-Making more of less.
Diagn Cytopathol. 2008 Apr
Division of Anatomical Pathology, Department of Pathology, University of Stellenbosch and NHLS Tygerberg Hospital, Tygerberg, South Africa.
Although the incidence of TB has stabilized or declined in most world regions, it is increasing in Africa, Southeast Asia, and the Eastern Mediterranean, fuelled by the HIV pandemic. More than 4,000 people died daily from TB-related illnesses in 2005. TB is a major cause of childhood morbidity and mortality in these developing countries, and there is an urgent need for rapid and definitive modalities for mycobacterial diagnosis in children. This prospective study in Tygerberg Hospital, Cape Town, South Africa, evaluates the ability of fine needle aspiration biopsy (FNAB) to diagnose mycobacterial lymphadenitis in children, using cytomorphology, autofluorescence on Papanicolaou stained smears, Ziehl-Nielsen (ZN) staining and/or culture. FNABs were performed on 200 children, and 25 (12.5%) aspirates were inadequate. Cultures were positive in 79/175 (45%); Mycobacterium tuberculosis was identified in 61 and Mycobacterium bovis BCG in 18 cases. Using culture as the gold standard, the concordance of the different techniques was as follows: cytomorphology 70%, ZN staining 73%, and autofluorescence 68%. Using an alternative gold standard (culture positive and/or suggestive cytomorphology plus positive autofluorescence or ZN smear), the "true" diagnostic performance of the various techniques was as follows: cytomorphology-sensitivity 78%, specificity 91%, positive predictive value (PPV) 93%, ZN staining - sensitivity 62%%, specificity 97%, PPV 97%; autofluorescence-sensitivity 67%, specificity 97%, PPV 97%; and culture-sensitivity 75%, specificity 100%, and PPV 100%. FNAB was shown to provide a rapid and definitive diagnosis in the majority of cases of suspected tuberculous lymphadenitis in children, based on cytomorphology and identification of the organism. Diagn. Cytopathol. 2008;36:245-251.
Lymphadenitis in children is caused by Mycobacterium avium hominissuis and not related to 'bird tuberculosis'.
Eur J Clin Microbiol Infect Dis. 2008 Apr
Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands, email@example.com.
Mycobacterium avium is the most commonly encountered mycobacterium species among non-Mycobacterium tuberculosis complex (nontuberculous mycobacteria) isolates worldwide and frequently causes lymphadenitis in children. During a multi-centre study in The Netherlands that was performed to determine the optimal treatment for mycobacterial lymphadenitis, concern was expressed in the media about the possible role of birds as sources of these M. avium infections, referred to as 'bird tuberculosis.' To examine the involvement of birds in mycobacterial lymphadenitis, 34 M. avium isolates from lymphadenitis cases were subjected to IS1245 restriction fragment length polymorphism (RFLP) typing. This genotyping method enables the distinction of the subspecies M. avium subsp. hominissuis and the 'bird-type' M. avium spp. avium. Highly variable RFLP patterns were found among the lymphadenitis M. avium isolates, and all belonged to the M. avium hominissuis subspecies. A relation to pet birds in the etiology of mycobacterial lymphadenitis could not be established, and the source of the infections may be environmental.
Light-chain-restricted germinal centres in reactive lymphadenitis: report of eight cases
Histopathology. 2008 Mar
Lymphoma Group, Molecular Pathology Programme, Spanish National Cancer Centre (CNIO), Madrid, Spain. firstname.lastname@example.org
AIMS: Light-chain-restricted germinal centres are generally associated with the existence of a neoplastic lymphoproliferative disorder. The aim was to present a series of cases with persistent lymph node enlargement that featured some germinal centres showing light chain immunoglobulin restriction.
METHODS AND RESULTS: A series of six reactive lymphadenitis and two Castleman's disease cases was analysed by immunohistochemistry, IgH-polymerase chain reaction (PCR) and microdissected PCR. In all cases some germinal centres contained a population of plasma cells and plasmacytoid germinal centre cells showing light chain immunoglobulin restriction. In three cases the monotypic cells also showed distinct Bcl-2 expression. Two of the cases showed a predominant IgH rearrangement on a florid polyclonal background and one had an IgH monoclonal rearrangement, as revealed by PCR. Microdissected germinal centre PCR revealed a dominant repeated band in one of three cases and in another case a non-repeated clonal peak was observed. One of the patients developed a follicular lymphoma, which became evident from a subsequent biopsy.
CONCLUSIONS: These findings may be a manifestation of an underlying disorder in the regulation of the immune response, or an exaggeration of the germinal centre oligoclonal nature. This should be taken into account in the differential diagnosis of follicular hyperplasia.
Mediastinal tuberculous lymphadenitis with anthracosis as a cause of vocal cord paralysis.
Tuberk Toraks. 2007
Department of Chest Diseases, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey. email@example.com
Anthracotic pigmentation in the bronchial mucosa has been regarded as a bronchoscopic finding of pneumoconiosis or evidence of heavy atmospheric soot. Anthracotic pigmentation with bronchial narrowing or obliteration, surrounded by calcified or noncalcified lymph nodes is typical finding of anthracofibrosis. There is a potential relationship between bronchial anthracofibrosis and tuberculosis. Tuberculous lymphadenopathy of superior mediastinum presentation with hoarseness is very rare. The paper reports a case of tuberculous mediastinal lymphadenitis with anthracosis causing vocal cord paralysis. A 66-year-old woman was admitted to our clinic with the symptoms of dry cough, hoarseness, malaise, anorexia, night sweats and with the multiple mediastinal lymphadenopathy. Fiberoptic bronchoscopy revealed left vocal cord paralysis, bronchial mucosal inflammation and multiple anthracotic plaques. Bronchial lavage and mucosal biopsy were negative for malignancy and tuberculosis. The thoracotomy was performed and a mediastinal lymph node showing caseating granulomatous inflammation with anthracosis and parenchymal anthracosis were detected. The diagnosis of anthracosis and mediastinal tuberculous lymphadenitis was made and the patients put on antituberculous treatment. But she unfortunately died in the second month of the treatment because of the abdominal complication of gastric adenocarcinoma operation.
Estimation of apoptosis and cell proliferation in histiocytic necrotizing lymphadenitis using immunohistochemical double staining.
Department of Pathology, School of Medicine, Kurume University, Kurume, Japan. firstname.lastname@example.org
The aim of the present study was to estimate the relationship between apoptosis and cell proliferation in histiocytic necrotizing lymphadenitis (HNL). Fifteen patients with HNL were retrospectively analyzed. The patients were divided into three groups according to the proportion of the necrotic area as follows: necrosis (+), necrotic area <25%; necrosis (++), necrotic area 25-50%; and necrosis (+++), necrotic area >50%. Immunohistochemical double staining was performed for CD3 plus caspase-3 and for Ki-67 plus caspase-3 and positive cells were counted in two areas: one without and one with obvious apoptotic features. Most caspase-3-positive cells were also stained for CD3 (area exhibiting obvious apoptotic features: average, 92.3%). Furthermore, various proportions of both Ki-67- and caspase-3-positive cells were detected in all the groups (range, 5-70%). In the area with obvious apoptotic changes, the average percentage of both Ki-67- and caspase-3-positive cells (38.6%) was higher than that in the area without obvious apoptotic features (16.3%). A proportion of cells in HNL undergo proliferation and apoptosis simultaneously, such as neoplastic cells, thereby exhibiting rapid cell cycles.
The Merck Manual
Lupus vulgaris with tubercular lymphadenitis and IgA nephropathy.
Acute phase protein response in an experimental model of ovine caseous lymphadenitis.
A case of primary lung cancer with cervical tuberculous lymphadenitis
Granulomatous Lymphadenitis as a Manifestation of Q Fever
Pseudolymphomatous luetic associated with B cell clonality.
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