In this section
Enlargement of the cervical lymph nodes commonly occurs with
viral infections. These "reactive" nodes are usually small, firm
and non-tender and they may persist for weeks to months.
Acute bacterial adenitis is characterised by
larger nodes >10mm, which are tender and may be
fluctuant. Most typically these are in the anterior part of the
neck. There is often associated fever and warm, erythematous
overlying skin. The majority are caused by Staphylococcus Aureus or
Group A Streptococcus (Strep pyogenes). A site of entry may be
found e.g. mouth or scalp. Anaerobic bacteria may be associated
with dental disease in older children.
Also consider Kawasaki
Disease - unilateral, >15mm, painful nodes and other
Persistent enlargement of lymph nodes (> 2
weeks) may be caused by a number of other conditions:
Significant persistent enalargement may be associated with
atopic eczema. These nodes are often more prominent in the
posterior part of the neck and are usually bilateral.
Infectious mononucleosis (EBV), cytomegalovirus - may have
generalised lymphadenopathy and hepatosplenomegaly.
Mycobacterium avium complex - Adenoapthy is usually unilateral
and most cases occur in the under 5-year age group. Non-tender,
slightly fluctuant node, which may become tethered to underlying
structures. Violaceous hue to the overlying skin is sometimes seen.
Systemically well. Usually not immunocompromised.
Mycobacterium tuberculosis - non-tender nodes. History of
exposure. Systemic symptoms of fever, malaise, weight loss.
Cat Scratch Disease (Bartonella henselae) - tender, usually
axillary, nodes. History of a cat scratch or lick 2 weeks prior.
There may be a papule at the site.
Toxoplasma gondii - generalised lymphadenopathy. Systemic
features of fatigue or myalgia.
Lymphoma - Hodgkins, Non-Hodgkins
Leukaemia - ALL, AML, CML,
Juvenile chronic arthritis
Well - oral antibiotics for 10 days, with review in 48
Neonates, unwell or failed oral Rx - IV
Hypersensitive to penicillin: Cephazolin 25 mg/kg up to 2g IV 6
Severe penicillin hypersensitivity: Clindamycin 10mg/kg up to 450mg
Persisting adenitis (>2 weeks) - consider the
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