Neonate, unwell child, or persistent cervical lymphadenopathy despite oral antibiotics. Excision of whole node is preferred in suspected mycobacterial infection as incision and drainage may result in sinus formationĬonsider consultation with local paediatric team when.For fluctuant nodes not responding to IV antibiotics, consider consultation with general surgical team for incision and drainage.Flucloxacillin 50 mg/kg (max 2 g) IV 6HĪntimicrobial recommendations may vary according to local antimicrobial susceptibility patterns please refer to local guidelines.Unwell, or failed oral treatment - IV antibiotics Cefalexin 33 mg/kg (max 500 mg) oral tds.Well - oral antibiotics for 7 days, with review in 48 hours If there are signs of bacterial lymphadenitis (unilateral, tender, fluctuant), consider the following:.Most cases of cervical lymphadenopathy will be self-limited and do not require treatment.Biopsy (excisional biopsy remains gold standard FNA less helpful).CT or MRI may be required pre-operatively.Tuberculin skin test, Quantiferon Gold (if TB suspected).Serology (when specific infectious cause suspected) – EBV, CMV, HIV.Persistent Cervical Lymphadenopathy (2-6 weeks) Investigations Acute Cervical Lymphadenopathy (<2 weeks Observation and reassurance without investigation is usually appropriate for the well-appearing child with cervical lymphadenopathy.May be associated with rash, joint pain, conjunctival changesĪpproach to differential diagnosis Management Persistent head and neck eczema may cause prominent posterior cervical LNs May be associated loss of appetite, weight loss, night sweats, easy bruising, hepatosplenomegaly, mediastinal mass Systemic features of fatigue or myalgiaĬonsider if prolonged, painless, firm lymphadenopathy. Non-suppurative generalised lymphadenopathy. Indolent, chronic unilateral cervical lymphadenopathy, violaceous hue, usually in children <5 yoīartonella henselae (cat scratch disease)Įnlarged nodes are usually tender and located in the axillary region Systemic symptoms of fever, malaise, weight loss May be associated with generalised lymphadenopathy and hepatosplenomegaly Many viruses will cause cervical lymphadenopathy lasting up to 6 weeks
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