Swelling in the Neck and Lymph Nodes

Cervical Adenitis
It is an infection of tonsillar, submandibular, submental, occipital, superficial and deep jugular, nuchal, spinal accessory and transverse cervical lymph nodes located between the deep and superficial fascia of the neck. The causative agents are usually viruses, S. aureus, group A streptococci, other streptococci, anaerobic bacteria, Bartonella henseleae, atypical mycobacteria and Gram negative bacilli.

Acute bilateral adenitis is mostly caused by viruses and group A streptococcus, acute unilateral adenitis is S. aureus, group A streptococcus, anaerobic bacteria and viruses, subacute and chronic adenitis is caused by atypical mycobacteria, tuberculosis, toxoplasmosis and cat scratch disease. (Bartonella henseleae)’it depends.

Rarely, M. tuberculosis, fungi, T. gondii, F. tularencis, Y. pestis, HIV and C. diphtheriae may also be the causative agents. Microorganisms usually come to the lymph nodes from the upper respiratory tract, tonsils and teeth, or by trauma, rarely through the blood.

It varies depending on the duration of lymph node enlargement and whether it is unilateral or bilateral. Systemic symptoms are usually absent or mild. If there is cellulitis or bacteremia in the surrounding tissue, high fever may be seen.

In particular, streptococcal adenitis may initially have symptoms of upper respiratory tract infection. Lymph node size can be up to 2-6 cm, most often submandibular (50-60%)and upper cervical glands (25-30%)is affected.

The skin over the gland is usually hyperemic and there is a local temperature increase. Fluctuation is obtained in approximately ¼ of the cases. Suppuration may occur mostly in S. aureus and mycobacteria infections. Other regions (above the clavicle, axilla and inguinal region) where lymph nodes are densely located should be checked, and the size of the spleen and liver should be investigated.

Cervical lymphadenopathy is usually a systemic disease if diffuse lymphadenopathy and hepatosplenomegaly are present in the body. (viral infections such as EBV, CMV, toxoplasmosis, tuberculosis, collagen tissue diseases, leukemia?) developed in response. Information about the possible primary source is obtained by examining the areas where lymph drainage passes through the neck, such as the oral cavity, pharynx, nose, ear, and scalp.

Abscess formation, cellulitis, bacteremia, internal jugular vein thrombosis, factor-related complications (acute rheumatic fever, glomerulonephritis, scalded skin syndrome?)

In mild cases, clinical diagnosis is sufficient. However, if there is no response to antibiotic treatment, a sample should be taken by needle aspiration or incision, stained with Gram, Wright and Ziehl-Nielsen stains and examined, if necessary, cytologically and pathologically evaluated. In severe cases, it is appropriate to take a sample before starting treatment. Persistent, in undiagnosed adenitis at 8-12 weeks and if there are findings compatible with neoplasia (lower cervical and supraclavicular lymphadenopathies, weight loss, fever that does not go away, adhesions to the skin and deep tissues)

Differential diagnosis
Mumps, bacterial parotitis, dental abscesses, congenital neck masses (thyroglossal duct cyst, branchial cleft cyst, cystic hygroma, epidermoid cyst), neck tumors (lymphoma, neurogenic tumors, thyroid tumors, parotid tumors, Kawasaki disease, drug reactions, collagen tissue diseases) , sarcoidosis, reticuloendotheliosis, storage diseases.

In mild cases where the lymph node does not enlarge much, its sensitivity is low, and there is no primary infection focus, antibiotic treatment is not required, weekly follow-ups are sufficient until the lymph node begins to shrink.

If the growth continues or the patient presents, the lymph node is large. (but less than 3cm) If there is no tender, reddened skin and a primary infection focus, oral empirical antibiotic therapy is started and followed up until shrinkage occurs. Flucloxacillin, cephalexin, clindamycin or amoxicillin/clavulanate can be used as antibiotics in these patients.

If the lymph node is 3 cm or larger, inflamed, has concomitant cellulitis, and/or has systemic symptoms and signs, if it has not responded to initial antibiotic therapy, it would be appropriate to hospitalize the patient and take a sample with an incision or drainage drainage. If the causative agent is not detected, or while awaiting results, parenteral clindamycin, cefazolin + metronidazole, sulbactam/ampicillin, or vancomycin (or teicoplanin)+ One of the metronidazole treatments can be started.

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