Cervical Adenitis
The infection of the tonsils, submandibular, submental, occipital, superficial and deep juguler, nuchal, spinal accessory and transverse cervical lymph glands located between the deep and superficial fascia in the neck. The agents are usually viral, S. aureus, group A streptococci, other streptococci, anaerobic bacteria, Bartonella henseleae, atypical mycobacteria and Gram negative basilils.
Acute bilateral adenitis is predominantly caused by atypical mycobacteria, tuberculosis, toxoplasmosis, and cat tear disease (Bartonella henseleae) in the viral and group A streptococci, acute unilateral adenitis S. aureus, group A streptococci, anaerobic bacteria and viruses, subacute and chronic adenitis .
Rarely, M. tuberculosis, fungi, T. gondii, F. tularencis, Y. pestis, HIV and C. diphtheriae may also act as antagonists. Microorganisms usually come from the upper respiratory tract, tonsils and teeth, or trauma, and rarely through the blood to the lymph glands.
Clinic
The duration of the lymph gonad growth depends on whether it is single or double-sided. Systemic symptoms are often absent or mild. If there is cellulitis or bacteriemia in the tissue together, high fever can be seen.
In particular, streptococcal adenitis may initially present symptoms of upper respiratory tract infection. The size of the lymph node may be 2-6 cm, most submandibular (50-60%) and upper cervical glands (25-30%) are affected.
The skin on the diaper is usually hyperemic and has local heat buildup. Fluctuations are taken in about ¼ of the cases. It may be more swelling in S. aureus and mycobacterial infections. Other areas where the lymph nodes are intensively located (clavicle above, axilla and inguinal region) should be checked, spleen and liver size should be investigated.
If there is diffuse lymphadenopathy and hepatosplenomegaly in the body, cervical lymphadenopathy usually develops in response to a systemic disease (viral infections such as EBV, CMV, toxoplasmosis, tuberculosis, collagen tissue diseases, leukemia?). The examination of the regions of the lymph drainage neck, such as the oral cavity, pharynx, nose, ear, scalp, provides information about the potential primer source.
Complications
Abse formation, cellulitis, bacteriemia, internal juguler ven trombozu, effect related complications (acute rheumatic fever, glomerulonephritis, scalded skin syndrome?)
Diagnosis
Clinical diagnosis is sufficient in mild cases. However, if no response to antibiotic therapy is available, it should be sampled with needle aspiration or incision and stained with Gram, Wright and Ziehl-Nielsen stains and evaluated cytologically and pathologically if necessary. It is advisable to take a sample at the beginning of treatment in severe cases. Persia is diagnosed in 8-12 weeks with undiagnosed adenitis and findings compatible with neoplasia (lower cervical and supraclavicular lymphadenopathies, weight loss, non-falling fever, adhesions to deep and deep tissues)
Differential diagnosis
Mucinous, bacterial parotitis, dental abducens, congenital neck masses (thyroglossal duct cysts, brankial cleft cysts, cystic hygromas, epidermoid cysts), neck tumors (lymphoma, neurogenic tumors, thyroid tumors, parotid tumors, Kawasaki disease, drug reactions, collagen tissue diseases , sarcoidosis, reticuloendothelios, storage diseases.
Treatment
Antibiotic treatment is unnecessary in light cases where the lymph gland is not overgrown, the sensitivity is low and the primer infection center is absent. It is enough to follow the weekly checks until the lymph node starts to shrink.
If growth continues or patients refer to large (but less than 3 cm) lymph nodes, sensitive, skin red, and primer infection, oral empiric antibiotic therapy is started and followed until shrinkage. In these patients, flucloxacillin, cephalexin, clindamycin or amoxicillin / clavulanate may be used as antibiotics.
If the lymph node is 3 cm or more and the inflame is not responding to the initial antibiotic treatment if there is cellulitis together and / or if there are systemic symptoms and signs, it is appropriate to have the patient hospitalized and sampled and examined with incision or drainage drainage. If the agent is not detected, or one of the parenteral clindamycin, cefazolin + metronidazole, sulbactam / ampicillin or vancomycin (or teicoplanin) + metronidazole treatments is initiated while the results are waiting.
