Shotty cervical lymphadenopathy12/27/2023 Supraclavicular and posterior cervical lymphadenopathy are indicative of serious underlying conditions, including malignancy, tuberculosis, and toxoplasmosis. Chronic cases: insidious enlargement nontender, immobile, matted nodes may form to sinus tracts.May become fluctuant and form an abscess over time or become indurated.Enlarged ( 3–6 cm ), tender nodes with warmth and possibly erythematous skin over the node.Most commonly submandibular or deep cervical nodes ( > 80% of cases).Recent or current symptoms of bacterial infections (e.g., upper respiratory tract infection, dental conditions). Medication: allopurinol, carbamazepine, phenobarbital.Other, uncommon pathogens include: HIV, Toxoplasma gondii, and Treponema pallidum.Subacute bilateral cervical lymphadenopathy.Other pathogens include EBV, CMV, and HSV-1.Acute bilateral cervical lymphadenopathy: most commonly caused by viral infections of the upper respiratory tract.Subacute/chronic unilateral cervical lymphadenopathy.Group A Streptococcus (e.g., Streptococcus pyogenes ).Acute unilateral cervical lymphadenopathy: most commonly caused by bacterial infections ( > 80%).Infectious Unilateral cervical lymphadenopathy (UCL) Surgical incision and drainage may be indicated in cases with suppurative lymphadenitis. Most cases are treated empirically with antibiotics to cover the most common pathogens. Mild cases without fever, lymph node tenderness, or suspicion of group A streptococcal ( GAS) tonsillitis can be managed conservatively with active observation for disease regression. Biopsy may be needed to rule out malignancy. Diagnosis involves laboratory tests for inflammatory markers, serology, and bacterial cultures from pus samples that are used to detect pathogens and to monitor the course of the disease. Chronically inflamed lymph nodes are typically nontender and become indurated and matted over time. In acute BCL, lymph nodes are usually small, mobile, and mildly tender without erythema or warmth. In acute UCL, affected lymph nodes are often enlarged, tender, warm, and mobile, and may be accompanied by fever and malaise. Adenoviruses and enteroviruses are the most common causes of acute BCL, while Epstein-Barr virus ( EBV) and cytomegalovirus ( CMV) are most commonly responsible for subacute/chronic BCL. Bilateral cervical lymphadenopathy (BCL), which refers to swelling on both sides of the neck, is most commonly caused by viral infections of the upper respiratory tract. aureus and Streptococcus species, while chronic UCL can be the result of tuberculous or nontuberculous mycobacterial infections. Unilateral cervical lymphadenopathy (UCL) refers to localized swollen lymph node(s) on one side of the neck and is usually associated with bacterial infections. Cervical lymphadenopathy is most often seen in children under 5 years of age and typically affects the submandibular or deep cervical lymph nodes. Inflammatory cervical lymphadenopathy is more specifically referred to as cervical lymphadenitis, but terms may be used synonymously. Cervical lymphadenopathy refers to swelling of the cervical lymph node(s) and encompasses both infectious (e.g., bacterial or viral infections) and noninfectious causes (e.g., malignancy).
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