Polymerase chain reaction for pathogen identification in persistent pediatric cervical lymphadenitis

Area of Science:

• Pediatric infectious diseases
• Surgical pathology
• Microbiology

Background:

• Persistent cervical lymphadenitis in children often presents as culture-negative, posing diagnostic and therapeutic challenges.
• Surgical intervention is frequently required for refractory cases.

Purpose of the Study:

• To evaluate surgical treatments for culture-negative persistent cervical lymphadenitis in children.
• To identify causative organisms and assess treatment outcomes.

Main Methods:

• Retrospective case series of 60 pediatric patients treated at a single institution over 10 years.
• Surgical interventions included incision and drainage, curettage, and excisional lymphadenectomy.
• Pathogen identification utilized polymerase chain reaction (PCR), extended cultures, and histopathology.

Main Results:

• Sixty patients underwent 90 surgical procedures.
• Excisional lymphadenectomy achieved a 95% cure rate, significantly higher than curettage (58%) or incision and drainage (23%).
• Nontuberculous mycobacteria were the most frequent pathogens, followed by Bartonella and Legionella. Specific exposures were noted for Bartonella (cat contact) and Legionella (hot tub use).

Conclusions:

• Excisional lymphadenectomy is the preferred treatment for mycobacterial cervical lymphadenitis in children.
• Legionella is a significant, previously unrecognized pathogen in pediatric cervical lymphadenitis.
• PCR is valuable for pathogen detection, though less sensitive for mycobacteria.