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[Cervical lymph node inflammation in children]
1Service ORL du Pr Roulleau, Hôpital Necker, Enfants Malades, Paris.
Insights
Cervical lymph node infections in children are often caused by Staphylococcus, originating from skin infections, particularly in those under five. Streptococcus is the second most common cause, often linked to throat infections.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Bacteriology
Context:
- Study retrospectively analyzed 127 pediatric cervical lymph node infections (1974-1986).
- Identified infection origins in 30% of cases: cutaneous, pharyngo-tonsillar, and dental.
- Observed suppuration in two-thirds of cases, with Staphylococcus as the predominant pathogen.
Purpose:
- To investigate the origins, causative agents, and clinical progression of cervical lymph node infections in children.
- To guide appropriate antimicrobial management based on identified pathogens and their sensitivities.
Summary:
- Staphylococcus was the primary cause of cervical lymphadenitis, predominantly in children under five, with cutaneous origins.
- Streptococcus was the second most frequent pathogen, associated with pharyngo-tonsillar and dental infections, affecting older children.
- Anaerobic infections were rare; antibiotic treatment choices considered Staphylococcus resistance patterns.
Impact:
- Highlights the importance of identifying the infection source for effective treatment.
- Informs clinical decision-making regarding antibiotic selection for pediatric cervical lymphadenitis.
- Provides epidemiological data on pediatric cervical lymph node infections over a defined period.
Abstract:
One hundred and twenty seven cases of cervical lymph node infection were seen between 1974 and 1986 in children aged between 1 month and 10 years. The point of origin of the infection wa identified in 30% of cases and was, in decreasing order: cutaneous, in the cervico-cephalic region; pharyngo-tonsillar via the lymphatic structures of the pharynx or by direct effraction of the buccopharyngeal mucosa; and, finally, dental. The site of the secondary lymph node infection was generally below and behind the angle of the jaw and in some cases submandibular. Two thirds of cases progressed to suppuration and were evaluated bacteriologically. Four organisms were identified: Staphylococcus, very much in the majority. The origin of the infection was almost always cutaneous. There was a predilection for the child aged under 5 with a majority under 2. The streptococcus was in second place far behind the staphylococcus. The origin of the infection was pharyngo-tonsillar, with the beta-haemolytic streptococcus predominant, bucco-dental, with the alpha-haemolytic predominant, and a very small number of cases with a cutaneous origin. The age of these children was greater than in the staphylococcal infection group: the great majority were over 2 and all cases with a dental origin were aged over 5. There were a small number of anaerobic infections. In 2 of the 3 bacteriologically confirmed cases, the origin was pharyngo-tonsillar and development was obviously favored by the initial antibiotics prescribed. Management took into account the predominance of the staphylococcus, the resistance of this organism to penicillin G and its usual sensitivity to methicillin.(ABSTRACT TRUNCATED AT 250 WORDS)