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Association between the Clinical, Laboratory and Ultrasound Characteristics and the Etiology of Peripheral
Vojko Berce1, Nina Rataj1, Maja Dorič1
1Department of Pediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
Insights
Peripheral lymphadenopathy in children is often caused by bacterial lymphadenitis, infectious mononucleosis, or cat scratch disease. Clinical and lab findings help quickly diagnose these common pediatric conditions.
Area of Science:
- Pediatric Infectious Diseases
- Diagnostic Imaging
- Clinical Pathology
Background:
- Peripheral lymphadenopathy is a common pediatric concern, necessitating accurate etiological diagnosis.
- Distinguishing benign causes from rare malignant conditions is crucial for appropriate management.
- Understanding clinical and laboratory predictors aids in efficient diagnosis of pediatric lymphadenopathy.
Purpose of the Study:
- To identify the most frequent causes of peripheral lymphadenopathy in hospitalized children.
- To determine clinical, laboratory, and ultrasound characteristics for rapid etiological diagnosis.
- To differentiate common pediatric lymphadenopathy causes, avoiding unnecessary interventions.
Main Methods:
- Cross-sectional study of 139 hospitalized children with peripheral lymphadenopathy.
- Clinical evaluation, laboratory tests (including C-reactive protein, white blood cell count), and lymph node ultrasound.
- Statistical analysis to associate clinical/laboratory findings with specific etiologies.
Main Results:
- Bacterial lymphadenitis (47.5%), infectious mononucleosis (22.3%), and cat scratch disease (20.9%) were the most common causes.
- Bacterial lymphadenitis correlated with neutrophilia and elevated C-reactive protein.
- Infectious mononucleosis associated with pharyngitis, leukocytosis, and elevated liver enzymes; cat scratch disease with cat contact and absence of fever.
Conclusions:
- Bacterial lymphadenitis, infectious mononucleosis, and cat scratch disease are the primary causes of pediatric peripheral lymphadenopathy.
- Specific clinical signs and basic laboratory tests facilitate rapid differentiation of these conditions.
- A focused history and examination, coupled with select lab tests, can accurately diagnose common pediatric lymphadenopathy etiologies.
Abstract:
Peripheral lymphadenopathy affects most children at least once in a lifetime and represents a major reason for concern. Therefore, we aimed to identify the most common causes of peripheral lymphadenopathy in hospitalized children and to determine the clinical, laboratory and ultrasound characteristics that enable fast, easy and accurate etiological diagnosis. We performed a cross-sectional study including 139 children who were hospitalized because of peripheral lymphadenopathy. Ultrasound of lymph nodes was performed in 113 (81.3%) patients. Lymphadenopathy was generalized in nine (6.5%) patients. Malignant etiology was established in only three (2.2%) patients. Bacterial lymphadenitis, infectious mononucleosis (IM) and cat scratch disease (CSD) were diagnosed in 66 (47.5%), 31 (22.3%) and 29 (20.9%) patients, respectively. Bacterial lymphadenitis was significantly associated with neutrophilia (p < 0.01), and increased C-reactive protein levels (p < 0.01). IM was associated with pharyngitis (p < 0.01), leukocytosis without neutrophilia (p = 0.03) and increased blood liver enzyme levels (p < 0.01). CSD was associated with recent contact with a cat (p < 0.01), absence of a fever (p < 0.01) and normal white blood cell count (p < 0.01). Thorough history and clinical examination in combination with a few basic laboratory tests enable fast and accurate differentiation between the most common etiologies of lymphadenopathy in children to avoid unnecessary procedures and hospitalizations.
