Pediatric Cervical Lymphadenitis: Etiology, Clinical Presentation, and Antimicrobial Resistance

Background: Cervical lymphadenitis is prevalent in children. Several viruses and bacteria can cause cervical lymphadenitis. Staphylococcus aureus and Streptococcus pyogenes are known to predominate as bacterial causes. Choosing the effective antibiotic regimen to treat cervical lymphadenitis is difficult because of temporal and geographical variations in its etiologies and antibiotic resistance. We aim to elucidate the etiologies, treatment, and outcomes of cervical lymphadenitis in children in Iran. Methods: A total of 113 patients admitted to the Children's Medical Center in Iran were included in this retrospective cross-sectional study. Patients under 18 years in medical records were evaluated for demographics, signs and symptoms, lymph node aspiration or surgical drainage culture and antibiogram results, type and duration of treatment, complications, treatment failure, and patient discharge instructions. Results: Patients' mean age was 3.5 years (SD: 2.9; range: 3 months to 13 years), and 70 (62%) were male. Of 113 patients, 38 (34%) had a prior history of upper respiratory tract infection (URI), 2 (1.7%) had dental caries, 1 (0.9%) had Hodgkin's lymphoma, and 72 (64.1%) patients did not have any accompanying illnesses in presentation. The most common clinical manifestation was neck swelling or erythema (99.1%), followed by fever (73%), neck pain (30%), and torticollis (9%). Twenty-one (18.5%) patients underwent cervical lymph node aspiration, and 7 (6%) underwent surgical incision and drainage, of which 17 (61%) had a positive culture. Staphylococcus aureus was isolated in 16 (94%) cases. No positive culture was reported regarding fungi and acid-fast bacilli. Regarding their antibiogram reports, the lowest resistance rates were to vancomycin, cotrimoxazole, and oxacillin (6% each), followed by clindamycin and erythromycin (12% each) and penicillin (94%). The mean duration of hospitalization was 6 days (SD: 3.2; range: 2-22 days). Thirty-three (29%) patients underwent surgical drainage along with antibiotic therapy. Conclusion: Cervical lymphadenitis was prevalently accompanied by URI. Swelling and erythema in the neck were the most common clinical manifestations. The most common isolated organism was Staphylococcus aureus. We did not find Streptococci, which might be due to the beta-lactam usage before hospital admission. Most of the patients were treated with clindamycin during hospitalization. However, resistance to clindamycin was higher than that of other antibiotics effective against Staphylococci and Streptococci, like oxacillin. We recommend considering this resistance pattern in choosing antibiotics to prevent treatment failure and reduce the need for surgery.