- Children’s Health
Lymphadenitis is the inflammation of lymph nodes. It is often a
complication of bacterial infections, although it can also be caused by
viruses or other disease agents. Lymphadenitis may be either generalized,
involving a number of lymph nodes, or limited to a few nodes in the area
of a localized infection. Lymphadenitis is sometimes accompanied by
lymphangitis, which is the inflammation of the lymphatic vessels that
connect the lymph nodes.
The lymphatic system is a network of vessels (channels), nodes (glands),
and organs. It is part of the immune system, which protects against and
fights infections, inflammation, and cancers. The lymphatic system also
participates in the transport of fluids, fats, proteins, and other
substances throughout the body. The lymph nodes are small structures that
filter the lymph fluid and contain many white blood cells to fight
infections. Lymphadenitis is marked by swollen lymph nodes that develop
when the glands are overwhelmed by bacteria, virus, fungi, or other
organisms. The nodes may be tender and hard or soft and
"rubbery" if an abscess has formed. The skin over an
inflamed node may be red and hot. The location of the affected nodes is
usually associated with the site of an underlying infection, inflammation,
or tumor. In most cases, the infectious organisms are
. If the lymphatic vessels are also infected, in a condition referred to
as lymphangitis, there will be red streaks extending from the wound in the
direction of the lymph nodes, throbbing
, and high
and/or chills. The child will generally feel ill, with loss of appetite,
, and muscle aches.
The extensive network of lymphatic vessels throughout the body and their
relation to the lymph
nodes helps to explain why bacterial infection of the nodes can spread
rapidly to or from other parts of the body. Lymphadenitis in children
often occurs in the neck area because these lymph nodes are close to the
ears and throat, which are frequent locations of bacterial infections in
Lymphadenitis is also referred to as lymph node infection, lymph gland
infection, or localized lymphadenopathy.
Lymphadenitis and lymphangitis are common complications of bacterial
Causes and symptoms
Streptococcal and staphylococcal bacteria are the most common causes of
lymphadenitis, although viruses, protozoa, rickettsiae, fungi, and the
bacillus can also infect the lymph nodes. Diseases or disorders that
involve lymph nodes in specific areas of the body include rabbit fever
, lymphogranuloma venereum, chancroid, genital herpes, infected
, dental abscesses, and bubonic plague. Lymphadenitis can also occur in
conjunction with cellulitis, which is a deep, widespread tissue infection
that develops from a cut or sore. In children,
or bacterial sore throats are the most common causes of lymphadenitis in
the neck area. Diseases that involve lymph nodes throughout the body
, and brucellosis.
The early symptoms of lymphadenitis are swelling of the nodes caused by a
build-up of tissue fluid and an increased number of white blood cells
resulting from the body's response to the infection. Further
developments include fever with chills, loss of appetite, heavy
perspiration, a rapid pulse, and general weakness.
The diagnosis of lymphadenitis is usually based on a combination of the
child's medical history, external symptoms, and laboratory
cultures. The doctor will press (palpate) the affected lymph nodes to see
if they are sore or tender, and search for an entry point for the
infection, like a scratch or bite. Swollen nodes without soreness are
sometimes caused by cat-scratch disease, which is an uncommon illness. In
children, if the lymphadenitis is severe or persistent, the doctor may
need to rule out
, HIV, tumors in the neck region, and congenital cysts that resemble
swollen lymph nodes.
Although lymphadenitis is usually diagnosed in lymph nodes in the neck,
arms, or legs, it can also occur in lymph nodes in the chest or abdomen.
If the child has acutely swollen lymph nodes in the groin, the doctor will
need to rule out a
in the groin that has failed to reduce (incarcerated inguinal hernia).
Hernias occur in 1 percent of the general population; 85 percent of
children with hernias are male.
The most significant tests are a white blood cell count (WBC) and a blood
culture to identify the organism. A high proportion of immature white
blood cells indicates a bacterial infection. Blood cultures may be
positive, most often for a species of staphylococcus or streptococcus. In
some cases, the doctor may order a biopsy of the lymph node to look for
unusual infection or lymphoma.
When to call the doctor
If a child develops symptoms of lymphadenitis, he or she should be taken
to the doctor or emergency room.
The medications given for lymphadenitis vary according to the bacterium or
virus that causes it. For bacterial infections, the child will be treated
, usually a penicillin, clindamycin, a cephalosporin, or erythromycin.
Supportive care of lymphadenitis includes resting the affected area and
applying hot moist compresses to reduce inflammation and pain.
Cellulitis associated with lymphadenitis should not be treated surgically
because of the risk of spreading the infection. Pus is drained only if
there is an abscess and usually after the child has begun antibiotic
treatment. In some cases, biopsy of an inflamed lymph node is necessary if
no diagnosis has been made and no response to treatment has occurred.
Inflammation of lymph nodes due to other diseases requires treatment of
the underlying causes.
The prognosis for recovery is good if the child is treated promptly with
antibiotics. In most cases, the infection can be brought under control in
three or four days. However, in some cases it may take weeks or months for
swelling to disappear; the length of recovery depends on the underlying
cause of the infection. Children with untreated lymphadenitis may develop
abscesses, cellulitis, or blood poisoning (septicemia), which is sometimes
Prevention of lymphadenitis depends on prompt treatment of bacterial and
Parents may be concerned that enlarged lymph nodes in their child are
malignant. They should seek immediate medical attention for the child so
concerns can be addressed in a timely manner.
—A rupture in the wall of a body cavity, through which an organ
—Small, bean-shaped collections of tissue located throughout the
lymphatic system. They produce cells and proteins that fight infection
and filter lymph. Nodes are sometimes called lymph glands.
—Inflammation of the lymphatic vessels. It often occurs together
with lymphadenitis (inflammation of the lymph nodes).
—A systemic infection due to the presence of bacteria and their
toxins in the bloodstream. Septicemia is sometimes called blood
. Any of several species of spherical bacteria that form pairs or
chains. They cause a wide variety of infections including scarlet fever,
tonsillitis, and pneumonia.
Mandal, B., et al.
Lecture Notes on Infectious Disease.
Oxford, UK: Blackwell Publishing, 2004.
Available online at: http://www.emedicine.com/ped/topic32/htm.
Judith Sims Rebecca J. Frey, Ph.D.
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