Acute and Chronic Lymphadenitis

Question 1

Clinical presentation & associated aetiologies (organisms or syndrome)

Acute lymphadenitis - usually cervical

Answer 1

Staph aureus, strep pyogenes

Question 2

Generalised lymphadenopathy with fevers and fatigye

Answer 2

• EBV
• CMV
• Acute retroviral syndrome from HIV

Question 3

Preauricular LN - lymphatic drainage from infected conjunctiva

Answer 3

Bartonella henselae
Francisella tularensis
Adenovirus

Question 4

Post auricular LN - lymphatic drainage from infected scalp

Answer 4

Tinea capitis

Question 5

Cat exposure

Answer 5

1. Bartonella henselae (cat scratch disease)
2. Toxoplasmo gondii
3. Pasteurella multocida

Question 6

Cattle exposure (chronic lymphadenopathy_

Answer 6

Brucella spp

Question 7

Chronic granulomatous disease

Answer 7

Catalase positive organisms

Question 8

Management of acute lymphandenitis

Answer 8

1. Empiric rx to cover staph, strep
   - Cephalexin (MSSA, s pyogenes)
   - Clinda (MRSA, s pyogenes)
   - Bactrium (MSSA, MRSA)
2. Follow up - failure to respond indicates likely abscess (send spec for MCS)

Question 9

Ix and rx of subacute/chronic lympadenopathy

Answer 9

1. Bloods
   - FBE, ESR, CRP
   - Consider: EBV IgG/M, CMV IgG/M, T gondi IgG/M, Histoplasma capsulatum IgG/M, HIV ag/ab, QFN-G
2. Sample - send for MCS, AFB, fungal MCS, flow cytometry (malig), histopathology

Question 10

Pathogen specific considerations (consider when… and treatment)

1. Cat-scratch disease
2. Actinomycosis
3. Non TB mycobacteria

Answer 10

1. B. henselae - consider with affected axillary/epitrochlear node. Self limiting
2. Consider with chronic cervicofacial lymphadenitis after dental work. Rx penicillin/clinda
3. Consider with lymphadenopathy with overlying violaceous skin. Self limiting