Polymerase Chain Reaction for Pathogen Identification in Persistent Pediatric Cervical Lymphadenitis

Abstract

Objective: To study routine culture-negative persistent cervical lymphadenitis in children treated surgically during a 10-year period (December 26, 1997, to October 1, 2007) at a single institution.Design: Retrospective case series.Setting: Tertiary university-based pediatric referral center.Patients: Patients 18 years or younger with cervical lymphadenitis managed surgically (incision and drainage, curettage, and/or excisional lymphadenectomy) and medically (antibiotic therapy), culture-negative after 48 hours, and subsequently diagnosed using the polymerase chain reaction, extended culture incubation, and/or histopathologic evaluation. Main Outcome Measures:Number of surgical interventions, causative organisms, histopathologic features, and resolution of lymphadenitis.Results: Ninety surgical procedures were performed in 60 patients. The cure rate was 23% (approximately 14 patients) with incision and drainage, 58% (approxi-mately 35 patients) with curettage, and 95% (57 patients) with excisional lymphadenectomy. Nontuberculous mycobacteria were the most prevalent causative organisms, followed by Bartonella and Legionella organisms. Four of 6 patients with Bartonella infection had a history of cat exposure, and 4 of 6 patients with Legionella infection had a history of hot tub exposure.Conclusions: Excisional lymphadenectomy is the preferred treatment of mycobacterial persistent cervical lymphadenitis in children. Sufficient data are lacking for similar recommendations in patients with disease caused by Bartonella organisms, whereas for neck disease caused by Legionella organisms, excisional lymphadenectomy may be superior to incision and drainage. The polymerase chain reaction is useful for pathogen identification in pediatric cervical lymphadenitis, although it is less sensitive in identification of mycobacteria. To our knowledge, our study is the first to report multiple cases of legionellosis in otherwise healthy children. Legionella seems to be a previously unrecognized but relatively common pathogen in culture-negative persistent cervical lymphadenitis in children.

Pediatric cervicofacial lymphadenitis caused by Bartonella henselae

“…2 In those patients, the pain subsides within a few days whereas it takes several weeks to months for the lymphadenopathy to subside sonographically. Although cervicofacial lymphadenitis occurs frequently in children, a chronic persistent form can be a diagnostic and therapeutic challenge, 9 and CSD often remains unrecognized in cases of cervicofacial lymph node…”

Characterization of mortality and high-risk characteristics of thyroid cancer in Filipinos using the California Cancer Registry

“…Many Filipinos who immigrated to the U.S. in the 1970's−1980's were nurses and Filipinos still constitute 75% of all foreign nurses in the U.S. nurse workforce ( 9 ). Previous exposure to ionized radiation has been shown to lead to higher percentages of multifocal disease, extrathyroidal spread, stage IV disease, and death in thyroid cancer, but multiple studies have suggested otherwise including studies on healthcare workers ( 13 , 14 ).…”

Surgical treatment for chronic cervical lymphadenitis in children. Experience from a tertiary care paediatric centre on non-tuberculous mycobacterial infections

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