From the Guidelines
For children with cervical lymphadenopathy caused by nontuberculous mycobacterial (NTM) infections, excisional surgery without chemotherapy is the recommended treatment, with a success rate of approximately 95% 1. This approach is preferred because it frequently results in successful treatment, especially when diagnosis is made with fine needle aspiration or incisional biopsy.
- The use of excisional surgery has been shown to be effective in treating NTM cervical lymphadenitis, including disease caused by MAC and M. scrofulaceum 1.
- Incisional biopsy alone or the use of anti-TB drugs alone (without a macrolide) should be avoided as they have been associated with persistent clinical disease, including sinus tract formation and chronic drainage 1.
- For children with recurrent disease, a second surgical procedure is usually performed, or alternatively, a clarithromycin multidrug regimen may be used, especially in cases where surgical risk is high 1.
- In cases where a child has granulomatous disease with a strongly positive PPD tuberculin skin test, a course of anti-TB therapy may be recommended while awaiting the results of the lymph node culture, especially if there are risk factors for TB 1.
From the Research
Cervical Lymphadenopathy Treatment
- The treatment of cervical lymphadenopathy depends on the underlying cause, which can be infectious, autoimmune, or malignant in nature 2, 3.
- In cases of acute bacterial cervical lymphadenitis, treatment should provide adequate coverage for both Staphylococcus aureus and Streptococcus pyogenes 3.
- Most cases of cervical lymphadenitis are self-limited and require no treatment, but some may need antibiotic therapy or other interventions 3, 4.
- For patients with persisting cervical lymphadenopathy, early biopsy should be considered, especially if risk factors such as increasing age, generalized lymphadenopathy, and history of malignant disorder are present 5.
Diagnostic Approach
- A methodological approach to lymphadenopathy can disclose the accurate diagnosis, causing minimal discomfort for the patient and in a short time 2.
- Fine-needle aspiration (FNA), tuberculosis polymerase chain reaction (Tb-PCR), and complete blood count (CBC) are essential in the initial work-up for cervical lymphadenopathy 6.
- CBC can aid in detecting critical diseases and predicting the likelihood of open biopsy in patients with negative FNA and Tb-PCR 6.
- Ultrasound B-Mode gray scale examination can also provide valuable information, with factors such as bulky lesion, absence of hilus, and blurred outer contour associated with malignant lymphadenopathy 5.
Specific Treatments
- Antibiotic therapy is often used to treat bacterial infections, but may not be effective in all cases 3, 4.
- Methylprednisolone and osteopathic manipulative treatment may be beneficial in some cases, such as suppurative cervical lymphadenitis 4.
- Treatment of underlying conditions, such as malignancies or autoimmune disorders, is crucial in managing cervical lymphadenopathy 2, 5.