From the Guidelines
The treatment for lymphadenitis, specifically NTM cervical lymphadenitis, is primarily surgical excision, with a greater than 90% cure rate, as recommended by the American Journal of Respiratory and Critical Care Medicine 1.
Causes and Treatment Approaches
The cause of lymphadenitis can vary, and treatment approaches differ based on the underlying cause. For NTM cervical lymphadenitis, which is often caused by Mycobacterium avium complex (MAC), the preferred treatment is surgical excision. This approach has been shown to have a high success rate, with approximately 95% of cases being successfully treated with this method alone 1.
Surgical Excision
Surgical excision without chemotherapy is the recommended treatment for children with NTM cervical lymphadenitis, including those with disease caused by MAC and M. scrofulaceum 1. This procedure is highly effective, with a success rate of approximately 95% 1.
Alternative Treatments
For cases where surgical risk is high, or in instances of recurrent disease, an alternative approach may be considered. This can include the use of a clarithromycin multidrug regimen, similar to those used for pulmonary disease 1. However, experience with this approach is limited, and it is generally considered secondary to surgical excision.
Importance of Accurate Diagnosis
It is crucial to accurately diagnose the cause of lymphadenitis to ensure appropriate treatment. In cases where granulomatous disease is present, with or without acid-fast bacilli (AFB) on examination of the excised lymph nodes, and a positive PPD tuberculin skin test, a course of anti-TB therapy may be recommended while awaiting culture results 1. If cultures fail to yield any mycobacteria, anti-TB therapy should be discontinued unless there are significant risk factors for TB.
Key Considerations
- Surgical excision is the primary treatment for NTM cervical lymphadenitis 1.
- Alternative treatments, such as clarithromycin multidrug regimens, may be considered in specific cases but are not the first line of treatment.
- Accurate diagnosis is critical to determine the appropriate treatment approach.
- Patients should be closely monitored, and treatment should be adjusted based on culture results and clinical response.
From the Research
Treatment for Lymphadenitis
The treatment for lymphadenitis depends on the underlying cause of the condition.
- For infectious lymphadenitis, treatment may involve antibiotics, such as in the case of acute unilateral cervical lymphadenitis, especially in children with systemic symptoms 2.
- In some cases, corticosteroids may be used, but their usefulness is limited and they should not be used without an appropriate diagnosis 2.
- For lymphadenitis caused by mycobacterial infection, treatment may involve antimicrobial therapy, and routine culture for mycobacteria and fungi is recommended for all lymph nodes that show granulomatous changes 3.
- In cases where the cause of lymphadenitis is unknown, a biopsy may be necessary to determine the underlying cause and guide treatment 2, 4.
- Fine-needle aspiration, core needle biopsy, or open excisional biopsy may be used to diagnose and treat lymphadenitis, depending on the clinical presentation and location of the lymphadenopathy 2, 4.
Diagnostic Considerations
- Molecular methods, such as real-time PCR, may be used to diagnose infectious lymphadenitis, but culture remains critical in the case of low bacterial concentrations 5.
- The history and physical examination alone usually identify the cause of lymphadenopathy, but when the cause is unknown, lymphadenopathy should be classified as localized or generalized 2.
- Risk factors for malignancy, such as age older than 40 years, male sex, white race, supraclavicular location of the nodes, and presence of systemic symptoms, should be considered when evaluating lymphadenopathy 2.