Suppurative cervical lymphadenitis in adult: An analysis of predictors for surgical drainage |
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| Institution: | 1. Department of Otolaryngology — Head and Neck Surgery, Temple University Hospital, 3440 N. Broad Street, Philadelphia, PA, 19140, USA;2. Division of Otolaryngology — Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA;3. Department of Otolaryngology — Head and Neck Surgery, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA;1. Department of Infectious Diseases, Sterling Hospital, Ahmedabad, 380052, India;2. Division of Infectious Diseases, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, 33612, USA;3. Infectious Diseases Consultant, 405, AXIS Business Space, Nanpura, Surat, 395001, India;4. Clinical Microbiologist, Abha Laboratory Pvt Ltd, 2nd Floor, Rajratna Chambers, Dabgharwad, Bhagal, Surat, India;1. Department of Vascular Surgery, The Second Xiang-ya Hospital, Central South University, Changsha, China;2. Department of Vascular Surgery, Hainan General Hospital, Haikou, China;3. Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China;1. Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany;2. Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany;3. Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany;4. Department of Neurosurgery, Leipzig University Hospital, Leipzig, Germany;5. Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany;6. Department of Anesthesiology and Intensive Care Medicine, Leipzig University Hospital, Leipzig, Germany;1. Children''s Neurosciences Center, The Royal Children''s Hospital, Melbourne, Victoria, Australia;2. Murdoch Children''s Research Institute, Melbourne, Victoria, Australia;3. Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia |
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| Abstract: | ObjectiveLymphadenitis can be treated successfully by empirical antibiotic therapy. However, inflamed lymph nodes can progress into an abscess with local and/or systemic reaction, which requires more complex treatment strategies. The study aim to analyze possible predictors for abscess formation within inflamed nodes that require surgical drainage.Materials and MethodsWe retrospectively enrolled 241 patients with acute or sub-acute cervical lymphadenitis. Demographic including, lymph node characteristics, management, and final diagnosis were recorded. Predictors for abscess formation within the lymph node that required surgical drainage were evaluated using univariate and multivariate analysis. Patient and lymph node characteristics that differentiated suppurative cervical lymphadenitis (SCL) from other lymphadenitis were also analyzed.ResultsThere were 41 cases of SCL, 173 cases of uncomplicated cervical lymphadenitis, and 27 cases of tuberculous cervical lymphadenitis (TBLN). Abscess was surgically drained in 39 patients, while 2 patients received a needle aspiration. In 9 patients, SCL complications included cellulitis of the neck soft tissue, supraglottic swelling, internal jugular vein thrombosis, and sepsis. Two patients were diagnosed with melioidosis and actinomycosis after drainage. Multivariate analysis showed that an immunocompromised host, male sex, and receiving prior inadequate treatment were predictors for surgical drainage. TBLN patients had similar manifestations as SCL patients. However, affected nodes in SCL patients were singular, painful, and showed fluctuation.ConclusionsFollowing SCL diagnosis, abscess drainage and appropriate antibiotic treatment should be considered. Aspiration or surgical drainage can be effective in certain patients. Pathogen isolation and tissue biopsy should be performed to ensure accurate diagnosis and antibiotic selection. In addition, TBLN and melioidosis should be considered, especially in endemic areas. |
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