Cervical lymphadenitis

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.

Aim

To guide staff with the assessment and management of cervical lymphadenitis.

Assessment

Investigations

  • The majority of children have mild disease and require no investigations. 
  • Indicated only if systemic symptoms, suspicion of underlying infection or in immunocompromised patient.
    • FBC, CRP and Blood cultures are indicated in the unwell child who appears septic.
  • Ultrasound may be considered if atypical or clinical doubt about drainable collection.

Management 

Cervical lymphadenitis (acute) 
 Reactive lymph node (LN)
  • Nodes are usually small, discrete, mildly tender or non tender
  • LN are mostly commonly reactive due to viral URTI and may persist for some weeks
  • Management is expectant with clinical review by GP.
 Acute bacterial cervical lymphadenitis
  • Large (>1cm), discrete, tender cervical LN +/- overlying cellulitis
  • Usually anterolateral neck, may have scalp or dental sources
  • Antibiotics - skin, soft tissue and orthopaedic infections ChAMP empiric guidelines
  • Abscesses require surgical review for incision and drainage
  • In lesions that persist for more than 2 weeks, consider atypical pathogens such as non-tuberculous mycobacteria, Bartonella henselae or non infectious conditions

Nursing

Apply topical local anaesthetic cream (e.g. EMLA®) if patient condition is suggestive of requiring intravenous antibiotics.

Observations

  • Baseline observations include heart rate, respiratory rate, oxygen saturations and temperature.
  • Minimum of hourly observations should be recorded whilst in the emergency department.
  • Any significant changes should be reported immediately to the medical team.

Bibliography

  1. WA Health Child and Adolescent Health service. Skin, Soft Tissue and Orthopaedic Infections ChAMP Empiric Guidelines version 2 August 2014.
  2. External Review: Christopher Blyth (Infectious Diseases Consultant) September 2015
  3. Nelson Textbook of Pediatrics: 20th Edition Robert M. Kliegman, Bonita M.D. Stanton, Joseph St. Geme, Nina F Schor Publisher: Elsevier


Endorsed by:  Director, Emergency Department  Date:  Feb 2018


 Review date:   Feb 2020


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