Retrospective Review of Etiological Factors and the Management of Cervical Lymphadenopathy in the Pediatric Population Administered to Padeh-Poriya Medical Center

Aim: To characterize etiologies of cervical lymphadenopathy in children, determine if there is a definite advantage in starting an empirical treatment, and decide which tests are recommended in order to diagnose and treat most wisely, and to avoid unnecessary invasive testing.

Methods: The study includes 111 subjects aged 1-14 who were diagnosed between 2013-2018 with cervical lymphadenopathy. The study was performed retrospectively, by analyzing patient files.

Results: Cervical lymphadenopathy characterizes young males, usually under 4 years of age. The possible diagnoses found are reactive lymphadenopathy, bacterial infection, EBV/CMV, Cat-Scratch disease, Kawasaki disease, Toxoplasma, PFAPA, SLE. Reactive lymphadenopathy is most common followed by bacterial and EBV/CMV infections; The most common bacterium identified was Group A streptococcus. A satisfactory response to antibiotic treatment was mainly observed in patients with reactive lymphadenopathy.

Conclusions: Serological testing can be performed as part of the initial blood test panel, enabling to diagnose about one-third of patients and sparing further examinations, patient discomfort, and additional expenses. US/CT tests performed for the vast majority of patients did not provide a diagnosis. Physical examination may be sufficient, unless there are signs of a lymphoproliferative process. In cases of reactive enlargement, empirical antibiotic therapy can be given, and good results are expected. The only bacterial diagnosis characteristic is neutrophilia (>50%). However, blood counts can strongly indicate the presence of viral infection with EBV/CMV, with low neutrophil counts (<50%), high lymphocyte counts (>50%), and high LUC (>5%) being key features of the diagnosis.