Generalized Lymphadenopathy PDF

GENERALIZED LYMPHADENOPATHY By dr/ AHMED ELABD DEFINITION significant lymph node enlargement is considered with a diameter >1 cm in axillary and cervical, and > 1.5 cm in inguinal lymph node. By...

GENERALIZED LYMPHADENOPATHY By dr/ AHMED ELABD DEFINITION significant lymph node enlargement is considered with a diameter >1 cm in axillary and cervical, and > 1.5 cm in inguinal lymph node. By dr/ AHMED ELABD ETIOLOGY  Infections a) Bacterial: tuberculosis and disseminated skin infections, b) Viral: infectious mononucleosis, cytomegalovirus and HIV. c) Fungal: in immunocompromised child e.g. histoplasmosis, d) Protozoal: toxoplasmosis.  Malignancy: non- Hodgkin lymphoma, Hodgkin lymphoma, acute lymphoblastic leukemia, and histiocytosis.  Collagen diseases: rheumatoid arthritis and systemic lupus erythematosus. By dr/ AHMED ELABD  DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS  History and physical examination may suggest the proper diagnosis.  History of acute onset suggests viral or bacterial cause. Insidious onset suggests TB. or malignancy.  Anorexia, night sweats, weight loss and family history of TB. are suggestive of TB. Other system complaints and signs indicate systemic disease.  Fever, erythema and tenderness suggest bacterial infections or suggest abscess formation.  Matted, non-tender lymph nodes with or without sinus formation suggest TB.  Firm to hard, non-tender nodes, with or without matting or fixation to the skin or underlying structures suggest malignancy. By dr/ AHMED ELABD INVESTIGATIONS 1. Tuberculin test. 2. Complete and differential blood count. 3. Serum antibody titers of cytomegalovirus and infectious mononucleosis. 4. Chest radiography. 5. Excisional lymph node biopsy is indicated if associated with: 1. Persistent unexplained fever, 2. Severe weight loss and night fever, 3. Hard fixed nodes. 4. Increase in size over base line in 2 weeks, no decrease in 4-6 weeks or no regression to normal in 8-12 weeks, 5. Failure of response to empiric therapy. 6. Bone marrow examination. By dr/ AHMED ELABD TREATMENT  Depends on the course determined by good history and meticulous examination.  Antibiotic therapy if bacterial infection is suspected including antistaphylococcal antibiotics. If no response in' 1-2 days, ultrasound or CT should be done.  Drainage of pus plus culture and sensitivity, gram stain and Ziel-Nelsen stain.  Failure of response in 10-14 days suggests the need for further evaluation. By dr/ AHMED ELABD