Articulo De Linfadentitis

Cervical Lymphadenitis, Suppurative Parotitis, Thyroiditis, and Infected Cysts

Nawaf Al-Dajani, MD 
Susan H. Wootton, MD∗ 

Division of Infectious and Immunological Diseases, Department of Pediatrics, BC Children's Hospital, 4480 Oak Street, University of British Columbia, Vancouver, BC V6H 3N1, Canada

* Corresponding author. Vaccine Evaluation Center, Rm L-427, 4500 Oak Street,Vancouver, BC V6H 3N1. |

E-mail address:  swootton@cw.bc.ca |

PII S0891-5520(07)00015-3

 
Neck masses are common and have a variety of infectious agents and noninfectious causes. This article reviews the more common infectious causes of neck masses—cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts. Important clinical pearls, diagnostic evaluation includinglaboratory studies, and imaging are summarized. Methods for prevention are highlighted.

Neck masses are common and have a variety of infectious and noninfectious causes. A directed history and thorough physical examination are the cornerstones on which a diagnosis is made. In particular, the age of the patient is critical in formulating an appropriate differential diagnosis for neck masses. Unlikeadults, neck masses in children seldom represent ominous disease. This article reviews the more common infectious causes of neck swelling—cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts. Noninfectious causes of neck masses include tumors, congenital anomalies, and skin and salivary gland disease.
Cervical lymphadenitis
The cervical lymphatic system involves a greatarray of superficial and deep lymph nodes that protect the head, neck, nasopharynx, and oropharynx against infection. Cervical lymphadenitis is characterized by inflammation of one or more of these lymph nodes. Most cases of cervical lymphadenitis, especially in children, are caused by an infectious agent; some immunologic processes and malignancies result in a similar presentation. Thefollowing section reviews the differential diagnosis and therapy of cervical lymphadenitis caused by infectious processes.
Pathophysiology
The lymphatic system of the cervical region serves as the initial line of defense against infections for all structures within the head, neck, and upper respiratory tract. Micro-organisms of the skin, oropharynx, or respiratory tract can invade local cervical lymphnodes, resulting in localized infection [1], [2]. If this initial defense fails, micro-organisms can disseminate, resulting in systemic disease. There are three groups of cervical lymph nodes: (1) Waldeyer's ring (including the adenoids and tonsils); (2) the nodes that surround Waldeyer's ring (occipital, postauricular, preauricular, parotid, and facial nodes); and (3) the submaxillary,submental, and deep and superficial jugular nodes [3]. Most cervical lymphatics drain to the submaxillary and deep cervical lymph nodes. Consequently, these nodes are often involved in cervical lymphadenitis.
Etiology
Infectious causes of cervical lymphadenitis are multiple (Table 1). The most common bacterial organisms causing acute unilateral infection areStaphylococcus aureus and Streptococcuspyogenes. In newborns adenitis may be caused by group B streptococci, whereas viruses are more common in children [4]. The presence of dental or periodontal disease suggests anaerobic bacteria [2]. In the past, anaerobic infections were uncommon; an observation that probably represented inadequate anaerobic-culturing techniques at the time.

Table 1   --  Infectious agents associated withcervical lymphadenitis
Type of organism | Common | Rare |
Bacteria | Staphylococcus aureus
Streptococcus pyogenes
Peptostreptococcus spp
Peptococcus spp
Bacteroides spp
Bartonella henselae  | Non-group A streptococci
Enterobacteriaceae
Escherichia coli 
Klebsiella spp
Pseudomonas spp
Haemophilus influenzae 
Actinomyces Israeli 
Fusobacterium spp
Francisella tularensis 
Yersinia spp...