Lymphadenitis

Disease Description (Causes and Symptoms)

• Summary of definition: Lymphadenitis is a condition in which the lymph nodes become enlarged and inflamed as an immune response to infection (bacterial or viral), tuberculosis, or metastasis from a malignant tumor in another organ.
• Causes and pathophysiology:
  • Acute bacterial infection (mainly Staphylococcus, Streptococcus, and others after skin or upper respiratory tract infections) is the most common cause.
  • Viral causes (such as colds and mononucleosis) and tuberculous causes (which progress slowly, particularly in children and young adults) are possible.
  • Enlargement due to metastasis from tumors in other organs (metastatic cancer should especially be suspected in people in their 40s–50s or older).
  • Lymph nodes are sites where infectious antigens are processed and isolated; antigen stimulation can cause enlargement, pain, suppuration (abscess formation), and other changes.
• Main symptoms:
  • Local: Palpable mass (enlarged lymph node), pain (in acute infection), redness and warmth, swelling, skin ulceration and pus discharge (when advanced), reduced mobility (when adhered to surrounding tissues)
  • Systemic: Fever, malaise, decreased appetite, weight loss, night sweats (especially in tuberculous cases)
  • Clinical characteristics: Acute infectious lymphadenitis is usually painful, enlarges rapidly, and is mobile. Tuberculous lymphadenitis is usually painless and tends to involve the gradual enlargement of multiple nodules.

Treatment Methods

• General principles: Treatment varies according to the cause (identification of the cause → appropriate antimicrobial, antituberculous, or tumor treatment).
• Medication:
  • Suspected bacterial lymphadenitis: Oral or intravenous antibiotics (according to local antibiotic guidelines). Antibiotics covering Staphylococcus and Streptococcus are generally used (for example, amoxicillin-clavulanate or a penicillin-class drug in mild cases; clindamycin or another option if MRSA is suspected). Hospitalization and intravenous antibiotics are needed in severe cases or when an abscess is suspected.
  • Tuberculous lymphadenitis: Standard antituberculous drug therapy (multiple drugs; treatment lasts several months—according to national guidelines).
  • Viral lymphadenitis generally improves with symptomatic treatment (rest, antipyretics and analgesics).
• Procedures and surgery:
  • Drainage (incision and drainage) is necessary when an abscess forms.
  • When the cause is unknown or malignancy is suspected, the diagnosis is confirmed by biopsy (fine-needle aspiration [FNA], core-needle biopsy, or excisional biopsy).
  • Surgical excision may be performed if the condition does not respond to treatment or for diagnostic purposes.
• Lifestyle management and symptomatic treatment:
  • Apply warm compresses to relieve pain.
  • Get sufficient rest and drink adequate fluids.
  • Complete the full course of antibiotics as directed while taking them.
• Precautions (during treatment):
  • Do not squeeze or press the pus carelessly (risk of spreading the infection and scarring).
  • If there is no improvement within 48–72 hours after starting antibiotics, reassessment is necessary.
  • If it persists for more than 2 weeks, increases in size, or is accompanied by high fever or systemic symptoms, additional testing (imaging and biopsy) is necessary.
  • If a hard lump is palpable in the neck in a person aged 40 or older, active testing is necessary to rule out metastatic malignancy.

Checklist Before an Outpatient Visit (Including Items to Prepare and Example Questions)

• Items to prepare (bring to the hospital):
  • A list of current medications (including prescription drugs, over-the-counter drugs, and supplements)
  • Past medical history (history of tuberculosis, cancer, immunosuppressive treatment, diabetes, etc.)
  • The date and timing of any recent infection (upper respiratory tract infection or skin wound) or trauma
  • Notes recording when symptoms began and how they have progressed (changes in size, pain, presence of fever, discharge, etc.)
  • Previous test results, if available (blood tests, chest X-rays, ultrasound, etc.)
• Information to tell the healthcare provider first during the visit:
  • When the lymph node was first noticed and how its size has changed
  • Whether systemic symptoms such as fever, weight loss, night sweats, or fatigue are present
  • Whether there is skin ulceration or pus discharge
  • Whether antibiotics were recently taken and how the condition responded
  • History of tuberculosis exposure, recent travel, contact with animals, or an immunocompromised condition
• Example questions (items patients can write down in advance):
  • When did the symptoms begin, and how quickly did the lump grow?
  • Is there a fever or any systemic symptoms? Did antibiotics improve the condition?

General Example Questions to Ask the Doctor

• "What is the most likely cause of this lymph node enlargement?"
• "Which tests do you recommend (blood tests, imaging, or biopsy), and what is the purpose of each?"
• "What is the expected treatment duration and what are the common side effects of the antibiotic you plan to prescribe?"
• "How should I monitor my condition after treatment? When should I return for another visit?"
• "How likely is it that this lymph node is cancerous, and when is a biopsy necessary?"

Examples of Disease-Specific Questions

• If tuberculosis is suspected:
  • "Which tests would you perform to differentiate tuberculosis (chest X-ray, tuberculosis testing, PPD/IGRA, biopsy, etc.)?"
  • "Please explain the expected duration of antituberculous treatment and the side effects of each medication, such as hepatotoxicity."
• If an abscess (pus) or the need for drainage is suspected:
  • "Is drainage (incision and drainage) necessary in this area? What is the procedure and what is the recovery process like?"
  • "What is the risk of scarring or fistula formation (a connecting tract between the skin and the lymph node) after drainage?"

Additional guidance:

• When to seek urgent medical care: Immediate emergency care is necessary if the size increases rapidly, the skin quickly becomes red, severe pain or fever occurs, or there is difficulty breathing or swallowing.
• Course: Acute bacterial lymphadenitis usually improves within 1–3 weeks with appropriate antimicrobial treatment. Tuberculous lymphadenitis requires long-term treatment (several months), and some cases may require surgical treatment.