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Cervical lymphadenitis in children: Diagnostic approach and initial management

C Mary Healy, MD
Section Editors
Jan E Drutz, MD
Glenn C Isaacson, MD, FAAP
Morven S Edwards, MD
Deputy Editor
Mary M Torchia, MD


The evaluation and initial treatment of cervical lymphadenitis in children will be reviewed here. The pathogenesis, etiology, and clinical manifestations of cervical lymphadenitis and other causes of peripheral lymphadenopathy in children are discussed separately. (See "Cervical lymphadenitis in children: Etiology and clinical manifestations" and "Peripheral lymphadenopathy in children: Etiology" and "Peripheral lymphadenopathy in children: Evaluation and diagnostic approach".)


Cervical lymphadenopathy – Enlarged lymph node(s) of the neck, including preauricular, parotid, jugulodigastric, submental, submandibular, posterior cervical, superficial cervical, deep cervical, occipital, and posterior auricular (mastoid) (figure 1); lymphadenopathy encompasses both inflamed and noninflamed lymph nodes.

Cervical lymphadenitis – Enlarged, inflamed, and tender lymph node(s) of the neck; although strictly speaking, "lymphadenitis" refers to inflamed lymph nodes, the terms "lymphadenitis" and "lymphadenopathy" often are used interchangeably.

Acute lymphadenitis – Develops over a few days (but may persist for weeks to months).

Subacute/chronic lymphadenitis – Develops over weeks to months.

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Literature review current through: Oct 2017. | This topic last updated: Oct 11, 2016.
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  1. Leung AK, Davies HD. Cervical lymphadenitis: etiology, diagnosis, and management. Curr Infect Dis Rep 2009; 11:183.
  2. Healy CM, Baker CJ. Cervical lymphadenitis. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th ed, Cherry JD, Harrison GJ, Kaplan SL, et al (Eds), Elsevier Saunders, Philadelphia 2014. p.175.
  3. Neff L, Newland JG, Sykes KJ, et al. Microbiology and antimicrobial treatment of pediatric cervical lymphadenitis requiring surgical intervention. Int J Pediatr Otorhinolaryngol 2013; 77:817.
  4. Dulin MF, Kennard TP, Leach L, Williams R. Management of cervical lymphadenitis in children. Am Fam Physician 2008; 78:1097.
  5. Barton LL, Feigin RD. Childhood cervical lymphadenitis: a reappraisal. J Pediatr 1974; 84:846.
  6. DAJANI AS, GARCIA RE, WOLINSKY E. Etiology of cervical lymphadenitis in children. N Engl J Med 1963; 268:1329.
  7. Scobie WG. Acute suppurative adenitis in children: a review of 964 cases. Scott Med J 1969; 14:352.
  8. Brook I. Aerobic and anaerobic bacteriology of cervical adenitis in children. Clin Pediatr (Phila) 1980; 19:693.
  9. Gosche JR, Vick L. Acute, subacute, and chronic cervical lymphadenitis in children. Semin Pediatr Surg 2006; 15:99.
  10. Miller LG, Daum RS, Creech CB, et al. Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections. N Engl J Med 2015; 372:1093.
  11. Campbell RM, Douglas PS, Eidem BW, et al. ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 appropriate use criteria for initial transthoracic echocardiography in outpatient pediatric cardiology: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Academy of Pediatrics, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Coll Cardiol 2014; 64:2039.
  12. Snowden J, Stovall S. Tularemia: retrospective review of 10 years' experience in Arkansas. Clin Pediatr (Phila) 2011; 50:64.
  13. World Health Organization. WHO guidelines on tularemia. Geneva, Switzerland: World Health Organization; 2007. http://www.cdc.gov/tularemia/resources/whotularemiamanual.pdf. (Accessed on September 05, 2014).
  14. Choi P, Qin X, Chen EY, et al. Polymerase chain reaction for pathogen identification in persistent pediatric cervical lymphadenitis. Arch Otolaryngol Head Neck Surg 2009; 135:243.
  15. Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367.
  16. Margileth AM. The use of purified protein derivative mycobacterial skin test antigens in children and adolescents: purified protein derivative skin test results correlated with mycobacterial isolates. Pediatr Infect Dis 1983; 2:225.
  17. Perlman DC, D'Amico R, Salomon N. Mycobacterial Infections of the Head and Neck. Curr Infect Dis Rep 2001; 3:233.
  18. Lindeboom JA, Kuijper EJ, Prins JM, et al. Tuberculin skin testing is useful in the screening for nontuberculous mycobacterial cervicofacial lymphadenitis in children. Clin Infect Dis 2006; 43:1547.
  19. American Academy of Pediatrics. Diseases caused by nontuberculous mycobacteria. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.831.
  20. Fraser L, Moore P, Kubba H. Atypical mycobacterial infection of the head and neck in children: a 5-year retrospective review. Otolaryngol Head Neck Surg 2008; 138:311.
  21. Leung AK, Robson WL. Childhood cervical lymphadenopathy. J Pediatr Health Care 2004; 18:3.
  22. Schaad UB, Votteler TP, McCracken GH Jr, Nelson JD. Management of atypical mycobacterial lymphadenitis in childhood: a review based on 380 cases. J Pediatr 1979; 95:356.
  23. Flint D, Mahadevan M, Barber C, et al. Cervical lymphadenitis due to non-tuberculous mycobacteria: surgical treatment and review. Int J Pediatr Otorhinolaryngol 2000; 53:187.
  24. Maltezou HC, Spyridis P, Kafetzis DA. Nontuberculous mycobacterial lymphadenitis in children. Pediatr Infect Dis J 1999; 18:968.
  25. Wolinsky E. Mycobacterial lymphadenitis in children: a prospective study of 105 nontuberculous cases with long-term follow-up. Clin Infect Dis 1995; 20:954.
  27. Ord RJ, Matz GJ. Tuberculous cervical lymphadenitis. Arch Otolaryngol 1974; 99:327.
  28. Kent DC. Tuberculous lymphadenitis: not a localized disease process. Am J Med Sci 1967; 254:866.
  29. Brook AH, Winter GB. Cervico-facial suppurative lymphadenitis due to staphylococcal infection in childhood. Br J Oral Surg 1971; 8:257.