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Swollen lymph nodes are common in everyday practice of pediatrician. Almost half of the cases the child with an enlarged lymph node gets the direction to the doctor-Oncohematology.
Often, it is not quite justified: the nature of malignant lymphadenopathy (enlarged lymph node) is confirmed only in 1% of cases. Lymphadenopathy is usually inherent to an infectious or immune etiology.
Inflammation of the lymph nodes in a child Increase in lymph node — it is not inflammation, although between the words “lymphadenitis” (inflammation) and “lymphadenopathy” doctors often terminologically incorrect to put an equality sign. Spectrum of diseases causing lymphadenopathy, is quite broad. This hypoplastic diathesis, thymomegaly, immunodeficiency, infection (viral, fungal, bacterial), post-vaccination syndrome, infectious mononucleosis, allergic reactions to medications, syphilis, tuberculosis. As you can see, more lymph nodes may be a reaction of the cells of the immune apparatus to the action of antigen, tumor invasion or infectious disease. And only in the latter case, it is possible to talk about lymphadenitis, that is, the inflammation. In children the most frequently observed inflammation of the lymph nodes of the maxillofacial region, so this article will primarily focus on the specified lymphadenitis location. The most likely source of infection leading to lymphadenitis are Staphylococcus aureus and, less frequently, Streptococcus.
There are three forms of inflammation of lymph nodes: serous, purulent and adenilson. Infection once in the lymph node, causes vasodilation due to blood flow, this results in swelling filled with serous exudate. Dilate lymphatic sinuses (prosto inside the lymph node, performing the role of blood vessels) that also are filled with serous exudate, leukocytes, lymphocytes and microphages. In the future, when the increase in the number of white blood cells, serous lymphadenitis can pass in the purulent form. If the production of pus is so great that it is beyond the lymph node into the surrounding tissue, in this case talking about adenilson. If we translate all the numbers, most often diagnosed with suppurative lymphadenitis (about half of the total number of cases), and serous lymphadenitis and adenilson respectively account for 20-25%.
Symptoms of lymphadenitis is the Most characteristic symptom of lymphadenitis is enlarged lymph node, and, unlike lymphadenopathy, pressing on the swelling marked pain. This is accompanied by weakness, increased body temperature, loss of appetite. Lymphadenitis almost always precedes any disease: SARS, sinusitis, tonsillitis, rhinitis, stomatitis, periodontitis, glossitis, gingivitis. Speaking about each of the types of lymphadenitis separately, it should be noted that serous lymphadenitis, except a painful increase in lymph node and concomitant edema, does not manifest itself, that is, the General condition of the organism does not deteriorate. In children, a transition serous purulent lymphadenitis in noted in 45% of cases. This is due to the high susceptibility to infection of the lymphatic system, but also a developed network of lymphatic pathways, which is inherent to the child’s body. For suppurative lymphadenitis, as already mentioned, is characterized by swelling at the site of inflammation caused by increased infiltration, increased pain, blood flow to the skin. Overall health is deteriorating clinically, reminding a poisoning. When adenilson flushing of the skin and swelling at first do not manifest themselves because of the deep localization of the purulent center.
Diagnosis of lymphadenitis
The first diagnostic event with respect to lymphadenitis, as in the case of many other diseases, is a common blood test. It allows to identify the place in the body inflammation. The next stage of diagnosis is an ultrasound examination (it is also directly in the course of treatment to assess its effectiveness). And finally, if necessary, is made by biopsy.
A very important caveat: despite the localized lymphadenitis, is a problem not only to maxillofacial surgeons. Because of the variability of the etiology of the disease consult ENT doctor and a hematologist and TB specialist required.
Treatment of lymphadenitis
Treatment of lymphadenitis can be divided into two components that are typically used together: a conservative approach (i.e. without surgery) and surgical. The surgical technique used in 80% of cases and is a direct dissection of the inflamed lymph nodes and provision paths for the outflow of its contents. In some cases, use open biopsy (complete or partial removal of a lymph node through a small incision).
Conservative treatment consists of antibiotic therapy, the route of administration of medicines should only be injecting. Cephalosporins are used in the first two generations (cephaloridine, Cefazolin, Ceftriaxone, Cefotaxime) and penicillins (bitsillin, retarpen, oxacillin, Augmentin, Amoxiclav). The other groups of antibiotics (macrolides, aminoglycosides) are used less frequently. In order to fully destroy the pathogen, enough, usually, weeks. In addition to the antibacterial preparations also used anti-inflammatory and desensitizing means.
When purulent lymphadenitis and adenilson widely used ultrahigh-frequency therapy and electrophoresis with iodine. Physiotherapy is applied only after surgical intervention and drainage of the wound cavity.