Suppurative cervical lymphadenitis in adult: An analysis of predictors for surgical drainage



      Lymphadenitis can be treated successfully by empirical antibiotic therapy. However, inflamed lymph nodes can progress into an abscess with local and/or systemic reaction, which requires more complex treatment strategies. The study aim to analyze possible predictors for abscess formation within inflamed nodes that require surgical drainage.

      Materials and Methods

      We retrospectively enrolled 241 patients with acute or sub-acute cervical lymphadenitis. Demographic including, lymph node characteristics, management, and final diagnosis were recorded. Predictors for abscess formation within the lymph node that required surgical drainage were evaluated using univariate and multivariate analysis. Patient and lymph node characteristics that differentiated suppurative cervical lymphadenitis (SCL) from other lymphadenitis were also analyzed.


      There were 41 cases of SCL, 173 cases of uncomplicated cervical lymphadenitis, and 27 cases of tuberculous cervical lymphadenitis (TBLN). Abscess was surgically drained in 39 patients, while 2 patients received a needle aspiration. In 9 patients, SCL complications included cellulitis of the neck soft tissue, supraglottic swelling, internal jugular vein thrombosis, and sepsis. Two patients were diagnosed with melioidosis and actinomycosis after drainage. Multivariate analysis showed that an immunocompromised host, male sex, and receiving prior inadequate treatment were predictors for surgical drainage. TBLN patients had similar manifestations as SCL patients. However, affected nodes in SCL patients were singular, painful, and showed fluctuation.


      Following SCL diagnosis, abscess drainage and appropriate antibiotic treatment should be considered. Aspiration or surgical drainage can be effective in certain patients. Pathogen isolation and tissue biopsy should be performed to ensure accurate diagnosis and antibiotic selection. In addition, TBLN and melioidosis should be considered, especially in endemic areas.


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        • Gosche J.R.
        • Vick L.
        Acute, subacute, and chronic cervical lymphadenitis in children.
        Semin Pediatr Surg. 2006; 15: 99-106
        • Al-Dajani N.
        • Wootton S.H.
        Cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts.
        Infect Dis Clin North Am. 2007; 21: 523-541
        • Singh M.
        • Chaudhary J.
        Hodgkin's lymphoma masquerading as suppurative lymphadenitis.
        J Cytol. 2017; 34: 177-178
        • Kim J.M.
        • Kim J.Y.
        • Jung E.J.
        • Song E.J.
        • Kim D.C.
        • Jeong C.Y.
        • et al.
        Cooccurrence of metastatic papillary thyroid carcinoma and salmonella induced neck abscess in a cervical lymph node.
        Case Rep Med. 2017; 5670429
        • Fraser I.P.
        Suppurative lymphadenitis.
        Curr Infect Dis Rep. 2009; 11: 383-388
        • Kato T.
        • Oto K.
        • Endo T.
        • Furusho J.
        • Iwasaki A.
        • Sasaki Y.
        • et al.
        Microbial extracranial aneurysm of the internal carotid artery: complication of cervical lymphadenitis.
        Ann Otol Rhinol Laryngol. 1999; 108: 314-317
        • Knopf A.
        • Scherer E.Q.
        Complication after subacute cervical lymphadenitis.
        HNO. 2009; 57: 808-811
        • WHO
        Nutrition-Body mass index-BMI. report of a world health organization (WHO) expert committee.
        World Health Organization, Geneva, Switzerland2019
        • WHO
        Nutrition-Body mass index-BMI-for-age (5-19 years). report of a world health organization (WHO) expert committee.
        World Health Organization, Geneva, Switzerland2019
        • Asakura M.
        • Tanaka T.
        • Shoji K.
        • Karakawa S.
        • Ishiguro A.
        • Miyairi I.
        Chronic neutropenia in children with abscess forming cervical lymphadenitis caused by Staphylococcus aureus.
        Pediatr Infect Dis J. 2019; 38: 293-296
        • Quinn N.A.
        • Olson J.A.
        • Meier J.D.
        • Baskin H.
        • Schunk J.E.
        • Thorell E.A.
        • et al.
        Pediatric lateral neck infections - computed tomography vs ultrasound on initial evaluation.
        Int J Pediatr Otorhinolaryngol. 2018; 109: 149-153
        • Kwon M.
        • Seo J.H.
        • Cho K.J.
        • Won S.J.
        • Woo S.H.
        • Kim J.P.
        • et al.
        Suggested protocol for managing acute suppurative cervical lymphadenitis in children to reduce unnecessary surgical interventions.
        Ann Otol Rhinol Laryngol. 2016; 125: 953-958
        • Baek M.Y.
        • Park K.H.
        • We J.H.
        • Park S.E.
        Needle aspiration as therapeutic management for suppurative cervical lymphadenitis in children.
        Korean J Pediatr. 2010; 53: 801-804
        • Kato H.
        • Kanematsu M.
        • Kato Z.
        • Teramoto T.
        • Mizuta K.
        • Aoki M.
        • et al.
        Necrotic cervical nodes: usefulness of diffusion-weighted MR imaging in the differentiation of suppurative lymphadenitis from malignancy.
        Eur J Radiol. 2013; 82: e28-e35
        • Luu T.M.
        • Chevalier I.
        • Gauthier M.
        • Carceller A.M.
        • Bensoussan A.
        • Tapiero B.
        Acute adenitis in children: clinical course and factors predictive of surgical drainage.
        J Paediatr Child Health. 2005; 41: 273-277
        • Kimia A.A.
        • Rudloe T.F.
        • Aprahamian N.
        • McNamara J.
        • Roberson D.
        • Landschaft A.
        • et al.
        Predictors of a drainable suppurative adenitis among children presenting with cervical adenopathy.
        Am J Emerg Med. 2019; 37: 109-113
        • Sauer M.W.
        • Sharma S.
        • Hirsh D.A.
        • Simon H.K.
        • Agha B.S.
        • Sturm J.J.
        Acute neck infections in children: who is likely to undergo surgical drainage?.
        Am J Emerg Med. 2013; 31: 906-909
        • Worley M.L.
        • Seif J.M.
        • Whigham A.S.
        • Mims J.W.
        • Shetty A.K.
        • Evans A.K.
        Suppurative cervical lymphadenitis in infancy: microbiology and sociology.
        Clin Pediatr (Phila). 2015; 54: 629-634
        • Neff L.
        • Newland J.G.
        • Sykes K.J.
        • Selvarangan R.
        • Wei J.L.
        Microbiology and antimicrobial treatment of pediatric cervical lymphadenitis requiring surgical intervention.
        Int J Pediatr Otorhinolaryngol. 2013; 77: 817-820
        • Lindquist N.R.
        • Patro A.
        • Gitomer S.A.
        • Cañadas K.T.
        Pediatric acute unilateral suppurative lymphadenitis: the role of antibiotic susceptibilities at a large tertiary pediatric care center.
        Int J Pediatr Otorhinolaryngol. 2019; 120: 11-14
        • Mahawerawat K.
        • Kasemsiri P.
        Clinical presentation and treatment of melioidosis in the head and neck region.
        J Laryngol Otol. 2018; 132: 827-831
        • Chao S.S.
        • Loh K.S.
        • Tan K.K.
        • Chong S.M.
        Tuberculous and nontuberculous cervical lymphadenitis: a clinical review.
        Otolaryngol Head Neck Surg. 2002; 126: 176-179
      1. Mekonnen D., Derbie A., Abeje A., Shumet A., Nibret E., Biadglegne F., et al. Epidemiology of tuberculous lymphadenitis in Africa: a systematic review and meta-analysis. PLoS ONE. 2019:e0215647.

        • Rammeh S.
        • Romdhane E.
        • Arfaoui Toumi A.
        • Houcine Y.
        • Lahiani R.
        • Sassi A.
        • et al.
        Efficacy of fine-needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenitis.
        Acta Cytol. 2018; 62: 99-103
        • Asano S.
        Granulomatous lymphadenitis.
        J Clin Exp Hematop. 2012; 52: 1-16
        • Srivanitchapoom C.
        • Sittitrai P.
        Nasopharyngeal tuberculosis: epidemiology, mechanism of infection, clinical manifestations, and management.
        Int J Otolaryngol. 2016; 4817429