Infectious Diseases
Stephan Strobel, Lewis Spitz, Stephen D. Marks in Great Ormond Street Handbook of Paediatrics, 2019
A cat scratch inoculates the bacteria into the skin. After about 10 days, a small papule (Fig. 3.14) appears at the site of the scratch. Localised lymphadenopathy (Fig. 3.15) then appears some 2 weeks after the primary lesion. Scratches generally occur over the hands, arms or legs, and subsequent involvement of the axillary, cervical, epitrochlear or inguinal nodes may occur. The area over the enlarged nodes is generally warm, red and tender. Around 30% of patients have systemic symptoms which may include fever, malaise, headaches and anorexia. CSD can present as a fever of unknown origin, and there may be granulomatous involvement of the liver and spleen (Fig. 3.16). Complications can also include the development of an encephalopathy, aseptic meningitis, optic neuritis, osteomyelitis and Parinaud syndrome (granulomatous conjunctivitis with ipsilateral adenopathy).
Unexplained Fever In Hematologic Disorders Section 1. Benign Hematologic Disorders
Benedict Isaac, Serge Kernbaum, Michael Burke in Unexplained Fever, 2019
If lymphadenopathy persists for more than 4 to 6 weeks without an obvious cause, a lymph node biopsy must be done. According to various series,1 50 to 60% of the biopsies yield a positive diagnosis; 25% of cases with nondiagnostic biopsy, or “atypical lymphoid hyperplasia” (histologically suspicious but no clear-cut diagnosis of lymphoma) will develop a lymphoproliferative disorder within a year. Careful follow-up and repeated biopsies should be performed if the enlarged lymph nodes or the symptoms persist.
Cervicofacial Infections
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
Patients are mainly under 20 years of age and more than 90% have a history of feline contact.26,27 Serologic testing has a high sensitivity and specificity. Although there is no medical treatment, confirmation of the diagnosis by performing a blood test will reassure parents who often become concerned about possible malignancy. Lymphadenopathy may persist for months after other symptoms have disappeared.
An unexpected deterrent in diagnosing refractory celiac disease and enteropathy-associated T-cell lymphoma: a gluten-free diet
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Nooreen Hussain, Faiz Hussain, Tulika Chatterjee, Jan N. Upalakalin, Teresa Lynch
A CT of his abdomen showed diffuse lymphadenopathy throughout the mesentery with numerous nodes measuring up to 10–12 mm. A CT-guided mesenteric lymph node biopsy was negative for metastatic tumor with no convincing evidence of malignancy. Gastric biopsies showed moderate gastritis and duodenal mucosa showed chronic inflammation, increased intraepithelial lymphocytes, and moderate-to-severe villous blunting consistent with CD, Marsh 3B-C class. Jejunal biopsies were not done during this procedure. As the patient spent a number of years asymptomatic while on a gluten diet, he was considered to have adult onset CD. The patient reinstituted a gluten-free diet (GFD) as he was educated about the importance of a GFD to prevent worsening of symptoms and to decrease his risk for small bowel carcinoma. If there was no improvement in symptoms, and his anemia persisted despite strict adherence to a GFD, a repeat EGD with capsule endoscopy would then be performed.
Beyond the commonest: right lower quadrant abdominal pain is not always appendicitis
Published in Alexandria Journal of Medicine, 2020
Mahmoud Agha, Maha Sallam, Mohamed Eid
CT is the imaging modality of choice for diagnosis of Chron’s disease, at most radiology institutions. This due to its characteristic rapid acquisition time with high spatial resolution during a single breath-hold. It showed ileocecal relatively long segmental annular thickening and smooth stricture, giving the target sign. Abnormal post-contrast enhancement of the bowel wall may be seen as a result of increased vascular permeability and angiogenesis. Characteristic mesenteric inflammatory changes are usually seen in Chron’s disease, as fibrofatty proliferating strands, surrounding the engorged mesenteric blood vessels (comb sign). Also, scattered small mesenteric inflammatory lymphadenopathy, mesenteric abscess, enteric fistula, and skip lesions could be seen. The postcontrast intestinal mural contrast enhancement should be taken into consideration as a sign which reflects the degree of active inflammation and could differentiate IBD from the similar long segmental infiltrating neoplastic process, e.g. lymphoma [27,28]. Figure 9
Mycobacterium genavense infections in non-HIV immunocompromised hosts: a systematic review
Published in Infectious Diseases, 2018
Maryam Mahmood, Saira Ajmal, Omar M. Abu Saleh, Alexandra Bryson, Jasmine R. Marcelin, John W. Wilson
Patients generally presented with a combination of fever, abdominal pain or lymphadenopathy. The presence of cytopenias was reported in one-third of patients, pancytopenia was the most commonly reported abnormality in 19%. Diagnosis was most commonly based on findings of AFB within lymph nodes, bone marrow, blood cultures, stool, gastrointestinal tract mucosal biopsy and visceral biopsy specimens. Identification was through molecular diagnostics such as broad range PCR or sequencing, which were positive in 95% patients. M. genavense was able to be grown in culture in 60% of cases; all of these isolates were identified using molecular techniques. Mycobacterial growth in cultures was reported from many different sources including blood cultures, sputum or bone marrow. The majority of the reported mycobacterial growth in cultures was on liquid medium [2,4–7], one report mentioned growth on solid media with charcoal [7] and another on Middlebrook 7H10 agar supplemented with Mycobactin J [2]. Positive cultures were reported from 7 to 43 days of incubation [4,6]. Antimicrobial susceptibility results were reported in two patients; one isolate was resistant to ethambutol and isoniazid [5], the other isolate was susceptible to ethambutol, streptomycin and rifampin [8]. Neither report described supplementation of culture media with Mycobactin J [9].
Related Knowledge Centers
- Cervical Lymph Nodes
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- Infection
- Mycobacterial Cervical Lymphadenitis
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