[Intestinal invagination and mesenteric adenitis. A case of an adenitis due to Pasteurella pseudotuberculosis].
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Child↗
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[Subacute cervical adenitis in children. Focus on adenitis due to atypical Mycobacteria].
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Child↗
Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients.
OBJECTIVE: Our objective was to determine the clinical significance of mesenteric adentitis when detected on CT. MATERIALS AND METHODS: Mesenteric adenitis was considered present if a cluster of three or more lymph nodes measuring 5 mm or greater each was present in the right lower quadrant mesentery. If no other abnormality was detected on CT, then mesenteric adenitis was considered primary. If a specific inflammatory process was detected in addition to the lymphadenopathy, then mesenteric adenitis was considered secondary. Patients with a known neoplasm or HIV infection were excluded. Three separate groups of patients were examined for the presence and cause of mesenteric adenitis. Group 1 consisted of 60 consecutive patients prospectively identified with mesenteric adenitis on CT examinations. Group 2 consisted of 60 consecutive patients undergoing abdominal and pelvic CT for evaluation of blunt or penetrating abdominal trauma. Group 3 consisted of 60 consecutive patients undergoing abdominal and pelvic CT with acute abdominal symptoms. In all patients, the indication for imaging was documented, and the size of the largest lymph node, when present, was measured. In patients with mesenteric adenitis, the CT findings, clinical history, and clinical or surgical follow-up were subsequently evaluated to determine the cause of mesenteric adenitis. RESULTS: In the 60 patients prospectively identified with CT findings of mesenteric adenitis (group 1), 18 (30%) of 60 had primary mesenteric adenitis. The remaining 42 patients (70%) had an associated inflammatory condition that was established on CT as the likely cause of mesenteric adenitis. Mesenteric adenitis was present in none (0%) of the 60 patients in group 2 and in five (8.3%) of 60 patients in group 3. CONCLUSION: The incidence of mesenteric adenitis in patients with and those without abdominal pain is low. When evidence of mesenteric adenitis is present on CT examinations, usually a specific diagnosis can be established as its cause.
Abdomen, Acute↗
Mycobacterial cervical adenitis in Auckland: diagnosis by fine needle aspirate.
AIMS: To evaluate the role of fine needle aspiration (FNA) in the diagnosis of tuberculous and non-tuberculous mycobacterial cervical adenitis in Auckland, and to examine the demography of these conditions. METHOD: We reviewed the medical records of cases of mycobacterial adenitis in the Auckland region between 1991-1994. Cases were identified by cross-checking the reference mycobacteriology laboratory records, all hospital cytology reports from cases who had an FNA taken from the neck region and hospital discharge diagnosis databases. RESULTS: Twenty-two cases of M tuberculosis adenitis, and 13 of M avium adenitis were identified. No FNAs were smear positive for mycobacteria. The FNA from 6/18 (33%) cases of M tuberculosis adenitis and from 4/6 (66%) M avium adenitis cases were culture positive. Bacteriological confirmation was obtained (by various methods) in 72% of tuberculous and in 100% of M avium adenitis cases. The clinical picture was different for the two organisms: tuberculous adenitis occurred mainly in caucasian adults, while M avium adenitis cases were predominantly caucasian children. None of the confirmed cases of tuberculous adenitis demonstrated drug resistance to standard anti-tuberculous agents. CONCLUSIONS: (1) Clinicians should more consistently include mycobacterial tests when investigating neck lumps. (2) FNA is not a reliable diagnostic test for mycobacterial cervical adenitis in New Zealand. Here, FNA should only be regarded as a screening test for mycobacterial adenitis. If anti-tuberculous treatment is required before it is known whether FNA has provided a positive culture, excision biopsy should first be performed to identify the mycobacterium and its susceptibility pattern.
Adult↗
[Adenitis following BCG vaccination].
The authors present a study on 167 cases of post-vaccinal adenitis after B.C.G. administration. These occured after the experimental application in 1,187 newborns of two vaccines produced by different laboratories. Manifest adenitis developed only after the application of the vaccine with a higher virulence and a significant concentration of live germs (A), while the vaccine with a low concentration of live germs only determined inflammatory adenitis (vaccine B). In the cases when vaccine A was applied, both after intra-dermal introduction of a 0,10 mg dose or of a 0,05 mg dose, it determined adenitis with a long evolution and in 7,79 percent, respectively in 6,95 percent of the vaccinated children fistulization occured. In most of the cases adenitis developed in the first 6 months following vaccination (86,77 percent) but in some cases it appeared even after 1-2 years. In 78,3 percent of the cases adenitis had a long course and in only 21,7 percent they regressed rapidly. Adenitis did not involve the general condition of the children but determined a concern of the parents. The duration of evolution of adenitis was, as a general rule, of several months, or 1-2 years and even longer and the treatment with tuberculostatics (INH) did not significantly alter their evolution. When there was a tendency to the formation of abscesses, especially in the case of gigantic adenitis, a reduction of the duration of the evolution was obtained by puncture, and especially by lymph-node curettage. The intensity of the post-vaccinal allergy is noted in cases complicated by adenitis (100 percent), as well as its long persistance, while in non-complicated cases the allergy diminished each year both in intensity and frequency. The authors recommend that before the mass use of a vaccine this should be tested, especially in young children, in view of making the correct choice of the efficient dose, with a maximal efficiency and the lowest number of complications.
Abscess↗
CT diagnosis of mesenteric adenitis.
PURPOSE: To quantify how frequently mesenteric adenitis clinically mimics appendicitis and to determine its appearance at computed tomography (CT). MATERIALS AND METHODS: The medical records of 651 consecutive patients with an admission diagnosis of appendicitis were reviewed to determine how often mesenteric adenitis was the discharge diagnosis. The CT scans of a separate group of 18 patients with a discharge diagnosis of mesenteric adenitis were reviewed. These patients were part of a group of 100 consecutive patients prospectively evaluated with CT of the appendix for clinically suspected appendicitis. RESULTS: Fifty of 651 patients (7.7%) with an admission diagnosis of appendicitis had a discharge diagnosis of mesenteric adenitis. Mesenteric adenitis constituted 50 of the 252 (19.8%) discharge diagnoses other than appendicitis. All 18 CT scans of mesenteric adenitis showed three or more nodes that measured at least 5 mm in shortest axis clustered in the right lower quadrant, with a normal appendix identified. Eight patients had associated ileal or ileocecal wall thickening. CONCLUSION: Mesenteric adenitis is an important clinical mimic of appendicitis. It appears at CT as clustered, enlarged mesenteric lymph nodes with a normal appendix, and there may be associated ileitis or ileocolitis noted.
Appendicitis↗
Surgery for cervicofacial nontuberculous mycobacterial adenitis in children: an update.
OBJECTIVE: To assess optimal surgical treatment with excision or curettage techniques in children with cervicofacial nontuberculous mycobacterial (NTM) adenitis. DESIGN: Retrospective case series. SETTING: Tertiary university-based pediatric referral center. PATIENTS: Patients younger than 18 years diagnosed as having cervicofacial NTM adenitis by positive mycobacterial cultures or stains, or by histopathologic evaluation. INTERVENTIONS: Fine-needle aspiration biopsy for diagnosis, surgical excision and/or curettage of head and neck lesions for treatment. MAIN OUTCOME MEASURES: Number of procedures per patient, complications, resolution of mass. RESULTS: A total of 32 surgical procedures were performed in 25 children with cervicofacial NTM adenitis (mean, 1.3 procedures per patient; range, 1-3): 19 excisional and 13 curettage procedures. The 14 children who had excision as an initial procedure required no additional surgery. Of 11 children who had curettage as an initial procedure, 6 (55%) required additional procedures. Three of these children had additional surgery as planned staged procedures. Excisional surgery after initial curettage (5 patients) was simplified by initial debridement and secondary healing. No complications of curettage were noted. Transient marginal mandibular nerve weakness was seen in 4 patients who had excision. Fourteen of 16 fine-needle aspiration biopsy specimens were diagnostic for NTM adenitis. CONCLUSIONS: Cervicofacial NTM adenitis can be treated with excision or curettage. Excision remains the treatment of choice because of the high cure rate with a single procedure. We now consider curettage as a staged procedure for lesions in proximity to the facial nerve or with extensive skin necrosis, with initial curettage simplifying subsequent excision and wound closure. Preoperative counseling should include discussion of planned or unplanned revision surgery after curettage. Fine-needle aspiration biopsy allows early diagnosis of NTM adenitis.
Child↗
Acute adenitis in children: clinical course and factors predictive of surgical drainage.
OBJECTIVES: To describe clinical course of children hospitalized for a first episode of acute unilateral infectious adenitis and to identify factors predictive of surgical lymph node drainage. METHODS: We reviewed medical records of children from 0 to 17 years of age discharged from a tertiary care pediatric center with a diagnosis of adenitis between 1 April 1996 and 31 March 2001. Patients were included if they had acute (< or = 10 days) unilateral lymph node swelling greater or equal to 2.5 cm on initial physical examination. Exclusion criteria were: bilateral adenitis or adenitis at more than one site; prior adenitis; underlying chronic disease. RESULTS: Two hundred and eighty-four patients were included in this study. The mean age was 4.0 years (3.1 SD). Twenty-three per cent of infected nodes were > 5 cm in size and 92.6% were cervical. Thirteen of 252 blood cultures were positive (5.2%), of which one showed Streptococcus pneumoniae and 12 contaminants. Mean length of stay was 4.2 days (2.2 SD). Surgical node drainage was performed in 60 (21.1%) patients. Factors significantly associated with increased risk of surgical drainage were age < 1 year (adjusted OR: 14.5; 95% CI: 5.0-42.2) and node involvement > 48 h (adjusted OR: 2.9; 95% CI: 1.2-7.2). There were no major complications. Follow-up was documented in 183 patients, of whom 92.3% achieved complete healing. CONCLUSIONS: Children hospitalized for a first episode of acute unilateral infectious adenitis generally do well. Younger patients and those with longer duration of node involvement before admission have an increased risk of surgical node drainage.
Abscess↗
Mycobacterial adenitis: role of Mycobacterium bovis, non-tuberculous mycobacteria, HIV infection, and risk factors in Arusha, Tanzania.
OBJECTIVE: To assess risk factors and mycobacterial agents in mycobacterial adenitis. DESIGN: Cross sectional involving comparison analysis of high-risk groups. SETTING: Seven hospitals in rural and semi-rural districts of Arusha. SUBJECTS: The study comprised of 457 patients of clinically diagnosed mycobacterial adenitis. INTERVENTIONS: Biopsy materials were cultured and identification of mycobacterial isolates, and HIV infection testing were performed using standard methods. A questionnaire was used to establish information for assessing risk factors. MAIN OUTCOME MEASURES: Proportions of mycobacterial isolates, risk factors and odds ratios. RESULTS: Of the 457 specimens, 65(14.2%) were culture positive. Isolates identified were M. bovis, 7(10.8%) M. tuberculosis, 27(41.5%) and non-tuberculous mycobacteria 31(47.7%). HIV infection and ingestion of raw milk were linked with increased risk of M. bovis infection by OR of 13.6 (95% CI, 1.7 - 109.9) and 15.28 (3.26 - 71.7), respectively. On multivariate analysis, an OR of 16.2 (1.3 - 201.3) for having M. bovis adenitis was linked to HIV infection, raw milk and houses with poor ventilation. An OR of 5.2 (1.2 - 20.6) for non-tuberculous mycobacterial adenitis was linked to history of TB in the family, HIV infection, raw milk, raw animal products and poor knowledge on transmission of tuberculosis. CONCLUSIONS: M. bovis caused one out of ten cases of culture positive mycobacterial adenitis. Non-tuberculous mycobacteria were more common than M. tuberculosis (50% and 40% of the cases, respectively). HIV infection and raw animal products are among the risk factors identified for M. bovis and non-tuberculous mycobacterial adenitis.
Adolescent↗
Nontuberculous mycobacterial adenitis of the head and neck in children: experience from a tertiary care pediatric center.
OBJECTIVE: To describe our experience with the diagnosis, surgical treatment, and outcome of nontuberculous mycobacterial (NTM) adenitis of the head and neck in children, and to present a preliminary report about the use of NTM skin tests in our institution. STUDY DESIGN: Retrospective study. METHODS: The medical records of all children diagnosed with cervicofacial NTM adenitis were retrospectively reviewed for the period from January 1, 1995, through December 31, 2000. We also examined the use of intradermal skin tests for the diagnosis of NTM infection. RESULTS: Fifty patients were diagnosed with NTM cervicofacial adenitis. Pertinent demographic information, clinical presentation, investigation, and type of diagnostic procedures were documented. Surgical procedures, complications, and relapses were also noted. One unusual case of retropharyngeal adenitis is illustrated. All patients were treated with complete excision of their lesion at the first operation. No major complications were noted. Only one patient relapsed and required a second operation. Forty-one children were skin-tested with NTM antigens. Of these, 30 patients were dual-tested with Purified Protein Derivative (PPD) also. No adverse reactions were noted with the use of skin tests. Sensitivity of NTM antigens alone is 87%. Sensitivity of dual testing is 78%. No patient had a PPD-dominant reaction. CONCLUSION: Surgical excision is the treatment of choice of NTM adenitis because of the high cure rate with a single procedure, the excellent cosmetic result, and the low complication rate. NTM skin tests are safe and could be useful in early diagnosis of the infection but further investigation is needed.
Biopsy↗
Evidence for an aetiological role for adenovirus type 7 in the mesenteric adenitis syndrome.
Previous research has established the relationship between viral infection with adenovirus, influenza B virus and Coxsackie B virus, and mesenteric adenitis. A prospective controlled survey of the incidence of viral infection in mesenteric adenitis was undertaken in children attending a children's hospital over a period of 13 months. Eighteen patients, together with 18 controls who were matched for age, sex, and date of presentation, were studied. There were five cases of adenovirus type 7 infection in the mesenteric adenitis group and none in the control group (P=0.023--Fisher's exact test). The clinical problem at presentation is in differentiating mesenteric adenitis from appendicitis. If further work shows that viral infection is indeed more common in mesenteric adenitis, and is limited to a narrow range of viruses, then rapid identification of these viruses in children with "acute abdomens" would be a valuable aid to differential diagnosis.
Adenoviridae Infections↗
[Diagnostic problems of tuberculoid cervical adenitis. Apropos of 70 cases].
Pathologic criteria in tuberculoid adenitis enable differentiation between follicular adenitis with or without caseous necrosis and that involving suppurative necrosis. The absence of specific etiology is emphasized. Seventy cases of tuberculoid adenitis are analyzed. Of the 62 cases of adenitis labelled tuberculous, bacterial confirmation was obtained in only 22 (35%), suggesting probable diagnosis by excess for the remaining 40 cases. Related bacteriologic problems concern isolation of B.K. of the 3 cases classified as sarcoidosis, it was important to obtain data from broncho-alveolar lavage and serum conversion enzyme assay. Four patients with adenitis were diagnosed as having cat-scratch disease from positive specific intradermal reactions, the probable discovery of the responsible agent thus providing a bacteriologic diagnosis.
Adolescent↗
Diagnostic problems of tuberculous cervical adenitis (scrofula).
PURPOSE: This study was designed to review the diagnostic procedure for tuberculous cervical adenitis and propose a simple protocol for the work-up of patients with suspected tuberculous cervical adenitis. Moreover, it served to increase physician awareness of tuberculosis as possible cause of cervical mass. PATIENTS AND METHODS: We performed a retrospective study of 57 patients with tuberculous cervical adenitis who were treated at North West Armed Forces Hospital, Tabuk, Saudi Arabia between March 1989 and April 1993. The results of diagnostic procedures, chest x-ray, tuberculin test, fine-needle aspiration, microbiology culture, and histopathology were reviewed. RESULTS: Forteen percent showed changes in chest x-ray, 92% had positive tuberculin test, and 50% of the culture material grew Mycobacterium tuberculosis. All specimens for histopathology were suggestive of tuberculosis. CONCLUSION: A thorough history and physical examination, tuberculin test, and fine-needle aspiration will help arrive at an early diagnosis of tuberculous cervical adenitis and allow early commencement of treatment before final diagnosis can be made by incisional biopsy and culture. Tuberculosis should be included in the differential diagnosis of neck mass.
Adolescent↗
Mesenteric adenitis caused by Salmonella enterica serovar Enteritidis.
Mesenteric adenitis is a self-limited condition characterized by fever, localized right lower quadrant abdominal pain, and frequent leukocytosis, making it difficult to differentiate from appendicitis. We report a case of mesenteric adenitis in an 8-year-old boy who presented at the emergency department with right lower quadrant abdominal pain, diarrhea, and fever up to 40 degrees C. Acute appendicitis was initially suspected, but further abdominal ultrasound and contrast enhanced computed tomography studies showed a normal appendix with marked mesenteric adenopathy. Symptomatic treatment was given and pain and fever subsided 2 days later. Follow-up sonography showed resolution of adenopathy, confirming the diagnosis of mesenteric adenitis. The admission stool cultures grew Salmonella enterica serovar Enteritidis (S. Enteritidis). Unlike previous reports in western countries where Yersinia species prevails and was thought to be self-limited, S. Enteritidis carries potential risk for serious systemic complications, such as meningitis or septic arthritis. The isolation of this unusual microbiological species thus has both therapeutic and epidemiological implications for mesenteric adenitis in Taiwan.
Child↗
Reverse transcriptase in situ polymerase chain reaction in atypical mycobacterial adenitis.
OBJECTIVE: To determine whether reverse transcriptase (RT) in situ polymerase chain reaction (PCR) can facilitate the diagnosis of nontuberculous ("atypical") mycobacterial (NTM) cervical adenitis. DESIGN: Retrospective review of 12 patients with neck masses clinically diagnosed as NTM cervical adenitis. SETTING: University medical center caring for both ambulatory and hospitalized children. PATIENTS: Twelve pediatric patients (all younger than 9 years) with cervicofacial masses. INTERVENTION: Surgical excision of the presenting mass. MAIN OUTCOME MEASURES: Reverse transcriptase in situ PCR was used to detect mycobacterial RNA in excised tissue. All specimens were also cultured and stained for acid-fast bacilli. RESULTS: Reverse transcriptase in situ PCR was positive for NTM in 7 of 12 cases. CONCLUSIONS: Infection with NTM may be an extremely indolent process, and the success of RT in situ PCR depends on the presence of mycobacterial nucleic acids. Even in cases in which the findings of RT in situ PCR were positive, infected cells were few in number. Because of the sparsity of infection in the positive cases, NTM may be even more rare in the negative cases, ie, those in which mycobacterial nucleic acids do not exist and cannot be detected by any means, including RT in situ PCR. Although RT in situ PCR, cultures, stains for acid-fast bacilli, and tuberculin tests using purified protein derivative are all helpful in diagnosing NTM cervical adenitis, when nucleic acids are present RT in situ PCR is the simplest, most reliable, and quickest to perform and the results are easiest to interpret.
Child↗
Group A streptococcal cellulitis-adenitis in a patient with acquired immunodeficiency syndrome.
A rapidly enlarging left inguinal adenitis, with positive groove sign, and fever, chills, malaise, hypotension, headache, scarlatiniform rash, choleroid diarrhea, and proteinuria developed in an homosexual man who was positive for human immunodeficiency virus. The needle aspiration of the inguinal mass showed group A beta-hemolytic streptococci and the blood cultures were negative, suggesting group A streptococcal cellulitis-adenitis with toxic strep syndrome. Treatment with penicillin and surgical drainage was successful. Bacterial infections associated with defective humoral immunity appear to be common in patients with acquired immunodeficiency syndrome (AIDS), and some of these infections have a remarkable extensive and lethal evolution. Therefore streptococcal adenitis should be considered in any patient with AIDS or AIDS-related syndrome in whom rapidly enlarging inguinal nodes develop.
Acquired Immunodeficiency Syndrome↗
[Group B Streptococcus late-onset disease presenting as cellulitis-adenitis syndrome].
Cellulitis-adenitis syndrome is a rare clinical manifestation of group B Streptococcus (GBS) late-onset disease. Its significance lies in the fact that local infection may be the only initial sign of systemic infection that is often concurrent with meningitis. Soft tissue involvement (cellulitis-adenitis) can sometimes be the only initial manifestation of GBS infection. We report four cases of GBS cellulitis-adenitis syndrome from different hospitals in Barcelona and Tarragona. We emphasize that early diagnosis and treatment may improve the potentially poor prognosis of these patients, and stress the need to rule out central nervous system involvement by studying cerebrospinal fluid.
Cellulitis↗
Sebaceous adenitis in the Akita: clinical observations, histopathology and heredity.
Ninety-seven pure-bred Akitas were examined clinically and histologically for sebaceous adenitis. The diagnosis was established histologically in 23 Akitas by demonstrating an inflammatory reaction targeted against the sebaceous glands or a reduction in the number of glands. The clinical course of sebaceous adenitis in the Akita was similar to that seen in other breeds. The first skin lesions occurred mainly on the dorsal midline and ears. Compared with the Poodle, the age at first onset of the disease was more variable and the hair loss affected mainly the undercoat. The progression of sebaceous gland destruction varied between dogs and was not seen in all cases. Because bud-like sebaceous gland proliferation could be identified, it seems that regeneration of the sebaceous glands may occur. An autosomal recessive inheritance appears to be possible. Apart from a genetic background, immune-mediated factors possibly influence the onset and course of sebaceous adenitis.
Animals↗