Choi Peter, Qin Xuan, Chen Eunice Y, Inglis Andrew F, Ou Henry C, Perkins Jonathan A, Sie Kathleen C Y, Patterson Kathleen, Berry Stacey, Manning Scott C
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA.
Arch Otolaryngol Head Neck Surg. 2009 Mar;135(3):243-8. doi: 10.1001/archoto.2009.1.
To study routine culture-negative persistent cervical lymphadenitis in children treated surgically during a 10-year period (December 26, 1997, to October 1, 2007) at a single institution.
Retrospective case series.
Tertiary university-based pediatric referral center.
Patients 18 years or younger with cervical lymphadenitis managed surgically (incision and drainage, curettage, and/or excisional lymphadenectomy) and medically (antibiotic therapy), culture-negative after 48 hours, and subsequently diagnosed using the polymerase chain reaction, extended culture incubation, and/or histopathologic evaluation.
Number of surgical interventions, causative organisms, histopathologic features, and resolution of lymphadenitis.
Ninety surgical procedures were performed in 60 patients. The cure rate was 23% (approximately 14 patients) with incision and drainage, 58% (approximately 35 patients) with curettage, and 95% (57 patients) with excisional lymphadenectomy. Nontuberculous mycobacteria were the most prevalent causative organisms, followed by Bartonella and Legionella organisms. Four of 6 patients with Bartonella infection had a history of cat exposure, and 4 of 6 patients with Legionella infection had a history of hot tub exposure.
Excisional lymphadenectomy is the preferred treatment of mycobacterial persistent cervical lymphadenitis in children. Sufficient data are lacking for similar recommendations in patients with disease caused by Bartonella organisms, whereas for neck disease caused by Legionella organisms, excisional lymphadenectomy may be superior to incision and drainage. The polymerase chain reaction is useful for pathogen identification in pediatric cervical lymphadenitis, although it is less sensitive in identification of mycobacteria. To our knowledge, our study is the first to report multiple cases of legionellosis in otherwise healthy children. Legionella seems to be a previously unrecognized but relatively common pathogen in culture-negative persistent cervical lymphadenitis in children.
研究在一家机构中，1997年12月26日至2007年10月1日这10年间接受手术治疗的儿童常规培养阴性的持续性颈淋巴结炎。
回顾性病例系列研究。
以大学为基础的三级儿科转诊中心。
18岁及以下患有颈淋巴结炎的患者，接受了手术治疗（切开引流、刮除术和/或切除性淋巴结切除术）和药物治疗（抗生素治疗），48小时后培养阴性，随后通过聚合酶链反应、延长培养孵育和/或组织病理学评估进行诊断。
手术干预次数、致病微生物、组织病理学特征以及淋巴结炎的消退情况。
60例患者共进行了90次手术。切开引流的治愈率为23%（约14例患者），刮除术的治愈率为58%（约35例患者），切除性淋巴结切除术的治愈率为95%（57例患者）。非结核分枝杆菌是最常见的致病微生物，其次是巴尔通体和军团菌。6例巴尔通体感染患者中有4例有接触猫的病史，6例军团菌感染患者中有4例有接触热水浴缸的病史。
切除性淋巴结切除术是儿童分枝杆菌性持续性颈淋巴结炎的首选治疗方法。对于由巴尔通体引起疾病的患者，缺乏足够的数据来提出类似的建议，而对于由军团菌引起的颈部疾病，切除性淋巴结切除术可能优于切开引流。聚合酶链反应有助于儿童颈淋巴结炎病原体的鉴定，尽管其在鉴定分枝杆菌方面敏感性较低。据我们所知，我们的研究是首次报道多例原本健康儿童患军团菌病的病例。军团菌似乎是儿童常规培养阴性的持续性颈淋巴结炎中一种以前未被认识但相对常见的病原体。
