Infantile suppurative lymphadenitis
Introduction
Introduction to infantile suppurative lymphadenitis The lymphatic circulation of the face and neck is rich, and there are two groups of lymph nodes and most reticular lymphatic vessels in the circular chain and the vertical chain. Lymph nodes are an important defense system for the face and neck. When the bacteria are virulence and the body's resistance is low, it can cause lymphadenitis. The lymph node development of infants and young children is still not perfect, the lymphoid follicles are not completely formed, the connective tissue is few, the lymph node is thin, and its defense function is worse than that of adults. When the lymph nodes develop suppurative inflammation, it is easy to break through the capsule and develop into cellulitis. The infection can also enter the blood circulation, and toxemia or sepsis occurs. The child has a more acute onset, early lymph node congestion, edema, hardening, lymph nodes with swelling and swelling, and tenderness. At this time, the systemic reaction is light and easy to be ignored. The infection enters the suppuration phase from the serous stage, and can penetrate the lymph node capsule. When the inflammation spreads to the surrounding tissues, the range is enlarged, the tenderness is obvious, and the lymph nodes adhere to the surrounding tissues, so the boundary cannot be cleared. Abscesses of superficial abscess, such as submandibular abscess, can be convulsive and fluctuating, the abscess in the neck is covered by the sternocleidomastoid muscle, it is not easy to lick and fluctuate, but the tenderness is obvious, the skin of the affected area has inflammatory infiltration, pressure There is depression edema. At this time, the systemic symptoms are obvious, high fever, chills, and even convulsions, and the total number of white blood cells is increased. basic knowledge The proportion of sickness: 0.94% Susceptible people: infants and young children Mode of infection: non-infectious Complications: abscess
Cause
Causes of infantile suppurative lymphadenitis
Cause:
Mostly due to upper respiratory tract infection, tonsillitis, measles, scarlet fever, facial skin bloated, oral mucosal damage and deciduous teeth caused by inflammation of the corresponding parts of the lymph nodes. Commonly submandibular lymphadenitis, followed by deep cervical lymphadenitis.
Pathophysiology
The lymphatic circulation of the face and neck is rich, consisting of two sets of lymph nodes and a plurality of reticular lymphatic vessels in the circular chain and the longitudinal chain. Lymph nodes are an important defense system for the face and neck. They can filter and phagocytose bacteria and foreign matter entering the lymph to prevent the spread of infection. If the bacteria are too toxic and the body's resistance is low, it can cause lymphadenitis. The lymph node development of infants and young children is still not perfect, the lymphoid follicles are immature, the connective tissue is few, the lymph node is thin, and its defense function is worse than that of adults. When the lymph nodes develop suppurative inflammation, it is easy to break through the capsule and develop into cellulitis. The infection can also enter the blood circulation, and toxemia or sepsis occurs.
Prevention
Infants with suppurative lymphadenitis prevention
Patients should pay attention to labor protection and avoid trauma. If there is skin damage, it should be treated in time to prevent the spread of infection. If you have tonsillitis, dental caries, finger infections, athlete's foot, sputum, etc. should also be antibacterial anti-inflammatory or appropriate treatment to control the infection. On weekdays, you should pay attention to exercise and enhance your physical fitness. Diet should be light, nutrition should be balanced, eat spicy spicy food.
Complication
Complications of infantile suppurative lymphadenitis Complications
If the infantile suppurative lymphadenitis continues to spread to the local lymph nodes, or the purulent lesions spread to the lymph nodes of the region through the lymphatic vessels, it can cause acute lymphadenitis. Infection of the upper extremities, breast, chest wall, back and ventral wall above the umbilicus causes axillary lymphadenitis; infection of the lower extremities, the ventral wall of the umbilicus, the perineum and the buttocks may occur in the inguinal lymphadenitis; head, face, mouth, neck and shoulders Infection, causing lymphadenitis in the submandibular and neck.
Symptom
Infants with suppurative lymphadenitis symptoms common symptoms fever submandibular lymphadenopathy tenderness neck lymph nodes enlargement lymph node pain superficial lymph nodes progressive enlargement lymph node congestion
The child has a more acute onset, early lymph node congestion, edema, hardening, lymph nodes with swelling and swelling, and tenderness. At this time, the systemic reaction is light and easy to be ignored. The infection enters the suppuration phase from the serous stage, and can penetrate the lymph node capsule. When the inflammation spreads to the surrounding tissues, the range is enlarged, the tenderness is obvious, and the lymph nodes adhere to the surrounding tissues, so the boundary cannot be cleared. Abscesses of superficial abscess, such as submandibular abscess, can be convulsive and fluctuating, the abscess in the neck is covered by the sternocleidomastoid muscle, it is not easy to lick and fluctuate, but the tenderness is obvious, the skin of the affected area has inflammatory infiltration, pressure There is depression edema. At this time, the systemic symptoms are obvious, high fever, chills, and even convulsions, and the total number of white blood cells is increased.
Examine
Examination of infantile suppurative lymphadenitis
Laboratory inspection
1. Blood: The total number and classification of peripheral blood leukocytes have certain reference value for the diagnosis of lymph node enlargement. Lymph node enlargement with total white blood cell count and neutrophil increase is common in bacterial infection, but some Gram-negative bacilli infections may not be the total number of white blood cells. High, but neutrophils often increase, lymph node enlargement with normal or decreased white blood cell count and lymphocytosis often consider viral infection, but patients with infectious mononucleosis caused by EB virus infection often have white blood cells in the second week Elevated, and abnormal lymphocytes (1O%-20% or more) are often found within three weeks, eosinophilia, suggesting parasitic infection or eosinophilic granuloma, lymphadenopathy accompanied by peripheral blood immature Most of the cells are leukemia or cancer, and malignant histiocytosis (malignant group), in addition to fever, hepatosplenomegaly, often shows a decrease in whole blood cells.
2, bone marrow examination: bone marrow smear cell morphology examination for leukemia, plasma cell tumor, malignant histiocytosis, high snow disease, Niemann - Peak diagnosis is decisive, if necessary, should do bone marrow pathology examination, for metastatic Although cancer is difficult to recognize the primary site, it is decisive for the recognition of metastatic cancer cells.
3, serological examination: suspected of infectious mononucleosis can be done heterophilic agglutination test, the titer has clinical value above 1:80, >1:200 can be diagnosed as infectious mononucleosis, Suspected leptospirosis patients can do agglutination dissolution test, more than 1:400 titer is positive, for suspected sexually transmitted diseases can do HlV antibody, syphilis serological examination, for suspected SLE and other autoimmune diseases When the lymph nodes are swollen, a serological examination should be performed.
4, lymph node puncture needle smear examination: lymph node enlargement is more obvious and the position of the superficial can be used for thicker needles for lymph node puncture, with a large negative pressure to a small amount of content smear examination, this method is simple and easy.
5, lymph node pathological examination: lymph node enlargement is more obvious and the cause is unknown, if there is no surgical contraindications, it is generally necessary to routinely do lymph node biopsy pathological examination, at the same time can do lymph node printing, morphological examination of its diseased cells, than Pathological sections are seen more clearly.
Image inspection
1. Lymphatic angiography: deep lymph nodes such as pelvic, retroperitoneal, and para-aortic lymph nodes are not easily accessible. Lymphangiography is a special examination method to understand whether it is swollen or not. In lymphangitis, lymph nodes are often enlarged and enlarged. The edge is smooth, when the malignant lymphoma is enlarged, the internal structure of the enlarged lymph node is destroyed and foamed. The lymph node metastasis of the lymph node metastasis is irregularly worm-like, often with internal structure filling defect or lymphatic obstruction.
2. Radionuclide scanning: radioactive colloids injected into the subcutaneous or interstitial space are phagocytosed by phagocytic cells and then enter the capillary lymphatics, drained to the corresponding lymph nodes, and images of lymph nodes and lymphatic channels can be obtained with a Y camera or scanner, such as injection. 1-2 between the toes, after a certain period of time can make the groin, extra-biliary, total iliac, para-aortic lymph nodes and other imaging, for the diagnosis of deep lymphadenopathy and clear swelling nature, such as one or more lymph nodes The image is obviously enlarged, and the radioactivity is increased. Most of them are lymphoma tumors. If one or more lymph nodes are missing or the radioactivity is significantly reduced or significantly delayed, it often indicates the presence of metastases in the lymph nodes.
3, other X-ray examination, CT examination, B-mode ultrasound, fiber endoscopy, etc., can help to identify the location and nature of the primary lesion.
Diagnosis
Diagnosis and diagnosis of infantile suppurative lymphadenitis
diagnosis
According to the history, clinical manifestations and local puncture, pus can be diagnosed.
Differential diagnosis
It should be differentiated from mucosal skin lymph node syndrome, also known as Kawasaki disease. The latter also occurs in infants under the age of 4, the cause is unknown, acute non-suppurative cervical lymphadenitis. The child also has conjunctival congestion, red lips, strawberry tongue, oropharyngeal mucosa congestion, blistering, molting, rash and membrane-like desquamation can occur in the mucous membrane skin, and erythema appears on the toe. Systemic aspects can occur abdominal pain, diarrhea, vomiting, cough, runny nose, proteinuria, etc., as well as arrhythmia, severe coronary artery damage, can cause heart failure and sudden death.
