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Lymph node enlargement can be of viral, bacterial, malignant, protozoan origin and can even be caused by live vaccines <ref name="pmid25996397"> (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25996397 Reorganized text.] ''JAMA Otolaryngol Head Neck Surg'' 141 (5):428. [http://dx.doi.org/10.1001/jamaoto.2015.0540 DOI:10.1001/jamaoto.2015.0540] PMID: [https://pubmed.gov/25996397 25996397]</ref>
Lymph node enlargement can be of viral, bacterial, malignant, protozoan origin and can even be caused by live vaccines <ref name="pmid25996397"> (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25996397 Reorganized text.] ''JAMA Otolaryngol Head Neck Surg'' 141 (5):428. [http://dx.doi.org/10.1001/jamaoto.2015.0540 DOI:10.1001/jamaoto.2015.0540] PMID: [https://pubmed.gov/25996397 25996397]</ref>
Examples of infections that can cause lymph node enlargement include:
Examples of infections that can cause lymph node enlargement include:
*Viral infections such as Epstein-Barr Virus and cytomegalovirus which cause infectious mononucleosis <ref name="pmid23281438">{{cite journal| author=Weiss LM, O'Malley D| title=Benign lymphadenopathies. | journal=Mod Pathol | year= 2013 | volume= 26 Suppl 1 | issue=  | pages= S88-96 | pmid=23281438 | doi=10.1038/modpathol.2012.176 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23281438  }} </ref> and CMV mononucleosis respectively.<ref name="pmid4317237">{{cite journal| author=Sinha AK, Lovett M, Pillay G| title=Cytomegalovirus infection with Lymphadenopathy. | journal=Br Med J | year= 1970 | volume= 3 | issue= 5715 | pages= 163 | pmid=4317237 | doi=10.1136/bmj.3.5715.163 | pmc=1702272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4317237  }} </ref>
*Viral infections such as Epstein-Barr Virus and cytomegalovirus which cause infectious mononucleosis, <ref name="pmid23281438">{{cite journal| author=Weiss LM, O'Malley D| title=Benign lymphadenopathies. | journal=Mod Pathol | year= 2013 | volume= 26 Suppl 1 | issue=  | pages= S88-96 | pmid=23281438 | doi=10.1038/modpathol.2012.176 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23281438  }} </ref> and CMV mononucleosis respectively.<ref name="pmid4317237">{{cite journal| author=Sinha AK, Lovett M, Pillay G| title=Cytomegalovirus infection with Lymphadenopathy. | journal=Br Med J | year= 1970 | volume= 3 | issue= 5715 | pages= 163 | pmid=4317237 | doi=10.1136/bmj.3.5715.163 | pmc=1702272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4317237 }} </ref> as well HHV8 <ref name="pmid10889905">{{cite journal| author=O'Leary J, Kennedy M, Howells D, Silva I, Uhlmann V, Luttich K | display-authors=etal| title=Cellular localisation of HHV-8 in Castleman's disease: is there a link with lymph node vascularity? | journal=Mol Pathol | year= 2000 | volume= 53 | issue= 2 | pages= 69-76 | pmid=10889905 | doi=10.1136/mp.53.2.69 | pmc=1186908 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10889905  }} </ref> and HIV.<ref name="pmid8924253">{{cite journal| author=Oksenhendler E, Duarte M, Soulier J, Cacoub P, Welker Y, Cadranel J | display-authors=etal| title=Multicentric Castleman's disease in HIV infection: a clinical and pathological study of 20 patients. | journal=AIDS | year= 1996 | volume= 10 | issue= 1 | pages= 61-7 | pmid=8924253 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8924253 }} </ref>
*Yersinia pestis, which causes the bubonic plague, causes lymph node swelling so large that it can be seen under the skin. These lymph nodes are called buboes and may become necrotic. <ref name="pmid19606935">{{cite journal| author=Butler T| title=Plague into the 21st century. | journal=Clin Infect Dis | year= 2009 | volume= 49 | issue= 5 | pages= 736-42 | pmid=19606935 | doi=10.1086/604718 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19606935  }} </ref>
*Yersinia pestis, which causes the bubonic plague, causes lymph node swelling so large that it can be seen under the skin. These lymph nodes are called buboes and may become necrotic. <ref name="pmid19606935">{{cite journal| author=Butler T| title=Plague into the 21st century. | journal=Clin Infect Dis | year= 2009 | volume= 49 | issue= 5 | pages= 736-42 | pmid=19606935 | doi=10.1086/604718 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19606935  }} </ref>
*Other bacterial infections such as cat-scratch disease, <ref name="pmid21243990">{{cite journal| author=Klotz SA, Ianas V, Elliott SP| title=Cat-scratch Disease. | journal=Am Fam Physician | year= 2011 | volume= 83 | issue= 2 | pages= 152-5 | pmid=21243990 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21243990  }} </ref>  cutaneous anthrax, <ref name="pmid21852539">{{cite journal| author=Sweeney DA, Hicks CW, Cui X, Li Y, Eichacker PQ| title=Anthrax infection. | journal=Am J Respir Crit Care Med | year= 2011 | volume= 184 | issue= 12 | pages= 1333-41 | pmid=21852539 | doi=10.1164/rccm.201102-0209CI | pmc=3361358 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21852539  }} </ref> and tuberculous lymphadenitis <ref name="pmid21865192">{{cite journal| author=Fontanilla JM, Barnes A, von Reyn CF| title=Current diagnosis and management of peripheral tuberculous lymphadenitis. | journal=Clin Infect Dis | year= 2011 | volume= 53 | issue= 6 | pages= 555-62 | pmid=21865192 | doi=10.1093/cid/cir454 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21865192  }} </ref>
*Protozoal infections including African sleeping sickness, <ref name="pmid23260189">Kennedy PG (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23260189 Clinical features, diagnosis, and treatment of human African trypanosomiasis (sleeping sickness).] ''Lancet Neurol'' 12 (2):186-94. [http://dx.doi.org/10.1016/S1474-4422(12)70296-X DOI:10.1016/S1474-4422(12)70296-X] PMID: [https://pubmed.gov/23260189 23260189]</ref> Chagas' Disease, <ref name="pmid21412398">{{cite journal| author=Salazar Schettino PM, Bucio Torres M, Cabrera Bravo M, Ruiz Hernández AL| title=[Chagas disease in Mexico. Report of two acute cases]. | journal=Gac Med Mex | year= 2011 | volume= 147 | issue= 1 | pages= 63-9 | pmid=21412398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21412398  }} </ref> and toxoplasmosis. <ref name="pmid15194258">{{cite journal| author=Montoya JG, Liesenfeld O| title=Toxoplasmosis. | journal=Lancet | year= 2004 | volume= 363 | issue= 9425 | pages= 1965-76 | pmid=15194258 | doi=10.1016/S0140-6736(04)16412-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15194258  }} </ref>
Examples of malignancies that cause lymphadenopathy are:
* Primary: Hodgkin lymphoma <ref>{{cite journal |last1=Glass |first1=C|title=Role of the Primary Care Physician in Hodgkin Lymphoma|journal=American Family Physician|volume=78 |issue=5 |pages=615–622 |date=September 2008|url=http://www.aafp.org/afp/2008/0901/p615.html |pmid=18788239}}</ref> and non-Hodgkin lymphoma give lymphadenopathy in all or a few lymph nodes.<ref name=Status>Status and anamnesis, Anders Albinsson. Page 12</ref>
* Secondary: metastasis, Virchow's Node, neuroblastoma, <ref>{{cite journal |last1=Colon|first1=NC|last2=Chung|first2=DH|title=Neuroblastoma|journal=Advances in Pediatrics|volume=58 |issue=1 |pages=297–311 |year=2011|pmid=21736987|doi=10.1016/j.yapd.2011.03.011 |pmc=3668791}}</ref> and chronic lymphocytic leukemia.<ref>{{cite journal |last1=Sagatys|first1=EM|last2=Zhang|first2=L|title=Clinical and laboratory prognostic indicators in chronic lymphocytic leukemia|journal=Cancer Control|volume=19 |issue=1 |pages=18–25|date=January 2011|pmid=22143059|doi=10.1177/107327481201900103|doi-access=free}}</ref>
Autoimmune causes include: systemic lupus erythematosus <ref>{{cite journal |last1=Melikoglu |first1=MA|last2=Melikoglu|first2=M|title=The clinical importance of lymphadenopathy in systemic lupus erythematosus|journal=Acta Reumatologia Portuguesa|volume=33 |issue=4 |pages=402–406 |date=October–December 2008|pmid=19107085|url=http://www.actareumatologica.pt/oldsite/conteudo/pdfs/ARP_2008_4_402_07__AR_-_Lymphadenopathy.pdf}}</ref> and rheumatoid arthritis may have a generalized lymphadenopathy.<ref name=Status/>


==[[Lymphadenopathy differential diagnosis|Differentiating Lymphadenopathy from other Diseases]]==
==[[Lymphadenopathy differential diagnosis|Differentiating Lymphadenopathy from other Diseases]]==

Revision as of 05:23, 13 October 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Shyam Patel [2];Associate Editor(s)-in-Chief: Amandeep Singh M.D.[3], Raviteja Guddeti, M.B.B.S. [4] Ogechukwu Hannah Nnabude, MD

Synonyms and keywords: Lymph nodes enlarged; Enlarged lymph nodes; Lymphadenitis; Swollen lymph nodes; Swollen/enlarged lymph nodes
For patient information, click here

Overview

Lymphadenopathy, also called adenopathy, refers to any disease process that involves lymph nodes that are abnormal in consistency and size. This condition has multiple causes, the most common of which include neoplasia, autoimmune diseases, and infection. Lymphadenitis refers to lymphadenopathies that are due to inflammatory processes. It is characterized by nodal swelling, pain, skin changes, fever, edema, and/or purulent collections. [1]


Historical Perspective

Classification

Pathophysiology

Causes

Lymph node enlargement can be of viral, bacterial, malignant, protozoan origin and can even be caused by live vaccines [2] Examples of infections that can cause lymph node enlargement include:

  • Viral infections such as Epstein-Barr Virus and cytomegalovirus which cause infectious mononucleosis, [3] and CMV mononucleosis respectively.[4] as well HHV8 [5] and HIV.[6]
  • Yersinia pestis, which causes the bubonic plague, causes lymph node swelling so large that it can be seen under the skin. These lymph nodes are called buboes and may become necrotic. [7]
  • Other bacterial infections such as cat-scratch disease, [8] cutaneous anthrax, [9] and tuberculous lymphadenitis [10]
  • Protozoal infections including African sleeping sickness, [11] Chagas' Disease, [12] and toxoplasmosis. [13]

Examples of malignancies that cause lymphadenopathy are:

  • Primary: Hodgkin lymphoma [14] and non-Hodgkin lymphoma give lymphadenopathy in all or a few lymph nodes.[15]
  • Secondary: metastasis, Virchow's Node, neuroblastoma, [16] and chronic lymphocytic leukemia.[17]

Autoimmune causes include: systemic lupus erythematosus [18] and rheumatoid arthritis may have a generalized lymphadenopathy.[15]


Differentiating Lymphadenopathy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

References

  1. Gosche JR, Vick L (2006). "Acute, subacute, and chronic cervical lymphadenitis in children". Semin Pediatr Surg. 15 (2): 99–106. doi:10.1053/j.sempedsurg.2006.02.007. PMC 7111159 Check |pmc= value (help). PMID 16616313.
  2. (2015) Reorganized text. JAMA Otolaryngol Head Neck Surg 141 (5):428. DOI:10.1001/jamaoto.2015.0540 PMID: 25996397
  3. Weiss LM, O'Malley D (2013). "Benign lymphadenopathies". Mod Pathol. 26 Suppl 1: S88–96. doi:10.1038/modpathol.2012.176. PMID 23281438.
  4. Sinha AK, Lovett M, Pillay G (1970). "Cytomegalovirus infection with Lymphadenopathy". Br Med J. 3 (5715): 163. doi:10.1136/bmj.3.5715.163. PMC 1702272. PMID 4317237.
  5. O'Leary J, Kennedy M, Howells D, Silva I, Uhlmann V, Luttich K; et al. (2000). "Cellular localisation of HHV-8 in Castleman's disease: is there a link with lymph node vascularity?". Mol Pathol. 53 (2): 69–76. doi:10.1136/mp.53.2.69. PMC 1186908. PMID 10889905.
  6. Oksenhendler E, Duarte M, Soulier J, Cacoub P, Welker Y, Cadranel J; et al. (1996). "Multicentric Castleman's disease in HIV infection: a clinical and pathological study of 20 patients". AIDS. 10 (1): 61–7. PMID 8924253.
  7. Butler T (2009). "Plague into the 21st century". Clin Infect Dis. 49 (5): 736–42. doi:10.1086/604718. PMID 19606935.
  8. Klotz SA, Ianas V, Elliott SP (2011). "Cat-scratch Disease". Am Fam Physician. 83 (2): 152–5. PMID 21243990.
  9. Sweeney DA, Hicks CW, Cui X, Li Y, Eichacker PQ (2011). "Anthrax infection". Am J Respir Crit Care Med. 184 (12): 1333–41. doi:10.1164/rccm.201102-0209CI. PMC 3361358. PMID 21852539.
  10. Fontanilla JM, Barnes A, von Reyn CF (2011). "Current diagnosis and management of peripheral tuberculous lymphadenitis". Clin Infect Dis. 53 (6): 555–62. doi:10.1093/cid/cir454. PMID 21865192.
  11. Kennedy PG (2013) Clinical features, diagnosis, and treatment of human African trypanosomiasis (sleeping sickness). Lancet Neurol 12 (2):186-94. DOI:10.1016/S1474-4422(12)70296-X PMID: 23260189
  12. Salazar Schettino PM, Bucio Torres M, Cabrera Bravo M, Ruiz Hernández AL (2011). "[Chagas disease in Mexico. Report of two acute cases]". Gac Med Mex. 147 (1): 63–9. PMID 21412398.
  13. Montoya JG, Liesenfeld O (2004). "Toxoplasmosis". Lancet. 363 (9425): 1965–76. doi:10.1016/S0140-6736(04)16412-X. PMID 15194258.
  14. Glass, C (September 2008). "Role of the Primary Care Physician in Hodgkin Lymphoma". American Family Physician. 78 (5): 615–622. PMID 18788239.
  15. 15.0 15.1 Status and anamnesis, Anders Albinsson. Page 12
  16. Colon, NC; Chung, DH (2011). "Neuroblastoma". Advances in Pediatrics. 58 (1): 297–311. doi:10.1016/j.yapd.2011.03.011. PMC 3668791. PMID 21736987.
  17. Sagatys, EM; Zhang, L (January 2011). "Clinical and laboratory prognostic indicators in chronic lymphocytic leukemia". Cancer Control. 19 (1): 18–25. doi:10.1177/107327481201900103. PMID 22143059.
  18. Melikoglu, MA; Melikoglu, M (October–December 2008). "The clinical importance of lymphadenopathy in systemic lupus erythematosus" (PDF). Acta Reumatologia Portuguesa. 33 (4): 402–406. PMID 19107085.



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