Lenfadenopati Tanısı ile Servis Yatışı Olan Çocukların Retrospektif Olarak Değerlendirilmesi

Öz

Amaç: Lenfadenit çoğunlukla enfeksiyona sekonder ortaya çıkmakla beraber nadiren altta yatan malign bir hastalığın belirtisi de olabilir. Klinisyenler için zorluk, altta yatan ciddi hastalığı atlamamak için dikkat ederken, bir yandan da agresif değerlendirmeyi ne zaman yapması gerektiğini belirlemektir. Çalışmamızda, konu hakkındaki bilgilerimizi arttırmak ve klinisyene tanı koymada ve tedaviyi belirlemede yardımcı olacak özellikleri belirlemek istedik. Gereç ve Yöntem: Retrospektif olarak 01.03.2019-31.10.2022 tarihleri arasında hastanemiz çocuk servislerinde lenfadenit tanısı ile yatan, 1 ay-18 yaş aralığındaki hastalar dahil edildi. Lenfadenitin saptandığı bölgeye göre hastalar 3 gruba ayrıldı: i) aksiller lenfadenit, ii) servikal lenfadenit ve iii) inguinal lenfadenit. Bulgular: Çalışmada hastaların 21’i (%60) erkekti ve hastaların yaş ortancası 75 (7-191) aydı. En sık Epstein Barr Virusu (%39) saptanırken, doku ve abse kültüründe en sık metisiline dirençli staphylococcus aureus (%37.5) üremesi görüldü. Ampisilin-sulbaktam (%91.4) ve klindamisin (%60) en sık uygulanan tedavilerdi. Hastaların %82.9’u başlangıç tedavisi ile klinik olarak düzelirken, altı hastanın tedavisi tekrar düzenlendi. Hastaların yatış süresi 8 (2-24) gün, hastanede intravenöz tedavi süresi 8 (2-21) gün olarak saptandı. ALT değeri servikal lenfadenit grubunda diğer iki gruba göre istatistiksel olarak anlamlı yüksekti (p=0.017). Servikal ve inguinal lenfadenit gruplarında CRP ve Sedim düzeyleri aksiller gruba göre istatistiksel anlamlı yüksek saptandı (p<0.001). LDH düzeyleri ise inguinal grupta diğer iki gruba göre anlamlı yüksekti (p<0.001). Sonuç: Servis yatış ihtiyacı olan tüm hastalardan, gerekli endikasyonlara göre mikrobiyolojik etkenlere yönelik tahlilleri gönderilmesi tedavi etkinliği ve süresinin belirlenmesi açısından uygun olabileceğini düşünmekteyiz. Ülkemizde MRSA görülme sıklığı sebebiyle Klindamisin tedavisinin ampirik başlanması düşünülebilir. Antibiyoterapinin en az 7 gün verilmesi komplikasyon ve relapsları önleyebilir.

Anahtar Kelimeler

• Antibiyotik Direnci
• Çocuk
• Lenfadenit
• Tedavi

Retrospective Evaluation of Hospitalized Children with a Diagnosis of Lymphadenitis

Öz

Aim: Lymphadenitis mostly occurs secondary to infection, it may rarely be a symptom of an underlying malignant disease. In this study, we wanted to increase our knowledge on the subject and to identify features that will help the clinician to diagnose and determine the treatment. Materials and Methods: Patients aged between 1 month and 18 years who were diagnosed with lymphadenitis in the Pediatric Services between 01.03.2019 and 31.10.2022 were included in retrospective study. Patients were divided into 3 groups according to the region of lymphadenitis: i) axillary lymphadenitis, ii) cervical lymphadenitis and iii) inguinal lymphadenitis. Results: 21 of the patients were male and the median age of the patients was 75 (7-191) months. While Epstein Barr Virus was detected most frequently, methicillin-resistant staphylococcus aureus growth was most common in tissue and abscess cultures. Ampicillin-sulbactam and clindamycin were the most common treatments. While 82.9% of the patients improved clinically with the initial treatment, the treatment of six patients was adjusted. ALT value was statistically significantly higher in the cervical lymphadenitis group than in the other two groups (p=0.017). CRP and Sedim levels in cervical and inguinal lymphadenitis groups were found to be statistically significantly higher than in the axillary group (p<0.001). LDH levels were significantly higher in the inguinal group than the other two groups (p<0.001). Conclusion: Due to the prevalence of MRSA in our country, empirical initiation of clindamycin treatment may be considered. Administration of antibiotics for at least 7 days can prevent complications and relapses.

Anahtar Kelimeler

• Antibiotic Resistance
• Child
• Lymphadenitis
• Treatment

Kaynakça

1. 1) Faraz M, Rosado FGN. Reactive Lymphadenopathies. Clin Lab Med 2021; 41(3):433-51.
2. 2) Pecora F, Abate L, Scavone S, Petrucci I, Costa F, Caminiti C, Argentiero A, Esposito S. Management of Infectious Lymphadenitis in Children. Children (Basel) 2021; 27;8(10):860.
3. 3) Peters TR, Edwards KM. Cervical lymphadenopathy and adenitis. Pediatr Rev 2000; 21(12):399-405.
4. 4) Oguz A, Karadeniz C, Temel EA, Citak EC, Okur FV. Evaluation of peripheral lymphadenopathy in children. Pediatr Hematol Oncol 2006; 23(7):549-61.
5. 5) Ling RE, Capsomidis A, Patel SR. Urgent suspected cancer referrals for childhood lymphadenopathy. Arch Dis Child 2015; 100(11):1098-9.
6. 6) Celenk F, Gulsen S, Baysal E, Aytac I, Kul S, Kanlikama M. Predictive factors for malignancy in patients with persistent cervical lymphadenopathy. Eur Arch Otorhinolaryngol 2016; 273(1):251-6.
7. 7) Huang W, Tang X, Malysz J, Han B, Yang Z. The spectrum of pathological diagnoses in non-sentinel axillary lymph node biopsy: A single institution's experience. Ann Diagn Pathol 2020; 49:151646.
8. 8) Hamilton W, Pascoe J, John J, Coats T, Davies S. Diagnosing groin lumps. BMJ 2021; 372:n578.

9. 9) Orkin SH, Nathan DG, Ginsburg D. Nathan and Oski’s Hematology of Infancy and Childhood, 8th Edition, Saunders, Philadelphia 2015.
10. 10) Howard-Jones AR, Al Abdali K, Britton PN. Acute bacterial lymphadenitis in children: a retrospective, cross-sectional study. Eur J Pediatr 2023; 182(5):2325-33.
11. 11) Venturini E, Grillandini C, Bianchi L, Montagnani C, Chiappini E, Galli L. Clinical features and outcomes of lymphadenopathy in a tertiary children's hospital. J Paediatr Child Health 2020; 56(8):1277-82.
12. 12) Friedmann AM. Evaluation and management of lymphadenopathy in children. Pediatr Rev 2008; 29(2):53-60.
13. 13) Zeppa P, Cozzolino I. Paediatric Lymphadenopathies. Monogr Clin Cytol 2018; 23:60-76.
14. 14) Deosthali A, Donches K, DelVecchio M, Aronoff S. Etiologies of Pediatric Cervical Lymphadenopathy: A Systematic Review of 2687 Subjects. Glob Pediatr Health 2019; 6:2333794X19865440.
15. 15) Yakut N, Kepenekli E. Evaluation of Cervical Lymphadenopathy in Children: Is Epstein-Barr Virus Infection Predictable? Med Bull Haseki 2021; 59:145-51.
16. 16) Ioachim HL, Medeiros LJ. Toxoplasmas lymphadenitis. Ioachim’s lymph node pathology. Lippincott Williams & Wilkinspp 2009; 159-64.
17. 17) Jabcuga CE, Jin L, Macon WR, Howard MT, Oliveira AM, King RL. Broadening the Morphologic Spectrum of Bartonella henselae Lymphadenitis: Analysis of 100 Molecularly Characterized Cases. Am J Surg Pathol 2016; 40(3):342-7.
18. 18) Feder HM Jr, Rezuke WN. Infectious mononucleosis diagnosed by Downey cells: sometimes the old ways are better. Lancet 2020; 395(10219):225.
19. 19) Desai S, Shah SS, Hall M, Richardson TE, Thomson JE; Pediatric Research in Inpatient Settings (PRIS) Network. Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis. J Hosp Med 2020; 15(4):197-203.
20. 20) Demongeot N, Akkari M, Blanchet C, Godreuil S, Prodhomme O, Leboucq N, Mondain M, Jeziorski E. Pediatric deep neck infections: Clinical description and analysis of therapeutic management. Arch Pediatr 2022; 29(2):128-32.
21. 21) Neff L, Newland JG, Sykes KJ, Selvarangan R, Wei JL. Microbiology and antimicrobial treatment of pediatric cervical lymphadenitis requiring surgical intervention. Int J Pediatr Otorhinolaryngol 2013; 77(5):817-20.
22. 22) Bishop EJ, Grabsch EA, Ballard SA, Mayall B, Xie S, Martin R, Grayson ML. Concurrent analysis of nose and groin swab specimens by the IDI-MRSA PCR assay is comparable to analysis by individual-specimen PCR and routine culture assays for detection of colonization by methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2006; 44(8):2904-8.
23. 23) Baek MY, Park KH, We JH, Park SE. Needle aspiration as therapeutic management for suppurative cervical lymphadenitis in children. Korean J Pediatr 2010; 53(8):801-4.
24. 24) Healy CM, Baker CJ. Cervical lymphadenitis. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 8th ed, Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ. (Eds), Elsevier, Philadelphia 2018; 124.
25. 25) Stevens DL, Gibbons AE, Bergstrom R, Winn V. The Eagle effect revisited: efficacy of clindamycin, erythromycin, and penicillin in the treatment of streptococcal myositis. J Infect Dis 1988; 158(1):23-8.
26. 26) Stoehr GP, Yu VL, Johnson JT, Antal EJ, Townsend RJ, Wagner R. Clindamycin pharmacokinetics and tissue penetration after head and neck surgery. Clin Pharm 1988; 7(11):820-4.
27. 27) White BP, Siegrist EA. Increasing clindamycin resistance in group A streptococcus. Lancet Infect Dis 2021; 21(9):1208-9.
28. 28) Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 399(10325):629-55.
29. 29) Carithers HA. Cat-scratch disease. An overview based on a study of 1,200 patients. Am J Dis Child 1985; 139(11):1124-33.
30. 30) Bass JW, Freitas BC, Freitas AD, Sisler CL, Chan DS, Vincent JM, Person DA, Claybaugh JR, Wittler RR, Weisse ME, Regnery RL, Slater LN. Prospective randomized double blind placebo-controlled evaluation of azithromycin for treatment of cat-scratch disease. Pediatr Infect Dis J 1998; 17(6):447-52.
31. 31) McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, Clark JE, Cooper CM, Curtis N, Goeman E, Hazelton B, Haeusler GM, Khatami A, Newcombe JP, Osowicki J, Palasanthiran P, Starr M, Lai T, Nourse C, Francis JR, Isaacs D, Bryant PA; ANZPID-ASAP group. Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. Lancet Infect Dis 2016; 16(8):e139-52.
32. 32) Shi T, Shen Y, Zhang W, Qian M, Chen X, Huang L, Tian J. Diversity of adenosine deaminase in children with EBV-related diseases. Ital J Pediatr 2022; 48(1):148.
33. 33) Ishii T, Sasaki Y, Maeda T, Komatsu F, Suzuki T, Urita Y. Clinical differentiation of infectious mononucleosis that is caused by Epstein-Barr virus or cytomegalovirus: A single-center case-control study in Japan. J Infect Chemother 2019; 25(6):431-6.