Increased lymph nodes in children

The increase in lymph nodes in children is observed with various infections, blood diseases, tumor processes, etc.

[1], [2]

Causes of enlarged lymph nodes in children

Acute enlargement of one group of lymph nodes in the child (regional) in the form of a local skin reaction over them (hyperemia, edema), tenderness arises with staphylo- and streptococcal infections (pyoderma, furuncle, sore throat, otitis, infected wound, eczema, gingivitis, stomatitis and other). Sometimes lymph nodes swell, which is accompanied by an increase in body temperature.

Diffuse increase in occipital, posterolateral, tonsillar and other lymph nodes in the child is noted for rubella, scarlet fever, infectious mononucleosis, acute respiratory-viral diseases. In older children, the reaction of the submaxillary and tonsillar lymph nodes is distinctly expressed in lacunar angina, diphtheria of throat.

In acute inflammation, lymphadenitis almost always disappears quickly. It lasts for a long time in chronic infections, for example, with tuberculosis. Tuberculosis of peripheral lymph nodes is limited to a certain area, most often by the cervical group. Lymph nodes are a significant, dense, painless package that tends to caseous decay and fistula formation, after which uneven scars remain. The nodes are welded together, with the skin and subcutaneous tissue. Sometimes tuberculosis of the cervical lymph nodes is compared with the collar. Intradermal vaccination against tuberculosis in rare cases can be accompanied by the reaction of axillary lymph nodes (the so-called bezhet). Auxiliary diagnostic methods are tuberculin tests, diagnostic punctures or biopsy. A generalized enlargement of the lymph nodes can be observed with disseminated tuberculosis and chronic tuberculous intoxication. Characteristic of the chronic course: in the affected lymph nodes develop fibrous tissue ("gland-pebble", according to AA Kisel). Sometimes with disseminated tuberculosis, it is possible for caseous decay and fistula formation.

Another chronic infection - brucellosis - is accompanied by a diffuse increase in the lymph nodes to the size of the hazelnut. They are not very painful. Simultaneously there is an increase in the spleen. From protozoic diseases, lymphadenopathy is observed with toxoplasmosis. Some of its forms are characterized by an increase in the cervical lymph nodes. To clarify the diagnosis of lesions, use an intradermal test with toxoplasmin and a complement fixation reaction. The generalized enlargement of lymph nodes can be observed in mycosis: histoplasmosis, coccidiomycosis, etc.

Lymph nodes in children also increase with certain viral infections. Occipital and occipital lymph nodes increase in rubella extension, later a diffuse enlargement of the lymph nodes; they are painful when pressed, have an elastic consistency. Peripheral lymph nodes can be moderately increased in measles, influenza, adenovirus infection. Swollen lymph nodes have a dense consistency and are painful on palpation. With Filatov's disease (infectious mononucleosis), the increase in lymph nodes is more pronounced in the neck region, usually on both sides, other groups are less often enlarged, up to the formation of packets. An increase in regional lymph nodes with the phenomena of periadenitis (adhesion to the skin) is noted in the disease of "cat scratch". At the same time, chills, mild leukocytosis may appear. Suppuration occurs rarely.

Lymph nodes can increase with infectious-allergic diseases. Wassler-Fanconi's allergic subsepsis is characterized by diffuse micro-polarity. Parenteral administration of a foreign protein often causes a serum sickness, which is accompanied by diffuse lymphadenopathy.

The most significant increase in regional lymph nodes is at the site of serum administration.

A significant increase in lymph nodes in a child is observed with blood diseases. In most cases, with acute leukemia, diffuse enlargement of the lymph nodes is noted. It appears early and is most expressed in the neck; their size is usually small - to the hazelnut. However, with tumor forms, the dimensions can be significant. This increases the lymph nodes of the neck, mediastinum and other areas, forming large packets. Chronic leukemia - myelosis - in children is rare, lymph nodes with it increase and are not very pronounced.

Lymph nodes often become the center of tumor processes - primary tumors or metastases in them. With lymphosarcoma, the enlargement of the lymph nodes can be seen or felt in the form of large or small tumor masses that, due to germination in the surrounding tissues, are immobile and can give symptoms of compression (edema, thrombosis, paralysis). The increase in peripheral lymph nodes is the main symptom of lymphogranulomatosis: the cervical and subclavian lymph nodes increase, which is a conglomerate, a packet with indistinctly determined nodes. They are initially mobile, not soldered to each other and surrounding tissues. Later, they can be soldered to each other and the underlying tissues, become dense, painless or moderately painful. Characteristic is the detection of Berezovsky-Sternberg cells in the punctate or histological specimen.

Enlarged lymph nodes can be found with chlorine, multiple myeloma, reticulosarcoma. Metastases in the regional lymph nodes are often observed in malignant tumors. Affected nodes increase and become dense.

The syndrome of enlarged peripheral lymph nodes in children can be noted with reticulogistiocytosis "X" (illness of Leterer-Siwa, Hend-Schüller-Christen), when there is an increase in cervical, axillary, or inguinal lymph nodes.

[3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]

Increased lymph nodes in children and children's lymphatics

Children's "lymphatics" as a manifestation of the features of the constitution. The growth of lymphatic tissue in children is very different. Children in their age, in contrast to adults, are bright "lymphatic". The first tissue that reacts to growth stimulation in the child's body, a tissue that has the richest representation of receptors for growth hormones, is the lymphoid tissue. When a child grows, his lymphoid formations (tonsils, adenoids, thymus gland, peripheral lymph nodes, clusters of lymphoid tissue on the mucous membranes, etc.) outstrip the growth of the skeleton and internal organs. Children's "lymphatics" - this is a purely physiological, absolutely symmetrical increase in lymph nodes and formations, accompanying the growth of the child. At the age of 6 to 10 years, the total lymphoid mass of a child's body can double the lymphoid weight of an adult. Then her involution begins. Among the manifestations of borderline health states can include such as hyperplasia of the thymus gland or peripheral lymph nodes that go beyond the physiological "lymphatics". Particular attention of physicians should involve a significant, reaching to violations of breathing hyperplasia of the thymus gland. Such degrees of hyperplasia of the thymus gland can not be physiological. Such children should exclude tumoral processes, immunodeficiency states, etc.

Significant degrees of "lymphatism," including hyperplasia of the thymus gland, can have children with markedly accelerated physical development and, as a rule, with overfeed, especially overfeeding protein. This "lymphatics" can be called "macrosomatic", or "accelerated". It belongs to children at the end of the first year or the 2nd, rarely 3-5 years of life. Its peculiar antipode is a variant of the classical anomaly of the constitution known as "lymphatic-hypoplastic diathesis". With this form, the increase in the thymus gland and, to a small extent, the hyperplasia of the peripheral lymphatic formations, is combined with small parameters of length and body weight at birth and subsequent retardation of the growth rate and increase in body weight, i.e., a state of hypoplasia or hypostatism. According to modern ideas, this variant of "lymphatics" is a reflection of the consequences of intrauterine infection or hypotrophy and the resulting neurohormonal dysfunction. When such dysfunction leads to a decrease in reserves or glucocorticoid function of the adrenal gland, the child may have a symptomatic hyperplasia of the thymus gland. Both types of "lymphatics" - both macrosomatic and hypoplastic - due to relative (growth) in the first variant and absolute insufficiency of adrenal reserves (in the second) have a general increased risk. This is the risk of a malignant course of intercurrent, most often respiratory infections. Against the background of hyperplasia of the thymus gland, the infection creates the risk of a sudden or, more correctly, sudden death. Earlier in pediatrics, this was called "thymic" death, or "Mors thymica".

The syndrome of "lymphatics", very reminiscent of the clinical picture of age-related children's "lymphatics", can be seen if the child has sensitization to some factor of his household environment. It is characterized by a greater degree of hyperplasia of the lymphatic formations, disturbances in the general condition (crying, restlessness, instability of body temperature), transitory nasal breathing disorders or runny nose. This is typical of respiratory sensitization with rapid stimulation of the growth of tonsils and adenoids, then of other lymph nodes. The same is observed with food sensitization. Then the first responding lymph nodes will be mesenteric with a clinical picture of regular "colic" and bloating, then - tonsils and adenoids.

Sometimes "lymphatics" assumes a recurrent-recurrent nature. In the first place, the submaxillary, anterolateral lymph nodes, and then the lymphatic oropharyngeal ring of Valdeier-Pirogov are more frequent. Less often is a multiple hyperplasia of peripheral nodes. Often after an infection, the increase in lymph nodes remains pronounced for a long time. Such symptomatology is peculiar to some forms of immunodeficiency states, in particular, the lack of antibody education. Such patients require an in-depth immunological examination.

And, finally, we should not forget about the most trivial reason for persistent hyperplasia of the lymph nodes. Sometimes it is a very symmetrical hyperplasia, and its difference from physiological "lymphatics" consists only in the presence of some general complaints. The doctor is obliged to suspect from each such child the presence of the current chronic infection and to conduct appropriate examination and treatment. If earlier our teachers and predecessors identified a tuberculosis infection in such patients, then we have a much wider choice - from the "bouquet" of intrauterine infections, including venereal infections, to a multitude of latent current virus infections and HIV. Thus, diagnoses of constitutional "lymphatics" have a right to exist only when other causes of lymphoid hyperplasia seem unlikely.