Enlarged lymph nodes3/2/2023 ![]() ![]() Lee Goldman MD, in Goldman-Cecil Medicine, 2020 Differential Diagnosis The differential diagnosis of Toxoplasma from lymphoma may, on occasion, save unnecessary invasive diagnostic workup. Toxoplasmosis has been estimated to cause between 3% and 7% of clinically significant lymphadenopathy. The prevalence of seropositivity by the fourth decade of life in North America is 30–50% and higher than 90% in certain European countries. Toxoplasma lymphadenopathy in immunocompetent patients normally resolves without treatment.Īcute infection by Toxoplasma gondii is common worldwide. 30Īntibodies to Toxoplasma gondii are usually detectable within 2 weeks of infection and reach a peak within 2 months. ![]() Histologic features in lymph node biopsies are suggestive of toxoplasmosis but are not diagnostic. The diagnosis of toxoplasmosis cannot be made solely on clinical grounds. However, 25% of patients take 2–4 months to return to normal, 8% take 4–6 months and in 6% the enlarged lymph nodes do not return to normal until much later. 30 The histologic appearance should be differentiated from lymphoma, cat-scratch disease and Kikuchi's lymphadenitis.Įnlarged glands will usually resolve within 1–2 months in 60% of patients. A chronic lymphadenopathy fluctuating in size over several months has also been described. On palpation, the lymph nodes are usually discrete, of varying firmness, and may or may not be tender they rarely suppurate or ulcerate. In approximately 15% of cases, Toxoplasma lymphadenopathy is associated with fever, headache, myalgia and sore throat that may mimic infectious mononucleosis. 30 Lymphadenopathy may be the only symptom of toxoplasmosis but generally there are additional symptoms – often fever and rarely splenomegaly and/or hepatomegaly. Toxoplasmic lymphadenopathy has been described in unusual sites such as the lung hilus, the mammary gland, parotid gland and chest wall. ![]() Retroperitoneal or mesenteric lymphadenopathy occur occasionally and cause abdominal pain. It is usually found at single sites in adults (in 90%), but multiple sites are more common in children. Lymphadenopathy is typically found in the neck, most commonly in the posterior and anterior cervical regions, followed by the suboccipital region, the axillae and then the groins. Lymphadenopathy is an important clinical sign of acquired primary toxoplasmosis in the immunocompetent and occurs in up to 84% (mean 64%) of cases in different studies. A firm, fixed node should always raise the question of malignancy, regardless of the presence or absence of systemic symptoms or other abnormal physical findings.Įthan Rubinstein, Yoav Keynan, in Infectious Diseases (Fourth Edition), 2017 Toxoplasmosis When caused by infectious agents other than bacteria, adenopathy may be characterized by atypical anatomic areas, a prolonged course, a draining sinus, lack of prior pyogenic infection, and unusual clues in the history (cat scratches, tuberculosis exposure, venereal disease). In contrast, regional adenopathy is most frequently the result of infection in the involved node and/or its drainage area ( Table 517.2). Is the lymphadenopathy localized or generalized? Generalized adenopathy (enlargement of >2 noncontiguous node regions) is caused by systemic disease ( Table 517.1) and is often accompanied by abnormal physical findings in other systems. Tumors or tumor-involved nodes are often present for >2 wk and may be associated with local extension (voice change, dysphagia) or systemic signs (fever, weight loss, night sweats). Tumor-bearing nodes are usually firm and nontender and may be matted or fixed to the skin or underlying structures. With chronic infection, many of these signs are not present. There may also be erythema and warmth of the overlying skin. What are the characteristics of the node? Acutely infected nodes are usually tender. Other lymph nodes usually are not palpable or visualized with plain radiographs. They are not considered enlarged until their diameter exceeds 1 cm for cervical and axillary nodes and 1.5 cm for inguinal nodes. With antigenic exposure, lymphoid tissue increases in volume. Is the node enlarged? Lymph nodes are not usually palpable in the newborn. Is the mass a lymph node? Nonlymphoid masses (cervical rib, thyroglossal cyst, branchial cleft cyst or infected sinus, cystic hygroma, goiter, sternomastoid muscle tumor, thyroiditis, thyroid abscess, neurofibroma) occur frequently in the neck and less often in other areas. Kliegman MD, in Nelson Textbook of Pediatrics, 2020 Diagnosis ![]()
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