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Internamentos por Linfadenite Cervical num Serviço de Pediatria Geral
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Advisor(s)
Abstract(s)
RESUMO
Introdução: A Linfadenite Cervical (LAC) é uma entidade
comum na idade pediátrica. As formas agudas bilaterais são as
mais frequentes, de etiologia viral e autolimitadas. As agudas
unilaterais são habitualmente bacterianas, provocadas pelo
Streptococcus pyogenes e Staphylococcus aureus. Nas subagudas/crónicas a Bartonella, as Mycobacteria e o Toxoplasma
devem ser etiologias consideradas.
Objetivos: Caracterização de população de crianças internadas numa enfermagem de Pediatria Geral por LAC.
Material e métodos: Estudo comparativo retrospetivo de
uma amostra de conveniência que inclui as crianças internadas,
entre Março de 1999 e Fevereiro de 2010.
Resultados e Discussão: Identificaram-se 61 crianças, 88,5% do sexo feminino. A LAC aguda correspondeu a 88,5%
dos casos, das quais 57,4% foram unilaterais. A forma subaguda/crónica ocorreu em 11,5%. A idade nas formas agudas foi
significativamente inferior à das subagudas/crónicas (p=0,034).
A etiologia bacteriana equivaleu a 96,7% sendo as restantes,
uma mononucleose infeciosa e uma toxoplasmose ganglionar.
O S. aureus e S. pyogenes corresponderam a 66,6% dos agentes bacterianos isolados. Identificaram-se três casos de LAC por
Mycobacterium tuberculosis, dois por Bartonella henselae e dois
por Ricketsia conorii.
As infeções prévias da cabeça e pescoço estiveram presentes em 27 (44,3%). Documentaram-se infeções virais predisponentes em cinco casos. As localizações cervical e submandibular foram as mais frequentes, 47,5% e 44,3%, respetivamente.
Evidenciou-se febre em 85,2% das crianças, sintomas regionais
(torcicolo e trismos) em 45% e flutuação em 29%. Houve necessidade de drenagem cirúrgica em 24,6% dos doentes, em seis
(9,8%) realizou-se citologia aspirativa e em 45 exames de imagem. A leucocitose (>15000/μL) e a proteína C reativa positiva
(>3,0 mg/dL) verificaram-se em 83,6% e 65,5% dos casos, respetivamente. O S. pyogenes e o S. aureus cursaram com mais
sinais inflamatórios e maior necessidade de drenagem cirúrgica
(p=0,01). Os antibióticos foram utilizados em todos os doentes
sendo o mais frequente a amoxicilina/ácido clavulânico (57,3%). A flucloxacilina administrou-se em 19,7% dos casos. A evolução
foi favorável em todos os casos.
Conclusão: O diagnóstico etiológico da LAC não é fácil na
maioria dos casos. Embora a grande maioria das crianças com
LAC não seja internada, existem alguns casos que, pela necessidade de investigação complementar ou de tratamento o sejam.
Portugal é um país de média incidência de Tuberculose pelo que
esta doença deve ser considerada, com especial atenção para a
emergência de M. tuberculosis multirresistentes.
ABSTRACT Introduction: Cervical lymphadenitis (CL) is a common condition in children. Acute bilateral CL is the most frequent presentation, usually self-limited and caused by virus. Acute unilateral CL is commonly bacterial, most frequently caused by Streptococcus pyogenes and Staphylococcus aureus. Bartonella, Mycobacteria and Toxoplasma must be considered when the CL is subacute/chronic. Objective: Characterization of children with CL hospitalized in a paediatric unit. Population and methods: Retrospective comparative study of a convenience sample that includes inpatient children, between March 1999 and February 2010. Results and Discussion: Sixty-one patients were identified, 88,5% female. All CL were infectious. Acute CL was observed in 88,5% of cases (57,4% unilateral and 31,1% bilateral). Subacute/chronic CL occurred in 11,5%. The average age in acute cases was significantly lower than in subacute /chronic ones (p=0,034). Bacterial CL occurred in 96,7% and the remaining cases included infectious mononucleosis (n=1) and ganglionar toxoplasmosis (n=1). S. aureus and S. pyogenes were isolated in 66,6% of the patients. In addition, Mycobacterium tuberculosis was identified in three cases, Bartonella henselae in two and Ricketsia conorii in two. Previous head and neck infections were found in 27 patients (44,3%) with CL. Preceding viral infections were found in five cases. Cervical and submandibular nodes were the most frequent involved, 47,5% and 44,3% respectively. Fever was present in 85,2% and regional complaints (torticollis and trismus) in 45%. In 29%, the nodes developed fluctuation and 24,6% needed surgical drainage. Six (9,8%) patients underwent fine-needle aspiration and 45 had image studies performed. Leukocyte count > 15000/μL and positive C Reactive Protein (>3 mg/dL) were present in 83,6% and 65,5% respectively. S. pyogenes and S. aureus infections were associated more frequently with skin inflammatory signs and need for surgical drainage (p=0,01). Antibiotics were used in all patients, most commonly amoxicillin-clavulanate (57,3%) and flucloxacillin (19,7%). The outcome was favourable in all patients. Conclusion: Aetiology identification for CL can be challenging. Although the majority of children with CL can be managed in an outpatient setting, there are cases that require in-hospital diagnostic investigation or intensive care. Since Portugal presents a medium incidence of tuberculosis, clinicians should maintain a high-level of suspicion for the emergence of multiresistant M. tuberculosis.
ABSTRACT Introduction: Cervical lymphadenitis (CL) is a common condition in children. Acute bilateral CL is the most frequent presentation, usually self-limited and caused by virus. Acute unilateral CL is commonly bacterial, most frequently caused by Streptococcus pyogenes and Staphylococcus aureus. Bartonella, Mycobacteria and Toxoplasma must be considered when the CL is subacute/chronic. Objective: Characterization of children with CL hospitalized in a paediatric unit. Population and methods: Retrospective comparative study of a convenience sample that includes inpatient children, between March 1999 and February 2010. Results and Discussion: Sixty-one patients were identified, 88,5% female. All CL were infectious. Acute CL was observed in 88,5% of cases (57,4% unilateral and 31,1% bilateral). Subacute/chronic CL occurred in 11,5%. The average age in acute cases was significantly lower than in subacute /chronic ones (p=0,034). Bacterial CL occurred in 96,7% and the remaining cases included infectious mononucleosis (n=1) and ganglionar toxoplasmosis (n=1). S. aureus and S. pyogenes were isolated in 66,6% of the patients. In addition, Mycobacterium tuberculosis was identified in three cases, Bartonella henselae in two and Ricketsia conorii in two. Previous head and neck infections were found in 27 patients (44,3%) with CL. Preceding viral infections were found in five cases. Cervical and submandibular nodes were the most frequent involved, 47,5% and 44,3% respectively. Fever was present in 85,2% and regional complaints (torticollis and trismus) in 45%. In 29%, the nodes developed fluctuation and 24,6% needed surgical drainage. Six (9,8%) patients underwent fine-needle aspiration and 45 had image studies performed. Leukocyte count > 15000/μL and positive C Reactive Protein (>3 mg/dL) were present in 83,6% and 65,5% respectively. S. pyogenes and S. aureus infections were associated more frequently with skin inflammatory signs and need for surgical drainage (p=0,01). Antibiotics were used in all patients, most commonly amoxicillin-clavulanate (57,3%) and flucloxacillin (19,7%). The outcome was favourable in all patients. Conclusion: Aetiology identification for CL can be challenging. Although the majority of children with CL can be managed in an outpatient setting, there are cases that require in-hospital diagnostic investigation or intensive care. Since Portugal presents a medium incidence of tuberculosis, clinicians should maintain a high-level of suspicion for the emergence of multiresistant M. tuberculosis.
Description
Keywords
Abcesso adenite criança linfadenite cervical tuberculose Abscess adenitis children lymphadenitis tuberculosis
Citation
Nascer e Crescer 2013; 22(4): 220-226