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ObjectivesTo establish a diagnostic tree analysis (DTA) model based on ultrasonography (US) findings and clinical characteristics for differential diagnosis of common causes of cervical lymphadenopathy in children.MethodsA total of 242 patients (131 boys, 111 girls; mean age, 11.2 ± 0.3 years; range, 1 month–18 years) with pathologically confirmed Kikuchi disease (n = 127), reactive hyperplasia (n = 64), lymphoma (n = 24), or suppurative lymphadenitis (n = 27) who underwent neck US were included. US images were retrospectively reviewed to assess lymph node (LN) characteristics, and clinical information was collected from patient records. DTA models were created using a classification and regression tree algorithm on the basis of US imaging and clinical findings. The patients were randomly divided into training (70%, 170/242) and validation (30%, 72/242) datasets to assess the diagnostic performance of the DTA models.ResultsIn the DTA model based on all predictors, perinodal fat hyperechogenicity, LN echogenicity, and short diameter of the largest LN were significant predictors for differential diagnosis of cervical lymphadenopathy (overall accuracy, 85.3% and 83.3% in the training and validation datasets). In the model based on categorical parameters alone, perinodal fat hyperechogenicity, LN echogenicity, and loss of fatty hilum were significant predictors (overall accuracy, 84.7% and 86.1% in the training and validation datasets).ConclusionsPerinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum were significant US findings in the DTA for differential diagnosis of cervical lymphadenopathy in children.Key Points• Diagnostic tree analysis model based on ultrasonography and clinical findings would be helpful in differential diagnosis of pediatric cervical lymphadenopathy.• Significant predictors were perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum.

We describe the epidemiology, diagnosis, and management of nontuberculous mycobacterial lymphadenitis cases detailed in a 28-year (1996-2023) multicenter cohort from Spain. The case numbers remained stable during the initial prospective phase (2013-2020), but a sharp decline was observed during 2021-2022. Disease onset occurred during spring or June in 45.9% of cases. Mycobacterium avium complex (43.1%) and M. lentiflavum (39.9%) were the most common species detected. M. lentiflavum affected mostly younger children from central Spain. The most common treatment strategy was complete surgical resection with (n = 80) or without (n = 88) antimicrobial drug treatment, followed by antimicrobial drugs alone (n = 76). Facial palsy developed in 10.4% of surgical cases. Adverse events because of antimicrobial drugs were uncommon. New fistula formation during follow-up occurred more in children managed with observation alone than in those treated with antimicrobial drugs alone (relative risk 2.7 [95% CI 1.3-5.3]; p = 0.014).

Due to its nonspecific clinical characteristics, histiocytic necrotizing lymphadenitis (HNL) is often misdiagnosed as a suppurative cervical lymphadenitis and lymphoma. Thus, this study aimed to investigate the clinical characteristics of HNL in pediatric patients. We retrospectively identified 61 patients with histopathologically confirmed HNL. Clinical and laboratory data, including age, sex, clinical manifestations, laboratory investigations, histological discoveries, treatment, and outcomes, were collected from the medical records to determine associations with extracervical lymph node (LN) involvement. The mean age of patients was 9.7 ± 2.8 years (range, 1.5–14.0 years), and the male-to-female ratio was 2.2:1. The most common systemic symptom was fever in all patients. The median pre-admission and total durations of fever were 13.0 (interquartile range [IQR]: 9.0–22.5 days) and 22.0 days (IQR: 17.0–33.0 days), respectively. Patients with temporary fever (< 2 weeks) had a higher peak temperature and were more likely to undergo LN biopsy after admission than those with a prolonged fever (≥ 2 weeks). Multivariate analysis revealed that peak temperature ≥ 40 °C was significantly associated with a longer fever duration (P = 0.023). Laboratory values showed leukopenia (68.9%), which presented more frequently in solitary cervical LNs than in extracervical LNs (82.4% vs. 52.9%, p = 0.027) in patients with prolonged fever. Conclusions : HNL is often misdiagnosed in older children with persistent fever and lymphadenopathy, leading to unnecessary diagnostic tests and evaluations, inappropriate antibiotic administration, and mismanagement. A multidisciplinary team, including primary care providers, rheumatologists, and pathologists, can improve patient outcomes by increasing their awareness of this rare condition. What is Known: • Histiocytic necrotizing lymphadenitis (HNL) is characterized by fever, leukopenia, and neck lymphadenopathy with unknown etiology. • The lack of neutrophils or eosinophils in the histology, immunohistochemistry results help distinguish HNL from infectious causes.  Although HNL is a self-limiting disease, antibiotics and steroid treatments were used inappropriately. What is New: • A fever peak ≥ 40 °C was associated with a longer fever duration in HNL patients.  Leukopenia presented more frequently in solitary cervical lymph node (LNs) than in extracervical LNs in patients with prolonged fever. •  Steroids are not recommended as a routine treatment, however, in some severe or relapsing cases with  persistent symptoms, prednisolone (5 mg twice a day for 2 days) or other steroids (an equivalent dose of  prednisolone) responded favorably.

Corynebacterium pseudotuberculosis causes caseous lymphadenitis (CLA) in goats and sheep. This study assessed oral fluid (OF) as a minimally invasive sample for CLA serodiagnosis by detecting antibodies to phospholipase D (PLD), CP40 protein, and protein kinase G (PknG) using Western blot (WB). Serum and OF samples from 96 goats from a CLA-affected herd in Poland were tested using a commercial ELISA coated with recombinant PLD (rPLD-ELISA; serum only) and WB (serum and OF). Depending on the cut-off, the rPLD-ELISA had 70–80% diagnostic sensitivity. WB on serum showed very high diagnostic sensitivity (98%) and good agreement with the rPLD-ELISA. WB on OF was highly consistent with WB on serum, however it had slightly lower diagnostic sensitivity (90%). Moreover, WB on OF showed substantial variations in antigen detection, with antibodies to PLD being most effectively detected. Considerably fewer OF samples had anti-CP40 and PknG antibodies, likely due to antibody class variations or detection limitations. Further investigation into immunoglobulin classes in different sample types and optimized secondary antibodies is essential for developing an effective OF-based diagnostic test for CLA.

Purpose To comprehensively analyze the clinical data of histiocytic necrotizing lymphadenitis (HNL) in adults with fever of unknown origin (FUO), with the aim of enabling precise diagnosis. Patients and methods A total of 15 HNL patients with FUO were enrolled. The analysis encompassed clinical manifestations, laboratory parameters 18 F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography ( 18 F-FDG PET/CT) imaging profiles, pathological features and therapeutic responses. Results All patients presented with fever and lymphadenopathy (predominantly cervical). Laboratory findings included leukopenia (3.28 × 10⁹/L [2.40–4.97]), elevated LDH (306 U/L [187–524]), ESR (40 mm/h [30–51]), ferritin (457.1 ng/mL [206-1823.3]), and CRP (25 mg/L [6.1–34.8]) 18 F-FDG PET/CT detected metabolic lymph node abnormalities in 13 cases, primarily cervical and axillary. The pathological features were extensive coagulative necrosis of lymph nodes with reactive hyperplasia of histiocytes as well as positive or scattered positivity IHC CD3, CD4, CD8 and CD68. Corticosteroid achieved favorable responses, with only 2 cases progressing during follow-up. Conclusion In clinical practice, patients with fever and lymphadenopathy should be given due attention. Pathological examination remains the gold standard for diagnosing HNL. Glucocorticoid therapy has proven effective, and the majority of patients with HNL exhibit a favorable prognosis.

This consensus statement update reflects our current published knowledge and opinion about clinical signs, pathogenesis, epidemiology, treatment, complications, and control of strangles. This updated statement emphasizes varying presentations in the context of existing underlying immunity and carrier states of strangles in the transmission of disease. The statement redefines the “gold standard” for detection of possible infection and reviews the new technologies available in polymerase chain reaction diagnosis and serology and their use in outbreak control and prevention. We reiterate the importance of judicious use of antibiotics in horses with strangles. This updated consensus statement reviews current vaccine technology and the importance of linking vaccination with currently advocated disease control and prevention programs to facilitate the eradication of endemic infections while safely maintaining herd immunity. Differentiation between immune responses to primary and repeated exposure of subclinically infected animals and responses induced by vaccination is also addressed.

Background Cervical suppurative lymphadenitis in children is commonly caused by Staphylococcus aureus or Streptococcus pyogenes. However, cases caused by Burkholderia multivorans (BM) are rare. The clinical presentation lacks specificity, making it difficult for clinicians to recognize, which may delay diagnosis and treatment. Case presentation We report a case of a 5-year-old boy admitted with recurrent fever and neck swelling. Initial treatment with meropenem and linezolid was ineffective, and symptoms persisted after 24 days of conservative therapy. Aspiration of pus yielded negative culture results. Definitive diagnosis was achieved through surgical biopsy of cervical lymph nodes, pathological examination, and metagenomic next-generation sequencing (mNGS), which identified BM as the causative pathogen. The patient was successfully treated with a combination of trimethoprim-sulfamethoxazole and meropenem. The cervical lesion exhibited granulomatous inflammation and was managed with adjunctive vacuum-assisted closure (VAC) therapy, resulting in complete wound healing without recurrence. Conclusions This study aims to raise awareness among all specialists about BM as a potential causative agent in cervical suppurative lymphadenitis. Early recognition and timely intervention can reduce misdiagnosis and missed diagnoses, improving patient outcomes.

Purpose Cervicofacial lymphadenitis caused by non-tuberculous mycobacteria (NTM) is a rare but increasing infection in children worldwide. The purpose of this study was to analyse and evaluate all microbiologically proven cases of NTM lymphadenitis in children under the age 14 years in Slovenia. Methods Between 2000 and 2020, we retrospectively reviewed laboratory and medical records for basic demographic and microbiological data. Different clinical samples were collected in medical centres and regional hospitals from all over Slovenia. Results In the period before mandatory BCG vaccination was discontinued (2000–2005), we did not observe any case of paediatric NTM lymphadenitis. After discontinuation of non-selective BCG vaccination of new-borns (2006–2020), we identified 55 cases of microbiologically confirmed NTM lymphadenitis in BCG-unvaccinated children with median age 26.0 months (range: 15.0–75.0 months). Mean annual incidence of paediatric NTM lymphadenitis accounted for 1.26 (range: 0.35–2.38) per 100,000 children. The main causative agents were Mycobacterium avium (38/55; 69.1%) and M. intracellulare (9/55; 16.4%). We did not find any M. chimaera isolate. Since 2006, each year we microbiologically confirm sporadic cases of paediatric NTM lymphadenitis, a condition not diagnosed before. Conclusions After discontinuation of universal BCG vaccination in March 2005, first cases of paediatric NTM lymphadenitis appeared. Several possible reasons could be attributed to observed trend and further multinational observational studies are warranted to explore possible causal relationships.

Caseous lymphadenitis (CLA), a chronic infectious disease caused by Corynebacterium pseudotuberculosis , remains a major concern in small ruminant populations owing to its persistent nature and impact on animal productivity. Despite the availability of commercial vaccines, their efficacy in goats has been inconsistent and field-based evidence supporting their use remains limited. In this study, we report the development and evaluation of a novel bacterin–toxoid vaccine formulated with C. pseudotuberculosis strain 51-12A obtained from a Korean native goat. The toxoid, prepared from culture supernatant and enriched with immunoreactive proteins such as PLD, CP40, NanH, and PknG, was combined with formalin-inactivated bacterin to formulate a dual-component vaccine. Immunization trials in 3–4-month-old goats demonstrated that animals receiving the combined vaccine mounted strong anti-PLD responses (optical density, OD; OD ≥ 1.0), exhibited complete protection against experimental challenge with 1 × 10⁶ colony-forming units (CFU)/mL of homologous strain, and showed no evidence of internal abscesses. In addition, field studies conducted at three independent farms confirmed the safety and immunogenicity of the vaccine under practical conditions. Vaccinated animals maintained elevated antibody titers and remained clinically healthy, while unvaccinated controls developed CLA-associated abscesses. Comparable immune responses observed in sheep suggest potential cross-species applicability. These findings highlight the efficacy and field suitability of this goat-adapted vaccine and support its potential role in CLA control strategies for small ruminant production systems.

Kikuchi-Fujimoto disease (KFD) is a reactive lymphadenitis of unclear etiology. To understand the pathogenesis of KFD, we performed targeted RNA sequencing of a well-characterized cohort of 15 KFD specimens with 9 non-KFD lymphadenitis controls. Two thousand and three autoimmunity-related genes were evaluated from archived formalin-fixed paraffin-embedded lymph node tissue and analyzed by a bioinformatics approach. Differential expression analysis of KFD cases compared to controls revealed 44 significantly upregulated genes in KFD. Sixty-eight percent of these genes were associated with the type I interferon (IFN) response pathway. Key component of the pathway including nucleic acid sensors, IFN regulatory factors, IFN-induced antiviral proteins, IFN transcription factors, IFN-stimulated genes, and IFN-induced cytokines were significantly upregulated. Unbiased gene expression pathway analysis revealed enrichment of IFN signaling and antiviral pathways in KFD. Protein–protein interaction analysis and a molecular complex detection algorithm identified a densely interacting 15-gene module of type I IFN pathway genes. Apoptosis regulator IFI6 was identified as a key seed gene. Transcription factor target analysis identified enrichment of IFN-response elements and IFN-response factors. T-cell-associated genes were upregulated while myeloid and B-cell-associated genes were downregulated in KFD. CD123+ plasmacytoid dendritic cells (PDCs) and activated T cells were noted in KFD. In conclusion, KFD is mediated by an aberrant type I interferon response that is likely driven by PDCs and T cells.