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apical lung pleura and upper lung fields. The most common presentation is an isolated
enlarged node that is nontender; though with progression, the node will become fixed and
matted, adhering to overlying skin. In children with suspected tuberculous lymphadenitis,
it is important to elicit any history of family members or close contacts with a diagnosis
of tuberculosis, symptoms of active disease, or risk factors for acquisition (travel,
homelessness, incarceration, human immunodeficiency virus [HIV] infection). Diagnosis
is made by a combination of skin testing, chest radiograph, and if possible, culture data
from the involved node. In addition, newly available serum interferon-γ–release assays
(QuantiFERON-TB Gold In-Tube test or T-SPOT.TB test) detect interferon-γ generated
by T cells in response to antigens found in M. tuberculosis and are available to aid in
diagnosis. Treatment of cervical lymphadenitis consists of antimycobacterial therapy, and
should follow established recommendations, such as those from the Centers for Disease
Control (CDC) (see Chapter 94 Infectious Disease Emergencies ).