Pediatric emergency medicine trisk 0923 0923

viscera, urinary
tract

FIGURE 47.3 Child with lymphadenitis that progressed to lymph node abscess.

There are several rare infectious causes of cervical lymphadenopathy that may be
encountered in the pediatric emergency department. Tularemia, caused by infection with
Francisella tularensis, occurs predominantly in the South Central United States
(Arkansas, Oklahoma, Missouri, and Kansas). It occurs after contact with infected
animals (rabbits, hamsters) or via tick or deerfly bites. The most common presentation in
children is a febrile illness with tender cervical or occipital adenopathy that may become
chronic. An associated papular or ulcerative lesion may be noted on the skin at the site of
animal contact or insect bite. Diagnosis is made by detecting serum antibodies to F.
tularensis, and antimicrobial therapy with doxycycline or a fluoroquinolone is appropriate
for mild illness. Toxoplasmosis, a parasitic infection caused by Toxoplasma gondii, is
acquired via contact with oocytes in cat feces or consumption of undercooked pork or