1. History and examination to look for obvious causes or worrisome features* |
2. Refer children with worrisome features for early biopsy¶ |
3. Evaluate and treat causes that appear obvious based on initial evaluation |
4. When the cause remains uncertain after the initial evaluation: - Lymph node <2 cm (0.8 inches) in longest diameter:
- Observe for 10 to 14 days:
- Regression in size – No additional evaluation or therapy
- No regression in size:
- Obtain CBC/differential; ESR/CRP; serology for EBV, CMV, and HIV; evaluate for Kawasaki disease and other uncommon causes of cervical lymphadenopathy as indicated by the history and examinationΔ
- Provide referral or treatment as indicated based upon results
- Lymph node ≥2 cm (0.8 inches) in longest diameter
- Obtain CBC, ESR/CRP, and chest radiograph
- Worrisome features* – Refer for biopsy
- No worrisome features and cause remains uncertain (including possible occult infection) – Perform TST and provide 10- to 14-day trial of antibiotics◊
- TST positive – Additional testing may be necessary to establish diagnosis of tuberculosis or nontuberculous mycobacteria
- TST negative and lymph node regresses in size – No additional evaluation or therapy
- TST negative and lymph node does not regress:
- Obtain serology for EBV, CMV, and HIV; evaluate for Kawasaki disease and other uncommon causes of cervical lymphadenopathy as indicated by the history and examinationΔ
- Provide referral or treatment as indicated based upon results
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5. Obtain biopsy¶ after 4 weeks if the diagnosis remains uncertain and the lymph node has not regressed in size or there is no response to antimicrobial therapy/broadened antimicrobial therapy§ |