Lymphadenopathy in African Children

Enlarged palpable lymph nodes is an extremely common clinical finding in children in Africa, being most prevalent in the first decades of life. Conditions that give rise to lymphadenopathy fit into two categories: reactive or neoplastic. The major cause of lymphadenopathy is reactive in nature and secondary to infection. Infections may be viral, bacterial (including mycobacterial), fungal or parasitic. Similar to acute lymphadenitis, chronic lymphadenitis is more often secondary to systemic processes. Histologically identified chronic granulomatous is 36.3% of a series of 1877 surgically biopsied lymph nodes. Although M. tuberculosis was the causative agent in the majority of cases, in almost 10%, the cause of the granulomatous inflammation was not identified, but possibilities include nontuberculous mycobacterial infection, syphilis, yaws and toxoplasmosis. The overall risk of malignancy is approximately 12% (one in every eight lymph nodes biopsied) in chronic cervical lymphadenopathy. All efforts should be taken to achieve a definitive diagnosis! FNAB aspiration biopsy is an effective triage procedure to screen for malignancy. A continued strong suspicion of malignancy that requires repeated sampling of deeper nodes may be indicated. If difficulties persist, results may be further improved by sampling multiple lymph nodes.