European Journal of Molecular & Clinical Medicine

Aim:  clinicopathological profile of significant cervical lymphadenopathy in children
Material and methods: This study was retrospective and descriptive. Data has been taken from the case files of all patients seen at the Dr. D. Y. Patil Medical College and Hospital, Pune(2021-2022). The age ranged from 1 month to 12 years.The Health Research and Ethics Committee of the Dr. D. Y. Patil Medical College and Hospital, Pune approved the study and waived the requirement for informed consent.
Results: 50 patients, 72% IP and 28% OP, presenting the symptoms associated with lymphadenopathy were included in this study out of which 62% were male and 38% were female. The median age of presentation was observed to be 6.9 years. Swelling in neck as one of the symptoms was present in majority of patients (90%). Fever (70%), cough (70%), loss of appetite (40%), and sore throat (36%) were the other major symptoms shown by the patients. More than one symptom was shown be 68% of the patients. Majority of cases had lymph node of size 1-2 cm (76%), firm consistency (84%) and mobile (66%). The mot common site of inflammation was anterior cervical (48%) followed by posterior cervical (34%). Tenderness of lymph node was absent in 79% of the cases. Associated findings included tonsillitis (24%), ear infection (16%), hepato/spleenomegaly (16), orodental infection (6%), skin lesion and rash (4% each). Blood counts evaluation showed neutrophilia in majority of cases (56%), followed by leucocytosis (52%), anaemia (32%), lymphocytosis (24%) and eosinophilia (8%). ESR was normal in 64% of the cases.  Throat culture resulted in 50% of cases showing normal commensals while as streptococcus and staphylococcus was found in 33% and 16% of cases respectively. Cytological examination revealed reactive lymphadenitis in 46% cases, tubercular lymphadenitis in 32% cases and Suppurative lymphadenitis in 12% cases. However, 4% cases yielded inadequate aspirate. Mantoux test was negative in 66% of the cases. A total of 23 patients were sent for X-ray, out of which 12 (24%) showed normal X-ray findings.
Conclusion: The above results present the repertoire of evaluations with respect to the detection of lymphadenopathy in children. This study also emphasises the importance of considering various strategies in proper and early detection to ensure timely management of lymphadenopathy.

Aim: To study the clinicopathological picture among children aged 1-18 years in relation to paediatrics Cervical Lymphadenopathy
Materialand methods: The research was carried out at the Department of Pediatrics. Blood tests for haemoglobin level, total and differential count, and erythrocyte sedimentation rate were performed on all patients in the study group. The Mantoux test was performed on all patients as part of their usual workup. Fine needle aspiration cytolology (FNAC) was performed on all patients in the study group after a swab was collected from the most prominent node in patients with the source of infection for culture and sensitivity.
Results: Significant cervical lymphadenopathy is widespread in the 6- to 12-year-old age group (45%), followed by the 12 to 18-year-old age group (33%). In 91 children (91%), the presenting symptom was neck edoema. In 90% and 52% of the youngsters, fever and cough were the presenting symptoms. 31% of children had a history of failure to acquire weight and decrease of appetite. 19% of the youngsters had a history of sore throat. Swelling was painless in the vast majority of instances (93%) and painful in 7%. More than one presenting symptom was found in 70 (70%) of the youngsters. Ear drainage and orodental discomfort were both present in 8% of the youngsters. Six youngsters had a history of interaction with a TB patient. The anterior cervical lymph nodes are the most usually impacted group of lymph nodes (44%), followed by the posterior cervical (33%).
Conclusion: Non-diagnostic hyperplasia owing to reactive lymphadenitis is the most prevalent cause of severe cervical lymphadenopathy in children. Following suitable examinations, the most frequent cause detected is infection. The most prevalent cause of lymphadenopathy in children is reactive lymphadenitis, followed by TB.

INTRODUCTION: Scrub typhus is  grossly under-diagnosed  or lately diagnosed in India because of its  non-specific clinical presentation, a limited awareness about the disease, a low index of suspicion among clinicians, and a lack of diagnostic facilities. Absence of typical features may create diagnostic dilema among physicians thereby  delaying the  diagnosis  which may lead to  complications & high mortality .
Material and method: A hospital based Cross sectional  study  which  was  conducted in the Department of Paediatrics, PRM Medical College, Baripada, Odisha from July  2021 to December 2021. Children from 1 month  to 14 years of age presenting with fever in whom rickettsia infection is suspected included. All children who are found to be Elisa or IgM positive for scrub typhus even if admitted for other disease included. All fever cases with rash /oedema/ pallor/icterus/lymphadenopathy/hepatosplenomegaly and or any other systemic features with or without eschar was included.
Results: The laboratory parameters of the cases are shown in Table 4. The total leukocyte count was elevated in 30.6% of the cases. An elevated serum creatinine level or a change in the serum creatinine level greater than 0.3 mg/dl, which is a diagnostic of AKI, was observed in 20% of cases. Hyponatremia was found in 6.9% of the cases. The serum CPK level (total and MB fraction) was elevated in 8.9% of cases.
Conclusion: Pediatric scrub typhus is a common infection and should be suspected in cases with fever for more than 5 days and non-specific signs and symptoms. Early detection and timely management lead to a higher recovery rate. Hypotension, hypoxia, azotemia, altered sensorium, and bleeding manifestations on admission were associated with unfavorable outcomes.

Objective
Fine Needle Aspiration Cytology (FNAC) is first line of investigation in diagnosing a variety of superficial and deep lesions. It is a easy, quick, cost effective,well tolerated  and reliable technique done  as a  outpatient department  procedure. Lymphadenopathy is clinically important in a myriad of conditions ranging from simple reactive lymphadenitis to neoplastic etiology. In this study, we explain the  utility of FNAC in  lymph node lesions ranging from infectious etiology to malignant lesions and we highlight Tuberculous Lymphadenitis.
Methods: This was a retrospective study and includes a total of  256patients of  all age groups and both sexes presenting with palpable lymphnodes at FNAC clinic of our institute over a period of 3 years .FNAC was conducted with 22-24 Gauge disposable needles attached to  5/10c.c syringes. Smears were fixed in 95% ethyl alcohol and stained with Hematoxylin and Eosin stain. Leishman stain was done on air dried smears. Ziehl- Neelsen (ZN) staining was done wherever required.
Results: Out of a total of 256 patients with   lymphadenopathy subjected to FNAC the commonest site was cervical lymphnodes(57.03%) .Females(54.68%)
 outnumbered males(45.31%) in our study .The commonest lesion  was found to be Granulomatous lymphadenitis(51.95%,followed by reactive
lymphadenitis(23.82%),non suppurative lymphadenitis(10.1%),acute suppurative lymphadenitis(6.25%),Metastatic deposit(5.07%),chronic suppurative lymphadenitis(1.95%) and HodgkinsLympoma(0.78%).
Conclusion: FNAC is a easy to perform,reliable in expensive method in diagnosing lymphadenopathy.In our study the predominant cause of lymphadenopathy was Tuberculous lymphadenitis,followed by reactive lymphadenitis.

Fine needle aspiration cytology (FNAC) is a simple, safe, reliable rapid and
inexpensive method of establishing the diagnosis in lymph node lesions. The value of FNAC, besides making a
diagnosis lies in early detection, direction of appropriate investigations and treatment options. The present study is
undertaken to study the usefulness of FNAC in diagnosing various lymph node lesions in patients presenting with
lymphadenopathy. Also to determine the pattern of diseases affecting lymph nodes and to study the spectrum of
lesions with respect to age, sex and site of occurrence. To study the distribution of Acid fast bacilli in tuberculous
lymphadenitis using Ziehl Neelsen stain.

Background: Tuberculosis is among the most common opportunistic infections in people living with HIV/AIDS and is also the most common cause of peripheral lymphadenopathy. These lymph nodes revealed four different patterns on FNAC, which indirectly reflected the immune status in these people. CD4 counts, being a primary marker for immunological status in HIV people, were used to initiate ART, monitoring disease progression and management. The present study was aimed to correlate these four cytomorphological patterns with CD4 counts.
Results: In the present study we observed that CD4 counts varied significantly with different cytological patterns. Pattern 1, having a lower CD4 counts, reflects a poor immune response, whilst pattern 4, having higher CD4 counts reflected a better immune response.
Conclusion: FNAC patterns can be used to predict the CD4 counts where flow cytometry facilities for CD4 count estimation may not be available.

Introduction: Enlargement of lymph node may result from the proliferation of lymphocytes intrinsic to lymph nodes, due to an infection or a lymphoproliferative disorder or from the migration and infiltration of nodal tissue by either intrinsic inflammatory cells or metastatic malignant cells. The aim of the present study was to investigate the Accuracy and role of FNAC in diagnosis of etiological profiles of lymphadenopathy and its comparison to histo-pathology examination.
Materials and Methods: Lymph node biopsies were received in 72 patients and the biopsy specimens were subjected to FNAC examination after fixing in 10% formalin. Histopathological examination was done and the results were correlated with the cytological reports to evaluate efficacy of the procedure. They were subjected to FNAC and only those thyroid swelling cases admitted to indoor and subsequently underwent surgery were included in this study. After HP study they were compared with preoperative FNAC report.
Result: During histo-pathological examination commonest cause of lymphadenopathy wastubercular lymphnoditis(29.1%) and metastatic carcinoma (27.7%). Reactive hyperplasia was (20.8%) at second place. Lymphomas constituted 18.0%. Granulomatous inflammatory lesion accounted for 4.16% of lymphnodeenlargement. Out of 72 cases, cytological diagnosis was matched with histopathological diagnosis in 66 cases.
Conclusion: Commonest cases of lymphadenopathy in children was reactive hyperplasia; in adult’s tubercular lymphadentis and lymphoma; while metastasis in older age. The commonest cause of metastasis in lymph node was squamous cell carcinoma. We have found FNAC a satisfactory tool in the diagnosis of tubercular and malignant lymphadenopathy.

Background: Rickettsial infections are the most covert re-emerging infections in present
times. They are incapacitating and notoriously difficult to diagnose, Weil-Felix (WF) test is
classic serological test which is widely available but not widely acceptable because of its low
sensitivity and specificity. Present study was aimed to study of usefulness of Weil-Felix test
as a simple diagnostic tool for diagnosis of rickettsial fever.
Material and Methods: Present study was single-center, prospective, observational study,
conducted in children < 18 years age, hospitalized with fever and presence of one or more of
the following clinical features: Rash, edema, eschar, hepatosplenomegaly, lymphadenopathy
OR had history of contact with pets or live stocks and history of tick-bite.
Results: In the present study maximum number of cases were from school going age group
(53.5%), male (67.4%), from Rural Areas (88.4%) & Tick bite could be demonstrated in
44.2% cases. Based on clinical features Lymphadenopathy was seen mainly 86.00%,
followed by maculopapular rash (76.7%), rash appearing 48-96 hrs. after fever (72.10%),
conjunctival congestion (55.80%), hepatomegaly (48.80%), rash on palms & soles, pedal
edema (34.9%) & purpura (14%). Out of 43 suspected cases, Weil-Felix test was positive in
31 cases (72.1%) and Negative in 12 cases (27.90%).
Conclusion: Rickettsial disease must be strongly suspected with a triad of fever, rash and
lymphadenopathy or having history of tick exposure/ bite and when the cause of fever cannot
be established. Weil Felix test can be carried out for early detection of suspicious casein
resource limited set up.

Introduction: Lymphadenopathy is a common clinical problem, usually benign, but malignancy may be associated. To confirm the diagnosis often required a biopsy of lymph nodes. Methods: All patients with cervical lymphadenopathy, more than 4 weeks and size more than 1cm were included in the study and a biopsy were done and sent for histopathological study. Results: Out of total 220 patients, 54.5% (n=120) were males & 45.5% (n=100) were females. The mean age was 38.9±1.02 years & the maximum number of patients were adults (50%). The most common cause of cervical lymphadenopathy was reactive hyperplasia (51.8%) followed by granulomatous infection (17.3%). however, in older adults, carcinoma was also a common cause of cervical lymphadenopathy (40%). Conclusion: The most common histopathological diagnosis of cervical lymph node biopsies in central India were reactive disease and granulomatous infections.

LYMPHADENOPATHY (LAP) or ADENOPATHY is a any disease of the lymphnodes which is abnormal in size, number and consistency. Lymphadenopathy is a most common condition in any form of disease which is noticed by a physician .But it is not a peculiar symptom of any disease. An inflammatory type of lymphadenopathy is called as LYMPHADINITIS. In this review Article we can see the classification of lymphadenopathy pathogens, clinical approach and clinical evaluation of lymphadenopathy and differential diagnosis. Depending upon the size and extent of lymphadenopathy we can evaluate the condition of the patient and give appropriate treatment.