GLANDS IN THE NECK AND ELSEWHERE

Lymph glands, like fever, help us fight infection. 

SYMPTOMS: Tiny pea-sized glands may be seen behind or in front of the neck, and also in other parts of the body like the groin and armpits in young children. They are not painful or tender. The child is otherwise well. These glands do not increase in size but, once noticed, remain for months without causing any harm to the child. They are often secondary to a minor infection in the head, arms or legs. Your doctor will probably ask for no tests in such a case and will just reassure you. More notice is to be taken if glands are suddenly observed in different parts of the body in a younger infant, especially if he also looks pale and sickly.

Serious attention also needs to be given if there is rapid enlargement of a gland or glands, or if a ‘big pea-sized’ or a still bigger gland remains persistently enlarged.


Common Causes

• Local cause
• Systemic illness

Local Causes
A sore throat due to a viral or bacterial infection, or infection of the teeth and gums can cause enlargement of the glands in front of the neck. Infection of the scalp over the head like boils and infection secondary to scratching due to lice, dandruff or chickenpox can cause swollen glands behind the neck. Small tender glands in this region can also be seen in viral infections like German measles and big non-tender glands due to glandular fever (also called Infectious Mononucleosis).

Glands in the armpits and groin can be enlarged due to a local infection (injury, boils, cat scratch or chickenpox). A gland just above the collarbone should be taken more seriously. It could be due to an infection in the lungs and more rarely due to a tumour in the chest. Sometimes, it can follow vaccination with BCG.

Tuberculosis can also present as a glandular swelling in different parts of the body. In tuberculosis, there is a significant enlargement of the gland. The swelling often gets adhered to the overlying skin. Sometimes, more than one gland is enlarged in the same region and these glands appear to get matted (stuck) to each other.


Systemic Illness
Viral infections accompanied by a rash (German measles, glandular fever) can result in enlargement of glands in different parts of the body. 

Tuberculosis can present as a localised glandular swelling or as a more generalised disease. 


Rare Causes
Malignant disorders like leukaemia and lymphomas and infections like AIDS are to be kept in mind in any persistent glandular swelling, especially if associated with unexplained fever, severe anaemia, tenderness in the bones, and bleeding from any part of the body.

MANAGEMENT: In any persistent or significant enlargement of glands, your doctor will probably ask for a blood test, a skin test (Mantoux Test), and a chest X-ray. If required, an ultrasonography of the abdomen may be asked for. If no definite cause is found, a biopsy of the gland may have to be undertaken.

Most glands secondary to local causes or glands due to viral infections get better on their own. Sometimes, antibiotics may be required to treat the local cause. Occasionally, the gland becomes severely inflamed with redness being noticed on the overlying skin. It is painful and the child has fever. Besides antibiotics, such children may need hot fomentation and even surgery.

11 February, 2013