Infectious causes of acute unilateral cervical lymphadenitis in children

Infectious agent	Clinical features
Common causes
Staphylococcus aureus	Usually occurs in children <5 years; may have history of recent skin infection, upper respiratory infection, or facial trauma
Group A Streptococcus	Usually occurs in children <5 years; may have history of recent skin infection, upper respiratory infection, or facial trauma
Anaerobic bacteria (eg, actinomycosis; Spirillum minor)	Poor dental hygiene; periodontal disease
Uncommon causes
Group B Streptococcus	Occurs in infants <3 months corrected gestational age; fever; irritability; poor feeding
Tularemia*	Contact with infected animal (eg, rabbit, pet hamsters) or bite of blood-sucking arthropod; may be papular lesion in the drainage field of the involved node
Alpha Streptococcus	Oral lesions
Pasteurella multocida	Cat or dog exposure (bite, lick, scratch)
Yersinia pestis^¶ (bubonic plague)	Intensely inflamed lymph node (red, swollen, tender) without fluctuance; possible, eschar, pustule, or necrotic lesion at site of flea bite
Gram-negative bacilli	History of ear, nose, and throat infections; may indicate need to test for underlying immunodeficiency (eg, Serratia spp)
Rare causes
Yersinia enterocolitica*	Suppurative lymphadenitis; fever; diarrhea
Anthrax	Contact with infected animals or animal products; cuts or abrasions; begins as painless, often pruritic papule that rapidly enlarges and develops a central vesicle or bulla, followed by a painless ulcer

* Infection can persist and become more chronic in appearance.
¶ Often associated with generalized lymphadenopathy.

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