Version June 2024
| Infectious agent | Clinical features |
| Common causes | |
| Nontuberculous mycobacteria | Usually occurs in children <5 years; frequent involvement of submandibular and tonsillar nodes; nontender; gradual enlargement with fluctuance, violaceous discoloration, and development of sinus tract; lack of response to antistaphylococcal and antistreptococcal antibiotics; TST may show 5 to 15 mm of induration at 48 hours; negative interferon-gamma release assay* |
| Cat scratch disease | Cat exposure; papule at site of inoculation (not always present); possible conjunctivitis; positive Bartonella henselae serology |
| Uncommon causes | |
| Toxoplasmosis¶ | Exposure to cat feces; ingestion of poorly cooked meat, soil, or contaminated food; posterior cervical involvement |
| Mycobacterium tuberculosis¶ | Birth in, travel to, or contact with a visitor from a region endemic for M. tuberculosis; TST usually with ≥15 mm induration at 48 hours; positive interferon-gamma release assay |
| Mycobacterium bovis | Ingestion of unpasteurized dairy products; exposure to cattle |
| Cervicofacial actinomycosis | Slowly progressive nontender indurated mass that evolves into multiple abscesses, fistulae, and draining sinus tracts |
| Rare causes | |
| Nocardia brasiliensis | Cutaneous lesions |
| Aspergillosis | Trauma, including burns and surgical wounds |
| Sporotrichosis | Papule at site of inoculation that usually ulcerates but may remain nodular with overlying erythema; similar lesions along lymphatic channels ("sporotrichoid spread") |
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