الفهرس 
INTRODUCTION
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Cervical lymphadenopathy is a common disorder in children due to a wide spectrum of disorders. On the basis of a complete history and physical examination, pediatricians have to select, among the vast majority of children with a benign self-limiting condition, those at risk for other more complex diseases requiring laboratory tests, imaging and, finally, tissue sampling. At the same time, they should avoid expensive and invasive examinations when unnecessary.
The present study aimed to evaluate the diagnosis of cervical lymphadenopathy among children attending Assiut University Children Hospital during the period from 1st of April 2017 to 30th of March 2018 according to Modified Guidelines of Chiappini; et al., 2015 for diagnosis of cervical lymphadenopathy in children.
The study included 70 patients with cervical lymphadenopathy, their ages range from 6 months to 16 years, 47 cases were males while 23 cases were females.
Data of the study showed that:
Data regarding the history:
- Data of the age, sex and admission unit were recorded in 100% of cases.
- Data of history: cervical LN s swelling onset in 93%, course in 86%, duration in 78.5%, pain in74.3% of cases, fever in 71%, sore throat in 70%, cough in 69%, night sweating in 64%, recurrent infection in 59%, skin rash in 57% of cases, weight loss in 53%,bleeding tendency in 35.7%,and exposure to animals in 28.5% of cases.
Data regarding general and systemic examination:
- Temperature was recorded in 100% of cases, examination of the mouth in 89%, searching for pallor in71%, jaundice in 74%, BCG scar in 43%, skin examination in 50%, and ear examination in 36% of cases.
- Abdominal inspection was done in 74% of cases, palpation of liver and spleen in 72% of cases.
- Chest examination was recorded in 80% of cases.
Data regarding examination of lymph nodes:
- Cervical LNs examination was recorded in 100% of cases, Supraclavicular LNs in 70% of cases, Axillary in 62% of cases, Inguinal in 60% of cases and Epitrochlear in 50% of cases.
Data regarding cervical LNs examination:
- LNs size was recorded in 71.4% of cases, site in 64.3%, tenderness in 57.4%, laterality in 78.6%, mobility in 45.7%, and overlying skin in 37.2% of cases.
Data regarding antibiotic trial among patients:
- 88.5% of the patients were given antibiotics while 11.5% were not given.
- Only 68.5% of them were indicated while 31.5% were not indicated.
- All the indicated cases were given the appropriate antibiotics types
- 83% of indicated cases were given the appropriate dose
- 94% of indicated cases were given the antibiotic for the appropriate duration.
Data regarding follow up of the patients:
- 86% of the patients were advised for follow up while 14% of the patients were not advised.
Data regarding investigations:
- CBC,ESR,CRP were indicated in 40 cases but were done in only 75% (30 cases) of the indicated cases,
- LDH was indicated in 30 cases but was done in only 66.7% (20 cases) of the indicated cases,
- Liver function tests was indicated in 15 cases but were done in only 80% (12 cases)of the indicated cases,
- Blood culture was indicated in 25 cases but was done in only 40% (10 cases) of indicated cases,
- Serology was indicated in 10 cases but was done in only 80% (8 cases) of indicated cases,
- TORCH was indicated in 12 cases but was done in only 83% (10 cases) of indicated cases,
- ANA, anti-ds DNA were indicated in 16 cases but were done in only 87.55% (14 cases) of indicated cases,
- Tuberculein skin test was indicated in 15 cases but was done in only 66.7% (10 cases) of indicated cases,
- IGRAs were indicated in 10 cases but were done in only 30% (3 cases) of indicated cases,
- CD markers and immunoglobulin assay were indicated in 3 cases but were done in only 66.7% (2 cases) of indicated cases,
- BM Examination was indicated in 5 cases but were done in only 80% (4 cases)of indicated cases,
- Chest X ray was indicated in 20 cases but was done in only 85%(17 cases) of indicated cases,
- Neck Ultrasound was indicated in 35 cases but was done in only 57%(20 cases) of indicated cases,
- Abdominal Ultrasound was indicated in 20 cases but was done in only 80% (16 cases) of indicated cases,
- CT scan and MRI abdomen was indicated in 8 cases but were done in 62.5 %( 5 cases) of indicated cases.
Data regarding Lymph node biopsy:
- 10 cases (14% of cases) were indicated to do LNs biopsy, however it was done in 15 cases (21.4% of cases).
- Although 3 cases only were indicated to do FNACs, it was done in 7 cases.
- 7 cases were indicated to do Excisional biopsy but it was done in 8 cases.
Data regarding diagnosis of the patients:
- 45 cases (64.3% of the patients) were of infectious etiology,
- 10 cases (14.3% of the patients) were of non-infectious etiology,
6 cases (8.6% of the patients ) due to immunological causes
3 cases were diagnosed SLE and 1 case was diagnosed JIA
1 case was diagnosed Common Variable immunodeficiency and 1 case was diagnosed Hyper Ig M syndrome
4 cases (5.7% of the patients ) due to malignancy
2 cases were diagnosed leukemia
2 cases were diagnosed lymphoma
- 15 cases (21.4% of the patients) were undiagnosed.
Data regarding prognosis of the patients:
- 40 cases (out of 48 cases) improved with antibiotics (83%)
- 6cases (out of 8 cases) improved without antibiotics (75%)