B70 Lymphadenitis acute (ICD-10:L04.9)

Introduction

Lymphadenitis acute, also known as acute lymphadenitis, is a condition characterized by the inflammation and enlargement of lymph nodes^[1]. It is commonly caused by bacterial infections, particularly Staphylococcus aureus and Streptococcus pyogenes, but can also result from viral or fungal infections^[2]. This condition typically develops as a complication of infections in nearby tissues and represents the body’s immune response to pathogens^[3].

Codes

• ICPC-2 Code: B70 Lymphadenitis acute^[4]
• ICD-10 Code: L04.9 Acute lymphadenitis, unspecified^[5]

Symptoms

• Swollen lymph nodes: Enlarged, tender, and painful lymph nodes that may feel firm or rubbery to touch^[6]
• Redness and warmth: The skin overlying affected lymph nodes appears red and feels warm due to increased blood flow and inflammation^[7]
• Fever: Low-grade to moderate fever (38-39°C) commonly accompanies acute bacterial lymphadenitis^[8]
• Fatigue and malaise: General feeling of illness, weakness, and reduced energy levels^[9]
• Pain: Significant tenderness and pain in the affected lymph nodes, which may worsen with movement or pressure^[10]
• Abscess formation: In severe cases, pus-filled abscesses may develop within the lymph nodes, requiring surgical drainage^[11]
• Regional symptoms: Depending on location, may include difficulty swallowing (cervical nodes) or restricted arm movement (axillary nodes)^[12]

Causes

• Bacterial infections: Most commonly caused by Staphylococcus aureus (49% of culture-positive cases) and Group A Streptococcus (43% of cases), with methicillin-resistant S. aureus (MRSA) accounting for only 6% in low-prevalence regions^[13]
• Viral infections: Epstein-Barr virus (EBV), cytomegalovirus (CMV), and other viral pathogens can cause lymphadenitis^[14]
• Fungal infections: Rare causes include histoplasmosis and coccidioidomycosis^[15]
• Cat scratch disease: Bartonella henselae transmitted through cat scratches or bites, with an annual incidence of 4.7/100,000 population^[16]
• Secondary infections: Skin infections, dental abscesses, or upper respiratory tract infections that spread to regional lymph nodes^[17]
• Tuberculosis: Atypical mycobacterial infections, though less common in developed countries^[18]

Diagnostic Steps

Medical History

• Comprehensive symptom assessment including onset, duration, and progression of lymph node enlargement^[19]
• Recent infections history, particularly upper respiratory tract infections, dental problems, or skin infections^[20]
• Animal exposure history, especially contact with cats, kittens, or cat scratches/bites^[21]
• Travel history and potential exposure to endemic diseases^[22]

Physical Examination

• Systematic palpation of affected lymph nodes to assess size, consistency, tenderness, and mobility^[23]
• Examination of skin overlying lymph nodes for erythema, warmth, or signs of fluctuation indicating abscess formation^[24]
• Assessment of regional areas for primary infection sources (skin lesions, dental problems, throat infection)^[25]
• General examination for fever, vital signs, and systemic signs of infection^[26]

Laboratory Tests

• Complete blood count (CBC): Elevated white blood cell count (leukocytosis) with left shift indicates bacterial infection^[27]
• Blood cultures: Essential in suspected bacteremia or systemic infection to identify causative organisms^[28]
• Fine-needle aspiration (FNA): Diagnostic accuracy of 90-92% for lymph node lesions; cost-effective at $250-750 compared to open biopsy^[29]
• Culture and sensitivity testing: From aspirated material to guide targeted antibiotic therapy^[30]

Diagnostic Imaging

• Ultrasound: First-line imaging modality to assess lymph node characteristics, internal structure, and presence of abscesses^[31]
• CT scan: Performed when abscess formation is suspected or to evaluate extent of infection and plan surgical intervention^[32]
• MRI: Rarely used but provides excellent soft tissue contrast for complex cases^[33]

Specialized Tests

• Serological testing: For suspected viral infections (EBV, CMV) or cat scratch disease (Bartonella henselae antibodies)^[34]
• PCR assays: Molecular diagnosis for Bartonella henselae and other specific pathogens^[35]
• Histopathological examination: Surgical biopsy when malignancy is suspected or diagnosis remains unclear^[36]

Follow-up and Patient Education

• Regular monitoring appointments to assess treatment response and symptom resolution^[37]
• Patient education on completing full antibiotic courses and recognizing signs of treatment failure^[38]
• Instructions for home care measures including warm compresses and pain management^[39]

Possible Interventions

Traditional Interventions

Medications:

Antibiotics (e.g., Flucloxacillin, Cephalexin, Amoxicillin-clavulanate):

• Cost: Generic versions $10-50/month^[40]
• First-line therapy: Flucloxacillin or first-generation cephalosporins for uncomplicated disease in low-MRSA settings^[13]
• Contraindications: Known penicillin or cephalosporin allergy
• Side effects: Gastrointestinal upset, diarrhea, skin rash
• Severe side effects: Clostridioides difficile infection, severe allergic reactions
• Warning: Complete full 10-14 day course; treatment duration may extend to 2-3 weeks for complete resolution^[41]

Clindamycin:

• Cost: Generic versions $15-40/month^[42]
• Used for complicated disease, MRSA infections, or penicillin-allergic patients^[43]
• Contraindications: Previous C. difficile colitis, severe hepatic impairment
• Side effects: Nausea, diarrhea, metallic taste
• Severe side effects: C. difficile-associated diarrhea, hepatotoxicity
• Warning: Monitor for antibiotic-associated colitis^[44]

NSAIDs (e.g., Ibuprofen, Naproxen):

• Cost: Generic versions $5-20/month^[45]
• Dosage: Ibuprofen 400-600mg every 6-8 hours for pain and inflammation^[46]
• Contraindications: Active peptic ulcer disease, severe renal impairment, heart failure
• Side effects: Gastrointestinal upset, headache
• Severe side effects: GI bleeding, renal impairment, cardiovascular events
• Warning: Take with food; monitor for GI complications^[47]

Acetaminophen:

• Cost: Generic versions $3-10/month^[48]
• Dosage: 500-1000mg every 6 hours, maximum 4000mg daily^[49]
• Contraindications: Severe hepatic impairment, chronic alcohol use
• Side effects: Generally well-tolerated
• Severe side effects: Hepatotoxicity with overdose
• Warning: Do not exceed maximum daily dose; avoid concurrent alcohol use^[50]

Combination therapy: Acetaminophen plus ibuprofen provides superior pain relief compared to either agent alone, with improved patient outcomes in acute pain management^[51]

Surgical Interventions:

• Incision and drainage: Required for abscessed lymph nodes; costs $4,732-10,738 depending on complexity and location^[52]
• Fine-needle aspiration: Diagnostic and potentially therapeutic procedure costing $77-250, significantly less expensive than open biopsy^[53]
• Excisional biopsy: Reserved for cases where malignancy is suspected or diagnosis remains unclear; costs $2,000-10,000^[54]

Alternative and Supportive Interventions

• Warm compresses: Apply for 10-15 minutes, 3-4 times daily to increase blood circulation and reduce swelling^[55]
• Lymphatic drainage massage: Gentle massage techniques may help reduce swelling and promote lymph flow^[56]
• Herbal remedies: Limited evidence for echinacea, goldenseal, or other immune-supporting herbs^[57]
• Probiotics: May help maintain gut health during antibiotic treatment^[58]

Lifestyle Interventions

• Rest and adequate sleep: Essential for immune system recovery and healing^[59]
• Hydration: Maintain adequate fluid intake (2-3 liters daily) to support immune function and help eliminate toxins^[60]
• Good hygiene practices: Regular handwashing, proper wound care, and dental hygiene to prevent secondary infections^[61]
• Nutritional support: Balanced diet rich in vitamins C and D, zinc, and protein to support immune function^[62]
• Stress management: Chronic stress impairs immune function; employ relaxation techniques, meditation, or counseling^[63]
• Activity modification: Avoid strenuous activities until acute symptoms resolve, but maintain gentle movement to promote circulation^[64]

Note: Cost ranges are approximate and vary significantly by geographic location, healthcare system, and insurance coverage. Patients should consult healthcare professionals for personalized treatment recommendations and accurate cost estimates^[65].

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – B70 Lymphadenitis acute (ICD-10:L04.9)

Mild	Moderate	Severe
Mode setting: 1 (Infection) Location: 0 (Localized) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 1 (Infection) Location: 0 (Localized) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 1 (Infection) Location: 0 (Localized) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Mode setting: 2 (Wound Healing) Location: 0 (Localized) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 2 (Wound Healing) Location: 0 (Localized) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 2 (Wound Healing) Location: 0 (Localized) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Mode setting: 7 (Immunotherapy) Location: 7 (Neuro system & ENT) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 7 (Immunotherapy) Location: 7 (Neuro system & ENT) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 7 (Immunotherapy) Location: 7 (Neuro system & ENT) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Mode setting: 7 (Immunotherapy) Location: 1 (Sacrum) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 7 (Immunotherapy) Location: 1 (Sacrum) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 7 (Immunotherapy) Location: 1 (Sacrum) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Total Morning: 60 minutes approx. $10 USD, Evening: 60 minutes approx. $10 USD	Total Morning: 120 minutes approx. $20 USD, Lunch: 120 minutes approx. $20 USD, Evening: 120 minutes approx. $20 USD,	Total Morning: 120 minutes approx. $20 USD, Lunch: 120 minutes approx. $20 USD, Evening: 120 minutes approx. $20 USD,
Usual treatment for 7-60 days approx. $140 USD – $1200 USD	Usual treatment for 6-8 weeks approx. $2,520 USD – $3,360 USD	Usual treatment for 3-6 months approx. $5,400 USD – $10,800 USD

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Lymphadenitis acute effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Lymphadenitis acute. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

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44. PMC. (2009). Combined acetaminophen and ibuprofen for pain relief. https://pmc.ncbi.nlm.nih.gov/articles/PMC2791549/
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47. Vinmec Healthcare. (2025). Swollen lymph nodes behind the neck and nape of the neck. https://www.vinmec.com/eng/blog/floating-lymph-nodes-on-the-back-of-the-neck-is-the-nape-of-the-neck-worrisome-en
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58. Longdom Publishing. (2023). Lymphadenitis: Etiology, Symptoms, Diagnosis, and Therapeutic Approaches. https://www.longdom.org/open-access/lymphadenitis-etiology-symptoms-diagnosis-and-therapeutic-approaches-104123.html
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60. MyHealth Alberta. (2024). Lymphadenitis: Care Instructions. https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abr6933
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64. Very Well Health. (2024). Lymphadenitis: Symptoms and Causes. https://www.verywellhealth.com/lymphadenitis-4780872
65. Howard-Jones, A.R., et al. (2023). Acute bacterial lymphadenitis in children: a retrospective analysis. European Journal of Pediatrics. https://pmc.ncbi.nlm.nih.gov/articles/PMC10175353/