{
 "topic": "Cervicitis",
 "slug": "cervicitis",
 "category_id": 14956,
 "passage_count": 14,
 "source_chars": 11429,
 "enough_material": true,
 "references": [
  {
   "title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition",
   "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.",
   "pages": [
    916,
    1299
   ]
  },
  {
   "title": "Netters Pediatrics (Florin \u0422., Ludwig St.)",
   "author": null,
   "pages": [
    149,
    561
   ]
  },
  {
   "title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "author": null,
   "pages": []
  },
  {
   "title": "Pediatric Board Study Guide",
   "author": null,
   "pages": [
    313
   ]
  },
  {
   "title": "Caring for the Hospitalized Child",
   "author": "Section on Hospital Medicine, American Academy of Pediatrics;Jeffrey C. Gershel;Daniel A. Rauch;",
   "pages": [
    178
   ]
  },
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    1256
   ]
  },
  {
   "title": "Diagnostic Imaging: Pediatrics",
   "author": "A. Carlson Merrow Jr. MD",
   "pages": [
    484
   ]
  },
  {
   "title": "Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, Eighth Edition",
   "author": "Tricia Lacy Gomella, Fabien G. Eyal and Fayez Bany-Mohammed",
   "pages": [
    1223
   ]
  }
 ],
 "passages": [
  {
   "source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 1299",
   "text": "Cervicitis in a postpubertal female, alone or in association with urethritis and involvement of Skene and Bartholin glands, may be due to infection caused by _Candida_ , herpes simplex, _Trichomonas_ , or discharge resulting from inflammation caused by foreign bodies (usually some form of contraceptive device). Leukorrhea may be associated with birth control pills. Salpingitis may be due to infection with other organisms. The symptoms must be differentiated from those of appendicitis, urinary tract infection, ectopic pregnancy, endometriosis, or ovarian cysts or torsion."
  },
  {
   "source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 561",
   "text": "McClung HJ: Prolonged fever of unknown origin in children, _Am J Dis Child_ 124:544-550, 1972. Pizzo PA, Lovejoy FH, Smith DH: Prolonged fever in children: review of 100 cases, _Pediatrics_ 55:468-473, 1975. **Infections of the Head and Neck** **87** Jessica L. Hills 538 SECTION XV \u2022 Infectious Disease ## CERVICAL LYMPHADENITIS Cervical lymph node enlargement is a common problem in children and adolescents. Almost all children have small palpable cervical lymph nodes. Cervical lymphadenopathy is defined by lymph nodes measuring more than 1 cm in diameter. Lymphadenitis refers specifically to inflammation of lymph nodes and is characterized by enlarged and tender nodes with warmth or erythema of the overlying skin. ## **ETIOLOGY AND PATHOGENESIS**"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Current Evidence Cervicitis, or inflammation of the cervix, can be acute or chronic in nature. The etiology of acute cervicitis is most often an infectious etiology (including Neisseria gonorrhoeae and Chlamydia trachomatis and potentially Mycoplasma genitalium ). Many of the cases of acute cervicitis will not have a specific infectious etiology identified. Other etiologies of acute cervicitis include mechanical irritation (e.g., tampon, IUD, sexual intercourse) and chemical irritation (e.g., contraceptive cream, douche). Chronic cervicitis is more often due to a noninfectious etiology. If untreated, infections can ascend the genitourinary tract and cause PID which may lead to infertility, chronic pelvic pain, and increased risk of ectopic pregnancy. In addition, cervical infections can be transmitted to sexual partners and increases the risk of acquiring HIV infections if exposed. Clinical Considerations Clinical Recognition"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "CERVICITIS Goals of Treatment To identify the causative agent and treat with antibiotics or removal of offending agent as appropriate, patients should also be screened for other sexually transmitted infections, evaluated for pelvic inflammatory disease (PID), and counseled on safe sexual practices. CLINICAL PEARLS AND PITFALLS The most common etiology of acute cervicitis is infectious. Cervicitis may be diagnosed incidentally in asymptomatic women. Sexually active women with cervicitis should be treated empirically for gonorrhea and chlamydia while test results are pending. Current Evidence"
  },
  {
   "source": "Pediatric Board Study Guide, p. 313",
   "text": "- If the chest radiograph is positive, the HCW needs to be evaluated further ## **Follow-up** - Children who have TB disease should be seen monthly while receiving therapy to document medication tolerance and adherence, weight gain, and achievement of appropriate milestones - Exceptions: Treating children who have TB meningitis, where treatment courses of 7\u201312 months often are used M. B. Laurens 306 ## **Mycobacterium Avium-Intracellulare** ## **Background** - Mycobacterium avium-intracellulare complex is the most common cause of nontuberculous disease in children - Caused by two types of bacteria: _Mycobacterium avium_ and _Mycobacterium intracellulare_ - Usually occurs in children with impaired cell immunity, including very young children <5 years old - Organisms are ubiquitous in soil ## **Clinical presentation** - Cervical lymphadenitis - Overlying skin is usually pink to violaceous - Usually unilateral - Increase in size over several weeks - Cutaneous infections"
  },
  {
   "source": "Caring for the Hospitalized Child, p. 178",
   "text": "Cervical lymphadenopathy is a common and generally benign finding among many preschool- and school-aged children. Most often, it is a reactive adenopathy secondary to a viral or bacterial illness. Adenitis is an infection of the node itself, most commonly _Staphylococcus aureus_ or group A _Streptococcus_ , although viral, anaerobic, nontuberculous mycobacteria and _Mycobacterium tuberculosis_ can also result in cervical adenitis. Cervical adenopathy can also be secondary to a systemic disease (especially Epstein-Barr virus [EBV], cytomegalovirus [CMV], autoimmune diseases, and malignancies). Congenital anomalies may be present at birth or may not become apparent until a rapid phase of growth or infection occurs. Thyroglossal duct cysts and branchial cleft sinuses and fistulas typically become apparent during infancy and early childhood, whereas branchial cleft cysts appear later in adolescence or early adulthood. Lymphoma and thyroid carcinomas most often occur in older children and adolescents."
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Clinical Considerations Clinical Recognition Patients with cervicitis may be asymptomatic. Symptomatic patients with cervicitis present with variable and nonspecific symptoms including purulent vaginal discharge, intermenstrual bleeding, postcoital bleeding, and dyspareunia. Less frequently, patients will present with urinary symptoms such as dysuria and urinary frequency due to a concomitant urethritis. Patients with isolated cervicitis are unlikely to have fever or significant pain. The presence of these should signal other conditions such as PID or a herpes simplex virus infection (HSV). Clinical Assessment"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 1256",
   "text": "The inflammatory process in cervicitis involves the deeper structures in the mucous membrane of the cervix uteri. Vaginal discharge can be a manifestation, but cervicitis is frequently asymptomatic. Patients also present with complaints of irregular or postcoital bleeding. Two major diagnostic signs characterize cervicitis: (1) a purulent or mucopurulent endocervical exudate visible in the endocervical canal or on an endocervical swab specimen (e.g., swab sign; Fig. 163.5), called **mucopurulent cervicitis** or cervicitis, and (2) sustained endocervical bleeding easily induced by gentle passage of a cotton swab through the cervical os, signifying friability. Cervical changes associated with cervicitis must be distinguished from cervical ectopy in the younger adolescent to avoid the overdiagnosis of inflammation (Fig. 163.6 and see Fig. 163.3). The pathogens identified most frequently with cervicitis are _C. trachomatis_ and _N. gonorrhoeae,_ although no pathogen is identified in most cases. HSV is a less"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "M. tuberculosis is a rare cause of cervical lymphadenitis in children in the United States, but remains a significant pathogen in other parts of the world. Children with tuberculosis may be of any age. Cervical node enlargement occurs with lymphatic extension from the paratracheal nodes to the cervical and submandibular regions. In addition, supraclavicular node enlargement can be seen as the result of drainage from the apical lung pleura and upper lung fields. The most common presentation is an isolated enlarged node that is nontender; though with progression, the node will become fixed and matted, adhering to overlying skin. In children with suspected tuberculous lymphadenitis, it is important to elicit any history of family members or close contacts with a diagnosis of tuberculosis, symptoms of active disease, or risk factors for acquisition (travel, homelessness, incarceration, human immunodeficiency virus [HIV] infection). Diagnosis is made by a combination of skin testing, chest radiograph, and if"
  },
  {
   "source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 916",
   "text": "- \u00bb Characterized as either complete (total loss of function) or incomplete (some preservation of function below the level of lesion). Epidemiologic studies of SCI suggest that there will be about 10,000 new injuries per year and that 20% will be in those younger than age 20 years. Motor vehicle accidents are the leading cause of SCI in all ages. Falls are common causes in young children. The phenomenon of SCI without obvious radiologic abnormality (SCIWORA) can be present in 20%\u201340% of young children. Children from birth to 2 years tend to have high-level injuries to the cervical spine because of anatomical features of their spine. The facets tend **884** **CHAPTER 28** to be shallower and oriented horizontally, and the boney spine is more flexible than the spinal cord. In addition, the head is disproportionately large and the neck muscles are weak. ## \u00bb **Clinical Findings** ## **A. Classification and Assessment of Injury Severity**"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Leonard JC, Jaffe DM, Olsen CS, et al. Age-related differences in factors associated with cervical spine injuries in children. Acad Emerg Med 2015;22(4):441\u2013446. Leonard JC, Kuppermann N, Olsen C, et al. Factors associated with cervical spine injury in children after blunt trauma. Ann Emerg Med 2011;58(2):145\u2013155. Leonard JR, Jaffe DM, Kuppermann N, et al. Cervical spine injury patterns in children. Pediatrics 2014;133(5):e1179\u2013e1188. Nigrovic LE, Kuppermann N, Macias CG, et al. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis. JAMA 2007;297(1):52\u201360. Nigrovic LE, Kuppermann N, Malley R, et al. Children with bacterial meningitis presenting to the emergency department during the pneumococcal conjugate vaccine era. Acad Emerg Med 2008;15(6):522\u2013528. Sans N, Faruch M, Lap\u00e8gue F, et al. Infections of the spinal column\u2014spondylodiscitis. Diagn Interv Imaging 2012;93(6):520\u2013529. CHAPTER 50 \u25a0 ODOR: UNUSUAL"
  },
  {
   "source": "Diagnostic Imaging: Pediatrics, p. 484",
   "text": "|Common Causes of Cirrhosis in Children|Common Causes of Cirrhosis in Children| |---|---| |**Disease**|**Key Facts**| |**Biliary Obstruction**|| |Biliary atresia|Presents in 1st weeks of life; early diagnosis essential; differentiated from<br>neonatal hepatitis by biopsy \u00b1 HIDA scan; ultrasound can be suggestive| |Choledochal cyst|Types classified via Todani classification system| |**Intrahepatic Cholestasis**|| |Alagille syndrome|Bile ducts malformed & reduced in number; associated with tetralogy of<br>Fallot, vertebral anomalies, & abnormal facies| |Progressive familial intrahepatic cholestasis|Autosomal recessive disorder of intrahepatic cholestasis; presents in<br>neonatal period| |**Genetic**|| |\u03b1-1 antitrypsin deficiency|Liver disease occurs in 10-15%; onset of lung disease usually between 20-<br>50 years of age| |Cystic fibrosis|Liver disease occurs in 25%; caused by plugging of bile ducts| |Wilson disease|Caused by defect in copper transport; copper accumulates in liver, brain,<br>& eyes|"
  },
  {
   "source": "Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, Eighth Edition, p. 1223",
   "text": "- **V. Clinical presentation.** CS is a multiorgan infection that may cause neurologic or skeletal disabilities or death in the fetus or newborn. However, when mothers with syphilis are treated early in pregnancy, the disease is almost entirely preventable. The risk of fetal infection increases with advancing gestation. Approximately two-thirds of liveborn neonates with CS are asymptomatic at birth but have low birthweight. Clinical manifestations after birth are arbitrarily divided into **early CS** (<2 years of age) and **late CS** (>2 years of age)."
  },
  {
   "source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 149",
   "text": "## _Differential Diagnosis_ When a child presents with recurrent infections, one must keep in mind that there are other causes that should be considered. The differential diagnosis includes cystic fibrosis; ciliary dyskinesia; and secondary immune defects from treatment of malignancies or underlying infections, such as HIV or cytomegalovirus (CMV). ## **EVALUATION AND MANAGEMENT** ## _Laboratory Studies_"
  }
 ]
}