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Infectious Disease and Microbiology – Mesenteric Adenitis
Mesenteric adenitis is an acute inflammation of the mesenteric lymph nodes, most commonly presenting with symptoms that closely mimic acute appendicitis. It may occur as a primary condition or secondary to other diseases such as Crohn’s disease, infectious colitis, appendicitis, diverticulitis, or systemic lupus erythematosus. In many cases, it is preceded or accompanied by enterocolitis.
It is most commonly seen in children aged 5–14 years and may account for up to 8% of hospital admissions initially suspected to be appendicitis. Although many infections are subclinical or mild, outbreaks have been associated with specific food exposures, particularly undercooked pork, unpasteurized milk, and contaminated food products. Intrafamilial transmission and rare cases linked to blood transfusion have also been reported.
The condition typically results from a gastrointestinal infection, most often involving Yersinia enterocolitica. The pathogen invades Peyer’s patches in the ileum and spreads to mesenteric lymph nodes, causing inflammation. Other infectious causes include Yersinia pseudotuberculosis, Salmonella, and Mycobacterium tuberculosis. Less commonly, viral agents such as Epstein–Barr virus or adenovirus may be involved.
Patients usually present with right lower quadrant abdominal pain and fever, making differentiation from appendicitis challenging. Associated symptoms often include diarrhea and nausea, while vomiting is less common. A history of recent ingestion of high-risk foods within 1–2 weeks prior to symptom onset may provide a clue. On examination, patients may appear acutely ill with localized tenderness in the right lower abdomen. Rebound tenderness can occur but is generally less pronounced than in appendicitis. Occasionally, immune-mediated complications such as erythema nodosum or reactive arthritis may develop, especially in individuals with HLA-B27.
Laboratory findings are nonspecific and may show elevated white blood cell counts, and stool studies may reveal leukocytes in cases with diarrhea. Diagnosis is primarily supported by imaging. Abdominal ultrasound is especially useful in children, demonstrating a normal appendix along with enlarged mesenteric lymph nodes. In adults, CT scanning can confirm the presence of clustered lymph nodes near the ileocecal region while excluding appendicitis. Stool cultures for Yersinia may require special techniques such as cold enrichment, and serologic tests can assist during outbreaks.
Mesenteric adenitis is usually a self-limited condition, and treatment is primarily supportive, including hydration and symptomatic care. Antibiotics are generally not required unless there is confirmed bacterial infection with significant symptoms. In such cases, trimethoprim-sulfamethoxazole is commonly used in children, while adults may receive trimethoprim-sulfamethoxazole or ciprofloxacin. Other antibiotic options include doxycycline, ampicillin, or aminoglycosides in selected cases.
Surgical consultation may be necessary when appendicitis cannot be excluded, and laparoscopy may be performed in uncertain cases. Hospital admission is indicated for patients with severe abdominal pain, fever, rebound tenderness, hypotension, or inability to tolerate oral intake.
The prognosis is excellent, as most cases resolve without complications. However, rare complications can occur, particularly in immunocompromised individuals. These include bacteremia, septic shock, intestinal necrosis, perforation, intussusception, and metastatic infections. Post-infectious immune conditions such as reactive arthritis, uveitis, nephritis, and erythema nodosum may also develop.
Mesenteric adenitis is an acute inflammation of the mesenteric lymph nodes, most commonly presenting with symptoms that closely mimic acute appendicitis. It may occur as a primary condition or secondary to other diseases such as Crohn’s disease, infectious colitis, appendicitis, diverticulitis, or systemic lupus erythematosus. In many cases, it is preceded or accompanied by enterocolitis.
It is most commonly seen in children aged 5–14 years and may account for up to 8% of hospital admissions initially suspected to be appendicitis. Although many infections are subclinical or mild, outbreaks have been associated with specific food exposures, particularly undercooked pork, unpasteurized milk, and contaminated food products. Intrafamilial transmission and rare cases linked to blood transfusion have also been reported.
The condition typically results from a gastrointestinal infection, most often involving Yersinia enterocolitica. The pathogen invades Peyer’s patches in the ileum and spreads to mesenteric lymph nodes, causing inflammation. Other infectious causes include Yersinia pseudotuberculosis, Salmonella, and Mycobacterium tuberculosis. Less commonly, viral agents such as Epstein–Barr virus or adenovirus may be involved.
Patients usually present with right lower quadrant abdominal pain and fever, making differentiation from appendicitis challenging. Associated symptoms often include diarrhea and nausea, while vomiting is less common. A history of recent ingestion of high-risk foods within 1–2 weeks prior to symptom onset may provide a clue. On examination, patients may appear acutely ill with localized tenderness in the right lower abdomen. Rebound tenderness can occur but is generally less pronounced than in appendicitis. Occasionally, immune-mediated complications such as erythema nodosum or reactive arthritis may develop, especially in individuals with HLA-B27.
Laboratory findings are nonspecific and may show elevated white blood cell counts, and stool studies may reveal leukocytes in cases with diarrhea. Diagnosis is primarily supported by imaging. Abdominal ultrasound is especially useful in children, demonstrating a normal appendix along with enlarged mesenteric lymph nodes. In adults, CT scanning can confirm the presence of clustered lymph nodes near the ileocecal region while excluding appendicitis. Stool cultures for Yersinia may require special techniques such as cold enrichment, and serologic tests can assist during outbreaks.
Mesenteric adenitis is usually a self-limited condition, and treatment is primarily supportive, including hydration and symptomatic care. Antibiotics are generally not required unless there is confirmed bacterial infection with significant symptoms. In such cases, trimethoprim-sulfamethoxazole is commonly used in children, while adults may receive trimethoprim-sulfamethoxazole or ciprofloxacin. Other antibiotic options include doxycycline, ampicillin, or aminoglycosides in selected cases.
Surgical consultation may be necessary when appendicitis cannot be excluded, and laparoscopy may be performed in uncertain cases. Hospital admission is indicated for patients with severe abdominal pain, fever, rebound tenderness, hypotension, or inability to tolerate oral intake.
The prognosis is excellent, as most cases resolve without complications. However, rare complications can occur, particularly in immunocompromised individuals. These include bacteremia, septic shock, intestinal necrosis, perforation, intussusception, and metastatic infections. Post-infectious immune conditions such as reactive arthritis, uveitis, nephritis, and erythema nodosum may also develop.
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