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Column originally published May 25, 2010

Infected Lymph Nodes Require Antibiotics And May Be Surgery

Question: Our one-year-old son got quite sick recently. He became irritable and didnʼt want to eat for one week. We then found a lump in his neck which was very tender. A couple of days later, he developed a fever. We took him to emergency room and we were told that he had an infection of the lymph gland. He was admitted to the hospital and was given intravenous antibiotics. His fever did come down, but the gland got larger and larger. Finally a surgeon was consulted, and she told us that our son needed surgery to drain the pus. After surgery, he got better very quickly and he is now happy and back to himself. However, I am still not sure how he got the infection, and whether I should have taken him to the doctor earlier.


It looks like your son had a pretty bad infection of a lymph gland in his neck which turned into an abscess that required surgical drainage. Although this is not very common, it is something that we do see from time to time. Let me explain to you what likely had happened.

Our body has a very complex and effective immune system that protects us from germs. There are many types of cells and many chemicals involved. Some are specialized cells called neutrophils that can literally gobble up bacteria and kill them. These neutrophils patrol all over the body and accumulate in great numbers when there is an infection.

There are other cells called lymphocytes that recognize bacteria and viruses and produce antibodies which can neutralize and kill them. Many lymphocytes are located in lymph glands around the body.

There are many lymph glands in the back of our nose and throat. Most of them are very small, the larger ones are called tonsils and adenoids. These lymph glands are connected to the ones in the neck. You may wonder why we have so many lymph glands in this part of our body. This is the place where many of the germs get into our body: food gets into our mouth and air passes through our nose into the lungs. By placing lots of lymph glands filled with lymphocytes in this strategic position, our body can capture the germs as soon as they enter, and try to localize the infection and prevent them from spreading to the rest of the body.

In addition to the germs that can infect us, there are lots of normal germs that we encounter every day. These normal germs are harmless and they actually help to keep our immune system strong and healthy. That is the reason why we should not over-sanitize our environment. Using chemicals like Lysol to kills all the germs in our environment can make us sick instead of keeping us healthy.

From time to time, we all get infected by viruses and bacteria that land in our nose and throat. If we have a healthy immune system, most virus infections are mild and last a few days only. Once the lymphocytes recognize them, they can produce antibodies that get rid of these viruses.

When bacteria infect the throat, they can spread to local lymph glands and then to the glands in the neck. Very quickly, neutrophils pour into these lymph glands to try to contain and kill these bacteria. If the infection is mild, he will overcome the infection and the lymph gland will get a little bigger, and you may never even realize an infection has occurred.

However, a more severe infection can lead to a greatly enlarged lymph gland which is also tender. The neutrophils that go to the infected lymph gland release a chemical that causes the fever. Most of the time, antibiotics given by mouth or through an intravenous line, are enough to kill the bacteria. Once in a while, when there is a severe infection, or when treatment was started late, an abscess can develop which needs to be drained by surgery.

Although you donʼt want to see your son being sick, it is not possible to completely prevent this from happening. Most of the throat infections are caused by viruses, and your doctor should not prescribe antibiotics anyway. Because lymph glands in the neck act as filters for germs, it is not uncommon for them to be a little enlarged. They can be as big as half to one centimeter in size, and usually not painful. If you find some of them, make sure you mention that to your doctor when your son gets his next regular checkup, but donʼt make an urgent visit. However, if you find an enlarged and tender lymph gland, you should see your doctor right away.

I hope this information helps you to understand what likely has happened to your son. You have done the best that you can, under the circumstance. Even if you had gone to your doctor one or two days earlier, it might not have prevented him from the surgical drainage.