Incidence 20,000 cases annually in the United States. Approximately 2,000 of which are hospitalized. Regional adenopathy often develops 5 to 50 days after the primary lesion appears. Some patients may have a mild fever with malaise as a prodrome. Diagnosis ESR commonly elevated.
Culture is difficult.
Differential Diagnosis Suppurative bacterial lymphadenitis, atypical mycobacterial infection, sporotrichosis , tularemia, toxoplasmosis, infectious mononucleosis, tumors, sarcoidosis, lymphogranuloma venereum, coccidioidomycosis. Uncommonly, patients may have prolonged morbidity with persistent high fevers, suppurative lymphadenitis, and severe systemic symptoms. Uncommonly, encephalopathy may occur. Antibiotic therapy has not been very effective in altering the course of the infection. Aspiration of a tender lymph node may relieve some pain.