The involved node may be firm and tender, with erythema of the overlying skin. Etiologic agents are group A beta-hemolytic Streptococcus species, Staphylococcus species, and viruses. Tularemia may be accompanied by regional adenopathy, most commonly cervical, with local tenderness, pain, suppuration, and fever. Generalized lymphadenopathy may also develop. Generalized lymphadenopathy in a child with tuberculosis may indicate a hematogenous spread of tubercle bacilli.
Localized involvement is most common in the mediastinal, mesenteric, or anterior cervical nodes.
The nodes are initially discrete, firm, mobile, and tender. If untreated, they become soft, fluctuant, matted, and adherent to the overlying skin, which may become erythematous. Bilateral involvement is characteristic of this condition. Pulmonary disease is common. Atypical mycobacteria can manifest cervical or submandibular involvement identical to TB, except the involvement is usually unilateral.