Histologic findings in the lymph nodes show focal accumulations of neutrophils in necrotic foci in the early stages. Lymphocytic hyperplasia and plasma cell infiltration follow. The classical lesion of this disease is the stellate abscess and can be identified in lymph node biopsies in secondary and occasionally tertiary stage disease. Continue treatment for 3 weeks, combined with aspiration of the lymph nodes if needed. Incision and drainage may lead to nonhealing fistula formation, which can be minimized by draining involved lymph nodes from above the inguinal ligament.
Surgery is often necessary for repair of late complications such as fistulas and strictures.
A surgery consult may be necessary for late complications or aspiration of fluctuant nodes. The goal of pharmacotherapy is to reduce morbidity and prevent complications. Antibiotics - Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. In children, consider age, weight, and the severity of the infection to determine the proper dosage. When bid dosing is desired, one half total daily dose may be taken q12h.