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Persisting swelling in lymph nodes, thick mucus post treatment. Could it be chronic infection?

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Posted on Sat, 15 Jun 2013
Question: Hello Dr.,

I wrote a few months ago about submandibular lymph node swelling. I had a bad cold/flu and after the fever etc subsided, I had continued sinusitus producing constant mucus. I noticed bilateral submandibular lymph nodes (approx 1cm) and they were hard and painless but very mobile. I visited the GP who prescribed amoxicillin and this helped remove the constant cough due to post-nasal drip. However, the swollen lymph nodes have remained and one had gotten a bit smaller (0.5cm) and the other is about the same size. I still every so often produce a thick mucus, but it doesn't affect my breathing and is not constant.

Do you think I have a chronic infection and is this the reason for the lymph nodes? Also, should I visit my doctor again and what would be the appropriate course of action? Is there any other complication which may be causing this?

Thanks.
doctor
Answered by Dr. Shruti Rijhwani (3 hours later)
Hi !
Thank you for your query.

Dear XXXXXXX

Looking into your problem i would say that most probably it seems to be due to chronic infection as it has subsided with treatment with antibiotics and responded to them but since it has been there for few months and hard also it needs to be investigated further .

The most appropriate approach will be to consult an ENT specialist and get yourself examined . An FNAC of the lymph node can be performed if they find anything to be suspicious and further biopsy can be planned as well which will lead us to correct diagnosis. Routine tests like CBC, ESR , CRP should be done to look for persisting infection.

Hope you are satisfied with the answer.

If you have any further queries feel free to ask.

Wish you good health.

Take care.
Dr. Shruti

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Shruti Rijhwani (14 hours later)
Dear Dr.,

Thank you for the response. The only further question I have is, how long after infection can the lymph nodes stay enlarged, and what size is considered worrysome?

In terms of the 'fee' of the nodes, they are firm and hard - similar to 'shotty' but one is actually just under 1cm. Also, I have been continuously poking and prodding them and I'm led to believe this can cause them to stay enlarged? Also, is it possible that they can remain permanently enlarged following an infection?

In my case, whilst the outward symptoms (cough, fever, constant musus production) have disappeared after the anti-biotics, I am still producing mucus intermittently which is quite thick and yellow/green. Would a CT scan reveal a lingering sinus infection and any other problems?

Thanks
doctor
Answered by Dr. Shruti Rijhwani (2 hours later)
Hi,

Thank you for your query.

Lymph nodes are pea-sized lumps of tissue that contain white blood cells which help to fight bacteria, viruses that causes infection.

The glands can swell to more than a few centimeters in response to infection or disease but tend to go down when you recover. There is no fixed time for it but generally within two weeks they become normal .

Infected Lymph nodes tend to be firm, tender, enlarged and warm.
Lymph nodes harboring malignant disease tend to be firm, non-tender, matted , fixed ,painless more than 1 cm in size and increase in size over time.

Sometimes, following infection lymph nodes occasionally remain permanently enlarged, though they should be non-tender, small (less the 1 cm), have a rubbery consistency and none of the characteristics described for malignancy or for infection.

Since you are still producing mucus intermittently which is quite thick and yellow/green that means that the infection is still persisting .It is a very good idea to get CT scan done to look for sinuses , their thickening or any fluid collection but that your ENT doctor will decide that an X XXXXXXX will be all that is required or some specialized tests needs to be done and continuous prodding will not lead to their enlargement until their is direct injury to lymph nodes .

If you have any further queries feel free to ask.
Wish you good health.
Take care,
Dr. Shruti
Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. Shruti Rijhwani

Rheumatologist

Practicing since :2008

Answered : 2366 Questions

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Persisting swelling in lymph nodes, thick mucus post treatment. Could it be chronic infection?

Hi !
Thank you for your query.

Dear XXXXXXX

Looking into your problem i would say that most probably it seems to be due to chronic infection as it has subsided with treatment with antibiotics and responded to them but since it has been there for few months and hard also it needs to be investigated further .

The most appropriate approach will be to consult an ENT specialist and get yourself examined . An FNAC of the lymph node can be performed if they find anything to be suspicious and further biopsy can be planned as well which will lead us to correct diagnosis. Routine tests like CBC, ESR , CRP should be done to look for persisting infection.

Hope you are satisfied with the answer.

If you have any further queries feel free to ask.

Wish you good health.

Take care.
Dr. Shruti