viscera, urinary tract FIGURE 47.3 Child with lymphadenitis that progressed to lymph node abscess There are several rare infectious causes of cervical lymphadenopathy that may be encountered in the pediatric emergency department Tularemia, caused by infection with Francisella tularensis, occurs predominantly in the South Central United States (Arkansas, Oklahoma, Missouri, and Kansas) It occurs after contact with infected animals (rabbits, hamsters) or via tick or deerfly bites The most common presentation in children is a febrile illness with tender cervical or occipital adenopathy that may become chronic An associated papular or ulcerative lesion may be noted on the skin at the site of animal contact or insect bite Diagnosis is made by detecting serum antibodies to F tularensis, and antimicrobial therapy with doxycycline or a fluoroquinolone is appropriate for mild illness Toxoplasmosis, a parasitic infection caused by Toxoplasma gondii, is acquired via contact with oocytes in cat feces or consumption of undercooked pork or