Lymphangitis

Lymphangitis is defined as an inflammation of the lymphatic channels that occurs as a result of infection at a site distal to the channel. Pathogenic organisms invade the lymphatic vessels and spread along these channels toward regional lymph nodes. The infected lymphatic vessel becomes inflamed. Bacteria can rapidly grow in the lymphatic system.

Pathophysiology: Pathogenic organisms enter the lymphatic channels directly through an abrasion or wound or as a complication of infection. After the organisms enter the channels, local inflammation and subsequent infection ensue, manifesting as red streaks on the skin. The inflammation or infection then extends proximally toward regional lymph nodes.

Causes:

In acute lymphangitis, bacteria enter the body through a cut, scratch, insect bite, surgical wound, or other skin injury.

Lymphangitis most often results from an acute streptococcal infection of the skin. Less frequently it results from a staphylococcal infection. The infection causes the lymph vessels to become inflamed.

Lymphangitis may be a sign that a skin infection is getting worse. It should raise concerns that bacteria may spread into the bloodstream, which can cause life-threatening problems.

Lymphangitis may be confused with a clot in a vein (thrombophlebitis). In individuals with normal host defenses, group A beta-hemolytic streptococcal (GABHS) species are the

most common causes of lymphangitis.

o GABHS elaborate fibrinolysins and hyaluronidase, which aid their invasion of lymphatic channels.

o Lymphangitis caused by GABHS can rapidly progress and has been associated with serious complications.

o Lymphangitis is more likely to occur in patients with cellulitis due to GABHS than in patients with cellulitis caused by Staphylococcus aureus.

Pasteurella multocida, associated with dog and cat bites, can cause cellulitis and lymphangitis.

In immunocompromised hosts, gram-negative rods, gram-negative bacilli, and fungi may cause cellulitis and resultant lymphangitis.

Wounds that occur in freshwater can become contaminated with Aeromonas hydrophila.

Worldwide, Wuchereria bancrofti is a major cause of acute lymphangitis. Signs and symptoms of lymphangitis caused by W bancrofti are indistinguishable from those of lymphangitis caused by bacteria.

Children with diabetes, immunodeficiency, varicella, chronic steroid use, or other systemic illnesses have increased risk of developing serious or rapidly spreading lymphangitis.

Symptoms:

Red streaks from infected area to the nearest lymph node. These streaks may be tender and warm. The affected areas are red, swollen, and painful.

The primary site may be an abscess, an infected wound, or an area of cellulitis

Blistering of the affected skin may occur.

Enlarged lymph nodes (glands) above the area of red streaks

Throbbing pain along the affected area

Fever of 100 to 104 degrees Fahrenheit (38-40 C)

Chills

General ill feeling (malaise)

Headache

Loss of appetite

Muscle aches

Differential Diagnoses:

Contact Dermatitis

CellulitisSeptic thrombophlebitisSuperficial thrombophlebitisNecrotizing fasciitisMyositisSporotrichosis

Treatment:

Lymphangitis may spread within hours. Treatment should begin promptly.

Treatment may include:

Antibiotics to treat any underlying infection Analgesics  to control pain

Anti-inflammatory medications to reduce inflammation and swelling

Warm moist compresses to reduce inflammation and pain

Surgery may be needed to drain any abscess.

Outlook (Prognosis):

Prompt treatment with antibiotics may result in complete recovery, though it may take weeks, or even months, for swelling to disappear. The amount of time until recovery occurs varies, depending on the underlying cause.

Possible Complications:

Abscess formation Bacteremia and sepsis can occur.

Without appropriate antimicrobial therapy, cellulitis may develop or extend along the channels; necrosis and ulceration may occur.

Lymphangitis caused by group A beta-hemolytic streptococcus (GABHS) can progress rapidly, leading to bacteremia, sepsis, and death.

Prognosis The prognosis for patients with uncomplicated lymphangitis is good. Antimicrobial regimens are effective in more than 90% of cases.

Chronic lymphangitis occurs rare, appears as a result of a tuberculosis or parasitical infection.

LYMPHADENITIS

Lymphadenitis is the inflammation of a lymph node.

Etiology:

Odontogenic infection: acute periodontitis, supra-infection of a cyst. Periostitis. Osteomyelitis Abscesses, phlegmons Stomatitis Inflammation of tonsils Inflammations of auditory system (year) Dermatitis, boils, carbuncles Respiratory diseases, adenoviruses

The cause of lymphadenitis is a pyogenic nonspecific infection, mainly coccal flora where the dominant role has Staphylococcus.

Rarely lymphadenitis is the primary disease, generally it develops as a result of some other pathological process. So, in many cases lymphadenitis is the symptom of other disease. Depending on the clinical picture lymphadenitis may be as an independent disease. More often occurs lymphadenitis of submandibular region and of submental region.

Classification:

By evolution:

Acute: - serous- purulent

Chronic: - hyperplastic - Purulent

By localization:

Limited Diffuse – that includes neighboring tissues to the affected lymph node (adenophlegmon)

Clinical picture:

Acute serous lymphadenitis:

Appears pain and enlargement of 1 or 2 lymph nodes. At palpation their shape is oval or round, with soft-elastic consistency. General state is almost normal, sometimes may occur fever no more than 38 C. Serous lymphadenitis may pass to purulent form. Often, if the pathological process is removed, lymph nodes decrease in size, become softer and painless.

Acute purulent lymphadenitis:

Acute purulent inflammation of the lymph nodes occurs more rare than in chronic form.

Primary symptoms are difficult to determine because tissue suppuration happens slowly and consecutively, without any substantial general changes.

As the suppuration progresses lymph node (nodes) enlarge in size, appears infiltration around them during several days, sometimes during 1-2 weeks. That causes immobility of the lymph nodes, sometimes several lymph nodes fusion together that leads to bigger suppuration and fluctuation.

Pain in the lymph nodes increases. Gradually in the place of inflamed lymph node forms an abscess. General state of the patient depends on size of the affected tissues and process acuity. Body temperature increases, but not at all patients, to 37,6 – 37,8 C.

Adenophlegmon:

Sometimes the capsule of the lymph node necroses and pus penetrates into surrounding tissues. As a result develops phlegmonous inflammation – adenophlegmon, that is accompanied by edema of neighboring tissues, but proceeds, as usual, slower than odontogenic abscesses and phlegmons.

More often adenophlegmon develops in submandibular and submental regions. Appears fever, generally not higher than 38-38,5 C. Sometimes may occur general intoxication and chills. In blood stream – moderate leukocytosis and neutrophilia, increased erythrocyte sedimentation rate 35-40

mm/h – that correspond to a sluggish purulent process.

Chronic hyperplastic lymphadenitis:

Chronic form is an outcome of acute lymphadenitis. Lymph node is enlarged, has oval or round shape, with clear accurate contours, isn’t merged to surrounding

tissues. At palpation lymph node has a dense – elastic consistence, is painless. General state of patient doesn’t suffer. In rare cases, as a result of chronic inflammation of the lymph node can appear a significant overgrowth of

granular tissue, that substitutes lymphoid tissue. Granular tissue spreads beyond the limits of lymph node and adheres to the skin thus thinned her. This area of the skin can breakout and a fistulous canal will form. Sometimes suppuration may develop, but proliferative reaction is much more expressed.

Differential diagnosis of chronic hyperplastic lymphadenitis is made with:

Odontogenic cutaneous and subcutaneous granuloma Subcutaneous form of actinomycosis Tumor metastasis

Chronic purulent lymphadenitis:

Affected lymph node becomes bigger, painful, adheres to surrounding tissues. If the process is situated closer to the skin than affected lymph node adheres to it also. The skin gets a

pronounced pink or red color and doesn’t gather in a crease. Sometimes spontaneous opening of the pus collection may lead to fistula formation.

Treatment:

First of all primary cause must be removed Acute serous lymphadenitis is treated conservatively: physiotherapy, warm compresses, infiltration of

surrounding tissues with antibiotics+anesthetics, are indicated vitamins, antihistamines. In acute purulent lymphadenitis is made incision and all necrotic tissue (rests of the lymph node) must be

removed, applied drainage. Indicate general treatment.

In case of submandibular lymphadenitis incision is made parallel to mandibular base, anteriorly to facial vein and artery, in the place of most pronounced fluctuation.