Saturday, December 03, 2005
Lymphadenitis
Lymphadenitis
Related Terms:
adenopathy, lymphadenopathy, lymph node enlargement, lymph node inflammation, lymph node infection, postauricular node, supraclavicular node, epitrochlear node, popliteal node, tuberculous lymphadenitis, regional adenopathy, cervical adenopathy (1), bacteremia, septicemia, gangrene, cellulitis, necrosis, lymphedema
Related conditions: Lymphangitis, lymphadenopathy
Clinical:
Lymphadenitis simply defined as the enlargement and/or enlargement of a lymph node. The condition may be specifically localized , generalized with systemic infections or confined to regional lymph nodes draining a local area of infection (2)
The nodes may be swollen, hard, smooth, or irregular. They may also be painful and warm if near the skin. The location of the lymphadenitis is usually related to the site or origin of the infection.
Lymphedema patients are especially at risk due to the localized immunodifcient lymphedemous limb and because possible fibrosis will cause the infection to be more difficult to treat.
Etiology:
The most common causes of lymphadenitis are bacterial infections caused by streptococcal and staphylococcal. Other infections that may be involved include rabbit fever (tularemia), cat scratch disease, lymphogranuloma venerum, chancroid, genital herpes, infected acne, dental abscesses and even bubonic plague. (3)
Generalized lymph node enlargements common in infectious mononucleosis, cytomegalovirus infection, toxoplasmosis, brucellosis, secondary syphilis, and disseminated histoplasmosis. (2)
Regional lymphadenopathy is prominent in streptococcal disease, TB or nontuberculous mycobacterial disease, tularemia, plague, cat-scratch disease, primary syphilis, lymphogranuloma venereum, chancroid, and genital herpes simplex. (2)
Symptoms:
Overall body symptoms may include fever, chills, body aches (often flu-like), fatigue and general malaise Specific symptoms include nodes that are swollen, tender. Also common is a throbbing type pain at the point of infection. They may be either hard or rubbery to the touch. The skin over the node may be reddened and hot.
Diagnosis:
General diagnosis may be obtained by simple observation and examination. A complete blood workup may also be indicated as well as blood cultures to determine and/or rule out the possibility of a systemic infection as well as to determine the suspect bacteria involved.
Complications:
Complications may include bacteremia, septicemia, abscess formation, cellulitis, thrombophlebitis, tissue necrosis (gangrene)
Treatment:
Treatment involves antibiotic therapy. These should be specific to the cause of the infection. Anti-inflammatory medications may be used to decrease localized swelling and inflammation. Pain medication also may be used. If there is a serious abscess is involved, it may need to be surgically drained. Commonly used antibiotics include the penicillins, nafcillin, cephalosporins, and erythromycin.
In more severe infections, it may be necessary to surgically drain the affected node.
Prognosis:
The expectation of recovery is excellent with prompt diagnosis and treatment. High risk groups however, may be required to undergo antibiotic therapy for an extended period of time and may experience recurrence of the infection.
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Lymphadenitis
Lymphadenitis is the inflammation of a lymph node. It is often a complication of a bacterial infection of a wound, although it can also be caused by viruses or other disease agents. Lymphadenitis may be either generalized, involving a number of lymph nodes; or limited to a few nodes in the area of a localized infection. Lymphadenitis is sometimes accompanied by lymphangitis, which is the inflammation of the lymphatic vessels that connect the lymph nodes.
Lymphadenitis is marked by swollen lymph nodes that are painful, in most cases, when the doctor touches them. If the lymphadenitis is related to an infected wound, the skin over the nodes may be red and warm to the touch. If the lymphatic vessels are also infected, there will be red streaks extending from the wound in the direction of the lymph nodes. In most cases, the infectious organisms are hemolytic Streptococci or Staphylococci. Hemolytic means that the bacteria produce a toxin that destroys red blood cells.
The extensive network of lymphatic vessels throughout the body and their relation to the lymph nodes helps to explain why bacterial infection of the nodes can spread rapidly to or from other parts of the body. Lymphadenitis in children often occurs in the neck area because these lymph nodes are close to the ears and throat, which are frequent locations of bacterial infections in children.
Streptococcal and staphylococcal bacteria are the most common causes of lymphadenitis, although viruses, protozoa, rickettsiae, fungi, and the tuberculosis bacillus can also infect the lymph nodes. Diseases or disorders that involve lymph nodes in specific areas of the body include rabbit fever (tularemia), cat-scratch disease, lymphogranuloma venereum, chancroid, genital herpes, infected acne, dental abscesses, and bubonic plague. In children, tonsillitis or bacterial sore throats are the most common causes of lymphadenitis in the neck area. Diseases that involve lymph nodes throughout the body include mononucleosis, cytomegalovirus infection, toxoplasmosis, and brucellosis.
The early symptoms of lymphadenitis are swelling of the nodes caused by a buildup of tissue fluid and an increased number of white blood cells resulting from the body's response to the infection. Further developments include fever, often as high as 101-102°F (38-39°C) together with chills, loss of appetite, heavy perspiration, a rapid pulse, and general weakness.
The diagnosis of lymphadenitis is usually based on a combination of the patient's history, the external symptoms, and laboratory cultures. The doctor will press (palpate) the affected lymph nodes to see if they are sore or tender. Swollen nodes without soreness are often caused by cat-scratch disease. In children, the doctor will need to rule out mumps, tumors in the neck region, and congenital cysts that resemble swollen lymph nodes.
Although lymphadenitis is usually diagnosed in lymph nodes in the neck, arms, or legs, it can also occur in lymph nodes in the chest or abdomen. If the patient has acutely swollen lymph nodes in the groin, the doctor will need to rule out a hernia in the groin that has failed to reduce (incarcerated inguinal hernia). Hernias occur in 1% of the general population; 85% of patients with hernias are male.Laboratory tests
The most significant tests are a white blood cell count (WBC) and a blood culture to identify the organism. A high proportion of immature white blood cells indicates a bacterial infection. Blood cultures may be positive, most often for a species of staphylococcus or streptococcus. In some cases, the doctor may order a biopsy of the lymph node.
The medications given for lymphadenitis vary according to the bacterium or virus that is causing it. If the patient also has lymphangitis, he or she will be treated with antibiotics, usually penicillin G (Pfizerpen, Pentids), nafcillin (Nafcil, Unipen), or cephalosporins. Erythromycin (Eryc, E-Mycin, Erythrocin) is given to patients who are allergic to penicillin.Supportive care
Supportive care of lymphadenitis includes resting the affected limb and treating the area with hot moist compresses.Surgery Cellulitis associated with lymphadenitis should not be treated surgically because of the risk of spreading the infection. Pus is drained only if there is an abscess and usually after the patient has been started on antibiotic treatment. In some cases, a biopsy of an inflamed lymph node is necessary if no diagnosis has been made and no response to treatment has occurred.
Prognosis
The prognosis for recovery is good if the patient is treated promptly with antibiotics. In most cases, the infection can be brought under control in three or four days. Patients with untreated lymphadenitis may develop blood poisoning (septicemia), which is sometimes fatal.
Prevention of lymphadenitis depends on prompt treatment of bacterial and viral infections.(3)
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