eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Lymphangitis: Differential Diagnoses & Workup

Author: Raymond D Pitetti, MD, MPH, Associate Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine; Consulting Staff, University of Pittsburgh Physicians
Contributor Information and Disclosures

Updated: May 22, 2009

Differential Diagnoses

Contact Dermatitis

Other Problems to Be Considered

Cellulitis
Septic thrombophlebitis
Superficial thrombophlebitis
Necrotizing fasciitis
Myositis
Sporotrichosis

Workup

Laboratory Studies

  • In any child who presents with lymphangitis, a CBC count and blood culture should be obtained. In addition, a leading-edge culture or aspiration of pus should be considered.
  • The CBC count and differential often reveal marked leukocytosis.
  • Blood cultures may reveal that infection has spread to the bloodstream; however, results are rarely positive.
  • Culture and Gram staining of aspirate from the primary site of infection may help in identifying the infectious organism and in choosing antimicrobials.
    • Some authors recommend aspiration of the leading edge of the infection; others prefer sampling the area of maximum inflammation.
    • Data from a small comparative study appear to suggest that aspiration of the area of maximal inflammation may increase the yield positive cultures. However, aspiration is relatively insensitive for diagnosing causative organisms. The low density of pathogens present in the infected tissue results in the low sensitivity of aspiration.
    • The threshold sensitivity of Gram staining is approximately 100,000 microorganisms per milliliter, a concentration rarely found in cellulitis or lymphangitis.
    • Aspiration of the leading edge of maximal inflammation is not thought to be helpful in the acute management of cases of acute lymphangitis.

Imaging Studies

  • Plain radiography is unnecessary in routine cases.

Procedures

  • Abscessed areas may require incision and drainage.
  • Cultures and Gram staining of fluid may help identify the causative organism and help select appropriate antimicrobial agents.

More on Lymphangitis

Overview: Lymphangitis
Differential Diagnoses & Workup: Lymphangitis
Treatment & Medication: Lymphangitis
Follow-up: Lymphangitis
Multimedia: Lymphangitis
References
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References

  1. Abraham S, Tschanz C, Krischer J, Saurat JH. Lymphangitis due to insect sting. Dermatology. 2007;215(3):260-1. [Medline].

  2. Marque M, Girard C, Guillot B, Bessis D. Superficial lymphangitis after arthropod bite: a distinctive but underrecognized entity?. Dermatology. 2008;217(3):262-7. [Medline].

  3. Hirschmann JV. Antimicrobial therapy for skin infections. Cutis. Jun 2007;79(6 Suppl):26-36. [Medline].

  4. [Guideline] Calfee DP, Salgado CD, Classen D, et al. Strategies to prevent transmission of methicillin-resistant Staphylococcus aureus in acute care hospitals. Infect Control Hosp Epidemiol. Oct 2008;29 Suppl 1:S62-80. [Medline].

  5. Addiss DG, Eberhard ML, Lammie PJ. "Filarial" adenolymphangitis without filarial infection. Lancet. Mar 5 1994;343(8897):597. [Medline].

  6. Ben-Amitai D, Ashkenazi S. Common bacterial skin infections in childhood. Pediatr Ann. Apr 1993;22(4):225-7, 231-3. [Medline].

  7. Brook I. Management of human and animal bite wounds: an overview. Adv Skin Wound Care. May 2005;18(4):197-203. [Medline].

  8. Brook I. Microbiology and management of human and animal bite wound infections. Prim Care. Mar 2003;30(1):25-39, v. [Medline].

  9. Brown G, Chamberlain R, Goulding J, Clarke A. Ceftriaxone versus cefazolin with probenecid for severe skin and soft tissue infections. J Emerg Med. Sep-Oct 1996;14(5):547-51. [Medline].

  10. Ellis Simonsen SM, van Orman ER, Hatch BE, et al. Cellulitis incidence in a defined population. Epidemiol Infect. Apr 2006;134(2):293-9. [Medline].

  11. Falagas ME, Bliziotis IA, Kapaskelis AM. Red streaks on the leg. Lymphangitis. Am Fam Physician. Mar 15 2006;73(6):1061-2. [Medline].

  12. Fleisher G, Ludwig S, Campos J. Cellulitis: bacterial etiology, clinical features, and laboratory findings. J Pediatr. Oct 1980;97(4):591-3. [Medline].

  13. Hacker SM. Common infections of the skin. Characteristics, causes, and cures. Postgrad Med. Aug 1994;96(2):43-6, 49-52. [Medline].

  14. Howe PM, Eduardo Fajardo J, Orcutt MA. Etiologic diagnosis of cellulitis: comparison of aspirates obtained from the leading edge and the point of maximal inflammation. Pediatr Infect Dis J. Jul 1987;6(7):685-6. [Medline].

  15. Jain A, Daum RS. Staphylococcal infections in children: Part 1. Pediatr Rev. Jun 1999;20(6):183-91. [Medline].

  16. Jungmann P, Figueredo-Silva J, Dreyer G. Bancroftian lymphangitis in northeastern Brazil: a histopathological study of 17 cases. J Trop Med Hyg. Apr 1992;95(2):114-8. [Medline].

  17. Kazura JW, Spark R, Forsyth K, et al. Parasitologic and clinical features of bancroftian filariasis in a community in East Sepik Province, Papua New Guinea. Am J Trop Med Hyg. Nov 1984;33(6):1119-23. [Medline].

  18. Kostman JR, DiNubile MJ. Nodular lymphangitis: a distinctive but often unrecognized syndrome. Ann Intern Med. Jun 1 1993;118(11):883-8. [Medline].

  19. Sadick NS. Current aspects of bacterial infections of the skin. Dermatol Clin. Apr 1997;15(2):341-9. [Medline].

  20. Santos JI, Jacobson JA, Swensen P, Palmer WM. Cellulitis: treatment with cefoxitin compared with multiple antibiotic therapy. Pediatrics. Jun 1981;67(6):887-90. [Medline].

  21. Schwartz R, Das-Young LR, Ramirez-Ronda C, Frank E. Current and future management of serious skin and skin-structure infections. Am J Med. Jun 24 1996;100(6A):90S-95S. [Medline].

  22. Sigurdsson AF, Gudmundsson S. The etiology of bacterial cellulitis as determined by fine-needle aspiration. Scand J Infect Dis. 1989;21(5):537-42. [Medline].

  23. Yagupsky P. Bacteriologic aspects of skin and soft tissue infections. Pediatr Ann. Apr 1993;22(4):217-24. [Medline].

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Further Reading

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Keywords

lymphangitis, lymphangeitis, lymphangiitis, lymphatic system, inflammation of the lymphatic channels, bacteremia, cellulitis, septic thrombophlebitis, superficial thrombophlebitis, necrotizing fasciitis, myositis, sporotrichosis, Staphylococcus aureus, Pseudomonas, Streptococcus pneumoniae, Pasteurella multocida, Aermonas hydrophila, treatment, diagnosis

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Contributor Information and Disclosures

Author

Raymond D Pitetti, MD, MPH, Associate Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine; Consulting Staff, University of Pittsburgh Physicians
Raymond D Pitetti, MD, MPH is a member of the following medical societies: Allegheny County Medical Society, American Academy of Pediatrics, Pennsylvania Medical Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Gary J Noel, MD, Department of Pediatrics, Clinical Associate Professor, Weill Medical College of Cornell University
Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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