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Lymphangitis

  • Author: Raymond D Pitetti, MD, MPH; Chief Editor: Russell W Steele, MD  more...
 
Updated: Aug 13, 2015
 

Background

Lymphangitis is defined as an inflammation of the lymphatic channels that occurs as a result of infection at a site distal to the channel. (See Etiology.)

The lymphatic system encompasses a network of vessels, glands, and organs located throughout the body. Functioning as part of the immune system, it also transports fluids, fats, proteins, and other substances in the body. Lymph nodes, or glands, filter the lymph fluid. Foreign bodies such as bacteria and viruses are processed in the lymph nodes to generate an immune response to fight infection.

However, when pathogenic organisms enter the lymphatic channels, invading directly through an abrasion or wound or as a complication of infection, local inflammation and subsequent infection ensue, manifesting as red streaks on the skin. The inflammation or infection then extends proximally toward regional lymph nodes. Bacteria can grow rapidly in the lymphatic system (see the image below). (See Etiology and Prognosis.)

Trypanosomal chancre on shoulder with lymphangitis Trypanosomal chancre on shoulder with lymphangitis toward axilla.

Although no specific data regarding sex-related demographics are available for lymphangitis, two thirds of patients with cellulitis (a complication of lymphangitis occurring in the absence of appropriate antimicrobial therapy) are reported to be male. (See Presentation and Workup.)

Nodular lymphangitis is a distinct clinical entity, separate from lymphangitis. This disorder is characterized by inflammatory nodules along the lymphatics draining a primary skin infection. (See Etiology and Treatment.)

Patient education

For patient education information, see Swollen Lymph Nodes.

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Etiology

In individuals with normal host defenses, species of group A beta-hemolytic streptococci (GABHS) are the most common causes of lymphangitis. These organisms elaborate fibrinolysins and hyaluronidase, which aid their invasion of lymphatic channels. Lymphangitis caused by GABHS can rapidly progress and has been associated with serious complications.

Staphylococcus aureus can also cause lymphangitis, although the disorder is more likely to occur in patients with cellulitis due to GABHS than in those with cellulitis resulting from S aureus.

Other organisms that can cause lymphangitis include the following:

  • Pseudomonas species
  • Streptococcus pneumoniae - A relatively uncommon cause of lymphangitis
  • Pasteurella multocida - Associated with dog and cat bites; can cause cellulitis and lymphangitis
  • Gram-negative rods, gram-negative bacilli, and fungi - May cause cellulitis and resultant lymphangitis in immunocompromised hosts
  • Aeromonas hydrophila - Can contaminate wounds that occur in freshwater
  • Wuchereria bancrofti - This filarial nematode is a major cause of acute lymphangitis worldwide; signs and symptoms of lymphangitis caused by W bancrofti are indistinguishable from those of bacterial lymphangitis [1, 2]

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

Nodular lymphangitis

Nodular lymphangitis commonly follows superficial inoculation with one of the following organisms:

  • Sporothrix schenckii
  • Nocardia brasiliensis
  • Mycobacterium marinum
  • Leishmania panamensis
  • L guyanensis
  • Francisella tularensis
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Prognosis

The prognosis for patients with uncomplicated lymphangitis is good. Antimicrobial regimens are effective in more than 90% of cases. Without appropriate antimicrobial therapy, however, cellulitis may develop or extend along the channels; necrosis and ulceration may occur.

Morbidity and mortality

Lymphangitis may spread within hours. The morbidity and mortality associated with the disease is related to the underlying infection. Although no specific data are available regarding complications and mortality associated with lymphangitis alone, lymphangitis caused by GABHS can lead to bacteremia, sepsis, and death.

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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; Associate Division Chief, Division of Pediatric Emergency Medicine, Associate Medical Director, Emergency Department, Medical Director, Sedation Services, Medical Director, Express Care, Medical Director, Patient Safety, Consulting Staff, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh Physicians

Raymond D Pitetti, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, Pennsylvania Medical Society, Society for Pediatric Research, Allegheny County Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

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.

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. Akogun OB, Akogun MK, Apake E, Kale OO. Rapid community identification, pain and distress associated with lymphoedema and adenolymphangitis due to lymphatic filariasis in resource-limited communities of North-eastern Nigeria. Acta Trop. 2011 Sep. 120 Suppl 1:S62-8. [Medline].

  2. Akogun OB, Badaki JA. Management of adenolymphangitis and lymphoedema due to lymphatic filariasis in resource-limited North-eastern Nigeria. Acta Trop. 2011 Sep. 120 Suppl 1:S69-75. [Medline].

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

  4. 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].

  5. Tomas X, Pedrosa M, Soriano A, Zboromyrska Y, Tudo G, Garcia S, et al. Rare diagnosis of nodular lymphangitis caused by Mycobacterium marinum: MDCT imaging findings. Acta Radiol Short Rep. 2014 Feb. 3 (2):2047981614523172. [Medline].

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

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

 
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Trypanosomal chancre on shoulder with lymphangitis toward axilla.
 
 
 
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