eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Lymphangitis
Updated: May 22, 2009
Introduction
Background
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 or viruses, are processed in the lymph nodes to generate an immune response to fight an infection. 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.
Trypanosomal chancre on shoulder with lymphangitis toward axilla.
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.
Frequency
United States
No specific data are available.
International
No specific data are available.
Mortality/Morbidity
Although no specific data are available as to the mortality and morbidity associated with lymphangitis alone, those patients with lymphangitis due to group A streptococcal infections are at increased risk for significant morbidity and mortality. The morbidity and mortality associated with lymphangitis is related to the underlying infection.
Race
No specific data are available.
Sex
Although no specific data are available for lymphangitis, two thirds of children with cellulitis (a complication occurring in the absence of appropriate antimicrobial therapy) are reported to be male.
Age
No age predilection is reported.
Clinical
History
A history of minor trauma to an area of skin distal to the site of infection is often elicited in patients with lymphangitis.1,2
- Children with lymphangitis often have fever, chills, and malaise.
- Some children may report a headache, loss of appetite, and muscle aches.
- Patients often have a history of a recent cut or abrasion or of an area of skin that appears infected and spreading.
- Lymphangitis can progress rapidly to bacteremia and disseminated infection and sepsis, particularly when caused by group A streptococci.
Physical
- Upon clinical examination, erythematous and irregular linear streaks extend from the primary infection site toward draining regional nodes.
- These streaks may be tender and warm.
- The primary site may be an abscess, an infected wound, or an area of cellulitis.
- Blistering of the affected skin may occur.
- Lymph nodes associated with the infected lymphatic channels are often swollen and tender.
- Children may be febrile and tachycardic.
Causes
- In individuals with normal host defenses, group A beta-hemolytic streptococcal (GABHS) species are the most common causes of lymphangitis.
- GABHS 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.
- Lymphangitis is more likely to occur in patients with cellulitis due to GABHS than in patients with cellulitis caused by Staphylococcus aureus.
- Other organisms include S aureus and Pseudomonas species.
- Streptococcus pneumoniae is a relatively uncommon cause of lymphangitis.
- 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.
More on Lymphangitis |
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| Follow-up: Lymphangitis |
| Multimedia: Lymphangitis |
| References |
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References
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Further Reading
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
