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Key Features

Essentials of Diagnosis

  • Red streak from wound or cellulitis toward enlarged, tender regional lymph nodes

  • Chills, fever, and malaise

General Considerations

  • Lymphangitis and lymphadenitis are common manifestations of a bacterial infection

    • Usually caused by hemolytic streptococci or Staphylococcus aureus (or both)

    • Becomes invasive, generally from an infected wound

  • Wound may be small or superficial, or an established abscess may be present

  • Infection may progress rapidly, often in a matter of hours

Clinical Findings

Symptoms and Signs

  • Throbbing pain usually present in area of cellulitis at the site of bacterial invasion

  • Malaise

  • Anorexia

  • Sweating

  • Chills

  • Temperature of 38–40°C

  • Rapid pulse

  • Red streak may be definite or very faint and easily missed

  • Regional lymph nodes may be significantly enlarged and tender

Differential Diagnosis

  • Superficial thrombophlebitis

  • Cat-scratch fever (Bartonella henselae infection)

  • Acute streptococcal hemolytic gangrene

  • Cellulitis

  • Necrotizing fasciitis

Diagnosis

Laboratory Tests

  • Leukocytosis with a left shift

  • Blood cultures often positive for Staphylococcus or Streptococcus

Treatment

Medications

  • Analgesics

  • Empiric antibiotic therapy for hemolytic streptococci or S aureus (or both organisms) should always be instituted

    • Cephalexin, 0.5 g orally four times daily for 7–10 days

    • If high-risk for methicillin-resistant S aureus, trimethoprim-sulfamethoxazole two double strength tablets orally twice daily for 7–10 days

    • Table 30–6

Table 30–6.Examples of empiric choices of antimicrobials for adult outpatient infections (in alphabetical order).

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