Lymphangitis & Lymphadenitis

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 soft tissue infection

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

  • Vancomycin, 15 mg/kg intravenously every 12 hours is used when there are signs of systemic inflammatory response