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Lymphangitis

by A. Damian Dhar, MD, JD

(See Lymphadenitis.)

Lymphangitis is acute bacterial infection (usually streptococcal) of peripheral lymphatic channels.

Rare causes include staphylococcal infections, Pasteurella infections, Erysipelothrix, anthrax, herpes simplex infections, lymphogranuloma venereum, rickettsial infections, sporotrichosis, Nocardia infections, leishmaniasis, tularemia, Burkholderia infections, and atypical mycobacterial infections. Pathogens enter the lymphatic channels from an abrasion, wound, or coexisting infection (usually cellulitis). Patients with underlying lymphedema are at particular risk. Red, irregular, warm, tender streaks develop on an extremity and extend proximally from a peripheral lesion toward regional lymph nodes, which are typically enlarged and tender. Systemic manifestations (eg, fever, shaking chills, tachycardia, headache) may occur and may be more severe than cutaneous findings suggest. Leukocytosis is common. Bacteremia may occur. Rarely, cellulitis with suppuration, necrosis, and ulceration develops along the involved lymph channels as a consequence of primary lymphangitis.

Diagnosis is clinical. Isolation of the responsible organism is usually unnecessary. Most cases respond rapidly to antistreptococcal antibiotics (see Cellulitis). If response to treatment is poor or presentation is unusual, rare pathogens should be considered.

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