Typical causes of lymphangitis include streptococci. Rare causes of lymphangitis 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 of lymphangitis is clinical. Isolation of the responsible organism is usually unnecessary.
Most cases respond rapidly to antistreptococcal antibiotics (see treatment of cellulitis). If response to treatment is poor or presentation is unusual, rare pathogens should be considered.