Lymphangitis

Basics

Description

Lymphangitis is the infection of lymphatics that drain a focus of inflammation or other infection
Histologically, lymphatic vessels are dilated and filled with lymphocytes and histiocytes

Etiology

Acute lymphangitis:
- Caused by bacterial infection
- Most common: Group A β-hemolytic Streptococcus
- Less common: Other strep species, methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA):
  - Risk factors for Staph infection (MSSA and MRSA):
    - Recent hospital or long-term care admission
    - Recent surgery
    - Children
    - Soldiers
    - Incarcerated persons
    - Athletes in contact sport
    - Injection drug use
    - Men who have sex with men
    - Dialysis treatments and catheters
    - History of penetrating trauma
  - Additional risk factors for MRSA infection:
    - Prior MRSA infection
    - MRSA colonization
    - Area of high MRSA incidence
    - Close contact with MRSA patient
- Other organisms:
  - Pasteurella multocida (cat or dog bite)
  - Streptobacillus moniliformis (rat-bite fever)
  - Wuchereria bancrofti (filariasis): Mosquito borne
    - Consider in immigrants from Africa, Southeast Asia/Pacific, and tropical South America with lower-extremity involvement
Chronic (nodular) lymphangitis:
- Usually caused by mycotic, mycobacterial, and filarial infections
- Sporothrix schenckii (most common cause of chronic lymphangitis in the U.S.):
  - Inoculation occurs while gardening or farming (rose thorn)
  - Organism is present on some plants and in sphagnum moss
  - Multiple SC nodules appear along course of lymphatic vessels
  - Typical antibiotics and local treatment fail to cure lesion
- Mycobacterium marinum:
  - Atypical Mycobacterium
  - Grows optimally at 25–32°C in fish tanks and swimming pools
  - May produce a chronic nodular, single wart-like or ulcerative lesion at site of abrasion
  - Additional lesions may appear in distribution similar to sporotrichosis
- Nocardia brasiliensis
- Mycobacterium kansasii
- W. bancrofti

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