Lymphangitis

Basics

Description

  • Lymphangitis is the inflammation of lymphatics draining an area of infection
  • Appearance of erythematous streaking on skin due to dilation of underlying lymphatic vessels
  • Acute lymphangitis usually caused by bacterial infection, and chronic by mycobacteria, fungal, or parasitic infection

Etiology

  • Acute lymphangitis:
    • Caused by bacterial infection
    • Most common: Group A β-hemolytic Streptococcus
    • Less common: Other strep species (eg, Strep pyogenes), methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA), HSV
    • Other organisms:
      • Pasteurella multocida (cat or dog bite)
      • Streptobacillus moniliformis (rat-bite fever)
      • Erysipelothrix rhusiopathiae (handling of infected poultry, swine, marine animals, or fish)
      • Wuchereria bancrofti or Brugia malayi (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 US):
      • Inoculation occurs while gardening or farming (rose thorn)
      • Organism is present on some plants and in sphagnum moss
      • Multiple subcutaneous nodules appear along course of lymphatic vessels
      • Typical antibiotics and local treatment fail to cure lesion
    • Mycobacterium marinum (“swimming pool granuloma”):
      • 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 or asteroides
    • Mycobacterium kansasii
    • Mycobacterium chelonae
    • W. bancrofti
    • Leishmania brasilensis or Mexicana
    • Francisella tularensis (tularemia)

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