Lymphangitis

Lymphangitis is a topic covered in the 5-Minute Emergency Consult.

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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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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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