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
  • Histologically, lymphatic vessels are dilated and filled with lymphocytes and histiocytes:
    • Inflammation frequently extends into perilymphatic tissues and may lead to cellulitis or abscess formation

Etiology

  • Acute lymphangitis:
    • Likely caused by bacterial infection
    • Most commonly group A β-hemolytic Streptococcus
    • Less commonly due to other strep groups, and occasionally Staphylococcus aureus, including resistant strains such as community-associated methicillin-resistant S. aureus (CA-MRSA):
      • CA-MRSA risk factors: Prior MRSA infection, household contact of CA-MRSA patient, military personnel, incarcerated persons, athletes in contact sports, IV drug users, men who have sex with men
      • Different antibiotic susceptibility than nosocomial MRSA
      • CA-MRSA now sufficiently prevalent to warrant empiric treatment
      • Suspect CA-MRSA in unresponsive infections or if multiple or recurrent abscesses
    • Other organisms:
      • Pasteurella multocida (cat or dog bite)
      • Spirillum minus (rat-bite fever)
      • Wuchereria bancrofti (filariasis): Consider in immigrants from Africa, Southeast Asia/Pacific, and tropical South America with lower-extremity involvement
  • Chronic lymphangitis:
    • Usually caused by mycotic, mycobacterial, and filarial infections
    • Sporothrix schenckii (most common cause of chronic lymphangitis in US):
      • 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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Citation

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TY - ELEC T1 - Lymphangitis ID - 307392 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307392/all/Lymphangitis ER -