Sandbox/00035
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Lymphangitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Sandbox/00035 On the Web |
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American Roentgen Ray Society Images of Sandbox/00035 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Acute lymphangitis may occur following direct inoculation of microorganisms through skin breaches or in the setting of erysipelas or cellulitis. Potential causative bacteria include Streptococcus pyogenes (most common), Staphylococcus aureus (if associated with prominent suppuration), Pasteurella multocida (if associated with animal bites), Erysipelothrix rhusiopathiae (if associated with handling of fish or raw meat), and Bacillus anthracis (if associated with exposure to infected animals or their products). Penicillins with or without anti-staphylococcal activity are the recommended initial treatment for acute lymphangitis.
Chronic granulomatous lymphangitis is typically caused by Sporothrix schenckii (rose gardener's disease) and treated with itraconazole. Sporotrichoid lesions may also result from infections with Mycobacterium marinum (swimming pool granuloma), Mycobacterium kansasii, Mycobacterium chelonae, Nocardia spp., Leishmania spp., Francisella tularensis, and Staphylococcus aureus (botryomycosis).
Filarial lymphangitis, most commonly caused by Wuchereria bancrofti (and sometimes by Brugia malayi or Brugia timori in Asia), is transmitted via mosquito bites and treated with diethylcarbamazine.
In addition to prompt antibiotics with appropriate coverage, adjunctive measures such as analgesics, anti-inflammatory drugs, limb elevation, or warm compresses may also be used for symptomatic relief.
Principles of Therapy for Acute Lymphangitis Adapted from Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases.[1]
Mild to Moderate Disease
- Nontoxic patients may be managed in an outpatient setting with oral agents such as penicillin V or amoxicillin, with one preceding dose of intramuscular ceftriaxone for moderate cases.
- Pyogenic infection suggestive of a staphylococcal etiology should be treated with penicillinase-resistant beta-lactams (eg, dicloxacillin or cephalexin) in areas where methicillin-resistant Staphylococcus aureus (MRSA) is not prevalent.
- For empiric coverage of both MRSA and beta-hemolytic streptococci, oral antibiotic options include the following:[2]
- Clindamycin alone
- Co-trimoxazole or doxycycline, in combination with a beta-lactam (eg, amoxicillin)
- Linezolid alone
Severe Disease
- Hospitalization should be considered in the following conditions:[3]
- Hypotension
- Marked left shift
- Elevated creatinine level
- Elevated creatine kinase level (2–3 times the upper limit of normal)
- C-reactive protein level >13 mg/L
- Low bicarbonate level
- If Staphylococcus aureus is suspected in patients with severe disease, empiric vancomycin should be administered parenterally.
Antibiotic Therapy
Adjunctive Therapy
- Chronic lymphedema may develop as a complication of recurrent lymphangitis. Remedies facilitating lymphatic drainage include manual massage, multilayered bandage wrapping, and intermittent pneumatic compression.[1]
References
- ↑ 1.0 1.1 Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier.
- ↑ Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ; et al. (2011). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clin Infect Dis. 52 (3): e18–55. doi:10.1093/cid/ciq146. PMID 21208910.
- ↑ Stevens, D. L.; Bisno, A. L.; Chambers, H. F.; Everett, E. D.; Dellinger, P.; Goldstein, E. J. C.; Gorbach, S. L.; Hirschmann, J. V.; Kaplan, E. L.; Montoya, J. G.; Wade, J. C. (2005). "Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections". Clinical Infectious Diseases. 41 (10): 1373–1406. doi:10.1086/497143. ISSN 1058-4838.