Lymphangitis overview: Difference between revisions
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{{CMG}}'''Associate Editor(s)-in-Chief:''' [[User:Vishal Devarkonda|Vishal Devarkonda, M.B.B.S]][mailto:vdevarko:@BIDMC.harvard.edu <nowiki>[2]</nowiki>] | {{CMG}}'''Associate Editor(s)-in-Chief:''' [[User:Vishal Devarkonda|Vishal Devarkonda, M.B.B.S]][mailto:vdevarko:@BIDMC.harvard.edu <nowiki>[2]</nowiki>] | ||
==Overview== | ==Overview== | ||
'''Lymphangitis''' is an [[inflammation]] of the [[lymphatic]] channels. Lymphangitis is an ancient disease. The exact origins of the disease are not clearly known.There is no classification system established for lymphangitis. However, based on the etiology, lymphangitis can be broadly classified into | '''Lymphangitis''' is an [[inflammation]] of the [[lymphatic]] channels. Lymphangitis is an ancient disease. The exact origins of the disease are not clearly known. There is no classification system established for lymphangitis. However, based on the etiology, lymphangitis can be broadly classified into infectious and non-infectious causes. The [[etiology]] varies depending on the [[clinical]] form of lymphangitis. Lymphangitis is [[inflammation]] of the lymphatic system, a system that is comprised of small [[vessels]] of the [[immune]] system that carry lymphatic fluid. The fluid is filtered in the [[lymph nodes]] and [[spleen]], drained into the [[subclavian veins]] through [[thoracic duct]] and finally returned back to the circulatory system. Differential diagnosis of lymphangitis includes [[contact dermatitis]], [[cellulitis]], [[thrombophlebitis]], [[fasciitis]] and [[myositis]]. Incidence, prevalence and demographics of lymphangitis are poorly studied. [[Trauma]], chronic disorders and [[infections]] of the [[skin]] are the common [[risk factors]] involved in the development of lymphangitis. Depending on [[etiology]], lymphangitis has a broad spectrum of [[Natural history, complications and prognosis template|natural history, complications, prognosis]], clinical presentation and physical findings. The presence of certain non-specific laboratory findings, in the presence of lymphangitis, may be suggestive of certain underlying causes. Examples of tests that may demonstrate abnormal findings include [[CBC]], [[ESR]], [[CRP]], and serology titers. The mainstay of therapy in lymphangitis is [[antimicrobial therapy]]. Supportive therapy includes [[analgesics]], [[anti-inflammatory]] agents, and warm compresses. [[Surgery]] is indicated in certain cases of nodular lymphangitis that are complicated by [[abscess]] and [[lymphedema]] in addition to appropriate medical therapy. There is no established [[primary prevention]] for lymphangitis. | ||
==Historical Perspective== | ==Historical Perspective== | ||
| Line 9: | Line 9: | ||
==Classification== | ==Classification== | ||
There is no classification system established for lymphangitis. Based on the etiology, lymphangitis can be broadly classified into: | There is no classification system established for lymphangitis. Based on the etiology, lymphangitis can be broadly classified into: | ||
*Lymphangitis due to infectious etiology | |||
*Lymphangitis due to non-infectious etiology | |||
==Causes== | ==Causes== | ||
The etiology varies depending on the clinical form of | The etiology varies depending on the clinical form of lymphangitis. | ||
==Pathophysiology== | ==Pathophysiology== | ||
Lymphangitis is [[inflammation]] of the lymphatic system, a system that is comprised of small vessels of the immune system that carry lymphatic fluid. The fluid is filtered in the [[lymph nodes]] and [[spleen]], drained into the [[subclavian veins]] and finally returned back to the circulatory system. | Lymphangitis is [[inflammation]] of the lymphatic system, a system that is comprised of small vessels of the immune system that carry lymphatic fluid. The fluid is filtered in the [[lymph nodes]] and [[spleen]], drained into the [[subclavian veins]] and finally returned back to the circulatory system. | ||
| Line 18: | Line 18: | ||
The presentation of red streaks on the skin in lymphangitis can also be a presentation of conditions such as [[contact dermatitis]], [[cellulitis]], [[thrombophlebitis]], [[fasciitis]] and [[myositis]]. Clinical findings like red linear streaks proximal to a distal site of infection, tender regional [[lymphadenopathy]] and [[fever]], along with a history suggestive of infection by causative organisms of lymphangitis helps in differentiating lymphangitis from other conditions.<ref name=lymphangitis>lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016</ref> | The presentation of red streaks on the skin in lymphangitis can also be a presentation of conditions such as [[contact dermatitis]], [[cellulitis]], [[thrombophlebitis]], [[fasciitis]] and [[myositis]]. Clinical findings like red linear streaks proximal to a distal site of infection, tender regional [[lymphadenopathy]] and [[fever]], along with a history suggestive of infection by causative organisms of lymphangitis helps in differentiating lymphangitis from other conditions.<ref name=lymphangitis>lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016</ref> | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Incidence, prevalence and demographics of lymphangitis are poorly studied. Specific epidemiological and demo-graphical data for individual infections are discussed in detail separately. | |||
==Risk Factors== | ==Risk Factors== | ||
Trauma, chronic disorders and infections of the skin are the common risk factors involved in the development of lymphangitis. | Trauma, chronic disorders and infections of the skin are the common risk factors involved in the development of lymphangitis. | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
Depending on etiologies, lymphangitis has spectrum of natural history, complication, and prognosis. Specific natural history, complications and prognosis for individual infections are discussed in detail separately. | Depending on etiologies, lymphangitis has a broad spectrum of natural history, complication, and prognosis. Specific natural history, complications and prognosis for individual infections are discussed in detail separately. | ||
==History and Symptoms== | ==History and Symptoms== | ||
Depending on etiologies, lymphangitis has spectrum of clinical presentation. Specific history and symptoms for individual infections are discussed in detail separately.<ref name=lymphangitis>lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016</ref><ref name=harrison>lymphanitis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on October 12,2016</ref><ref name="pmid27271418">{{cite journal| author=Füeßl HS| title=[Emergency checklist: Acute lymphangitis]. | journal=MMW Fortschr Med | year= 2016 | volume= 158 | issue= 11 | pages= 65 | pmid=27271418 | doi=10.1007/s15006-016-8384-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27271418 }} </ref><ref name="pmid8480962">{{cite journal| author=Kostman JR, DiNubile MJ| title=Nodular lymphangitis: a distinctive but often unrecognized syndrome. | journal=Ann Intern Med | year= 1993 | volume= 118 | issue= 11 | pages= 883-8 | pmid=8480962 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8480962 }} </ref><ref name="pmid18317034">{{cite journal| author=Schubach A, Barros MB, Wanke B| title=Epidemic sporotrichosis. | journal=Curr Opin Infect Dis | year= 2008 | volume= 21 | issue= 2 | pages= 129-33 | pmid=18317034 | doi=10.1097/QCO.0b013e3282f44c52 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18317034 }} </ref><ref name="pmid27051706">{{cite journal| author=Chung E, Pulitzer MP, Papadopoulos EB, Papanicolaou GA, Babady NE, Marchetti MA| title=Lymphangitic papules caused by Nocardia takedensis. | journal=JAAD Case Rep | year= 2015 | volume= 1 | issue= 3 | pages= 126-8 | pmid=27051706 | doi=10.1016/j.jdcr.2015.03.001 | pmc=4808715 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27051706 }} </ref><ref name="pmid11472559">{{cite journal| author=Taylor MJ, Cross HF, Ford L, Makunde WH, Prasad GB, Bilo K| title=Wolbachia bacteria in filarial immunity and disease. | journal=Parasite Immunol | year= 2001 | volume= 23 | issue= 7 | pages= 401-9 | pmid=11472559 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11472559 }} </ref><ref name="pmid20739055">{{cite journal| author=Taylor MJ, Hoerauf A, Bockarie M| title=Lymphatic filariasis and onchocerciasis. | journal=Lancet | year= 2010 | volume= 376 | issue= 9747 | pages= 1175-85 | pmid=20739055 | doi=10.1016/S0140-6736(10)60586-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20739055 }} </ref> | Depending on etiologies, lymphangitis has a broad spectrum of clinical presentation. Specific history and symptoms for individual infections are discussed in detail separately.<ref name=lymphangitis>lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016</ref><ref name=harrison>lymphanitis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on October 12,2016</ref><ref name="pmid27271418">{{cite journal| author=Füeßl HS| title=[Emergency checklist: Acute lymphangitis]. | journal=MMW Fortschr Med | year= 2016 | volume= 158 | issue= 11 | pages= 65 | pmid=27271418 | doi=10.1007/s15006-016-8384-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27271418 }} </ref><ref name="pmid8480962">{{cite journal| author=Kostman JR, DiNubile MJ| title=Nodular lymphangitis: a distinctive but often unrecognized syndrome. | journal=Ann Intern Med | year= 1993 | volume= 118 | issue= 11 | pages= 883-8 | pmid=8480962 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8480962 }} </ref><ref name="pmid18317034">{{cite journal| author=Schubach A, Barros MB, Wanke B| title=Epidemic sporotrichosis. | journal=Curr Opin Infect Dis | year= 2008 | volume= 21 | issue= 2 | pages= 129-33 | pmid=18317034 | doi=10.1097/QCO.0b013e3282f44c52 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18317034 }} </ref><ref name="pmid27051706">{{cite journal| author=Chung E, Pulitzer MP, Papadopoulos EB, Papanicolaou GA, Babady NE, Marchetti MA| title=Lymphangitic papules caused by Nocardia takedensis. | journal=JAAD Case Rep | year= 2015 | volume= 1 | issue= 3 | pages= 126-8 | pmid=27051706 | doi=10.1016/j.jdcr.2015.03.001 | pmc=4808715 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27051706 }} </ref><ref name="pmid11472559">{{cite journal| author=Taylor MJ, Cross HF, Ford L, Makunde WH, Prasad GB, Bilo K| title=Wolbachia bacteria in filarial immunity and disease. | journal=Parasite Immunol | year= 2001 | volume= 23 | issue= 7 | pages= 401-9 | pmid=11472559 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11472559 }} </ref><ref name="pmid20739055">{{cite journal| author=Taylor MJ, Hoerauf A, Bockarie M| title=Lymphatic filariasis and onchocerciasis. | journal=Lancet | year= 2010 | volume= 376 | issue= 9747 | pages= 1175-85 | pmid=20739055 | doi=10.1016/S0140-6736(10)60586-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20739055 }} </ref> | ||
==Physical Examination== | ==Physical Examination== | ||
Depending on etiologies, lymphangitis has spectrum of physical findings. Specific physical examination findings for individual infections are discussed in detail separately.<ref name=lymphangitis>lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016</ref><ref name="pmid8480962">{{cite journal| author=Kostman JR, DiNubile MJ| title=Nodular lymphangitis: a distinctive but often unrecognized syndrome. | journal=Ann Intern Med | year= 1993 | volume= 118 | issue= 11 | pages= 883-8 | pmid=8480962 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8480962 }} </ref><ref name="pmid18317034">{{cite journal| author=Schubach A, Barros MB, Wanke B| title=Epidemic sporotrichosis. | journal=Curr Opin Infect Dis | year= 2008 | volume= 21 | issue= 2 | pages= 129-33 | pmid=18317034 | doi=10.1097/QCO.0b013e3282f44c52 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18317034 }} </ref><ref name="pmid27051706">{{cite journal| author=Chung E, Pulitzer MP, Papadopoulos EB, Papanicolaou GA, Babady NE, Marchetti MA| title=Lymphangitic papules caused by Nocardia takedensis. | journal=JAAD Case Rep | year= 2015 | volume= 1 | issue= 3 | pages= 126-8 | pmid=27051706 | doi=10.1016/j.jdcr.2015.03.001 | pmc=4808715 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27051706 }} </ref><ref name="pmid11472559">{{cite journal| author=Taylor MJ, Cross HF, Ford L, Makunde WH, Prasad GB, Bilo K| title=Wolbachia bacteria in filarial immunity and disease. | journal=Parasite Immunol | year= 2001 | volume= 23 | issue= 7 | pages= 401-9 | pmid=11472559 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11472559 }} </ref><ref name="pmid20739055">{{cite journal| author=Taylor MJ, Hoerauf A, Bockarie M| title=Lymphatic filariasis and onchocerciasis. | journal=Lancet | year= 2010 | volume= 376 | issue= 9747 | pages= 1175-85 | pmid=20739055 | doi=10.1016/S0140-6736(10)60586-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20739055 }} </ref><ref name=harrison>lymphanitis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on October 12,2016</ref><ref name="pmid8930034">{{cite journal| author=Bruce DM, Heys SD, Eremin O| title=Lymphangitis carcinomatosa: a literature review. | journal=J R Coll Surg Edinb | year= 1996 | volume= 41 | issue= 1 | pages= 7-13 | pmid=8930034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8930034 }} </ref> | Depending on etiologies, lymphangitis has spectrum of physical findings. Specific physical examination findings for individual infections are discussed in detail separately.<ref name=lymphangitis>lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016</ref><ref name="pmid8480962">{{cite journal| author=Kostman JR, DiNubile MJ| title=Nodular lymphangitis: a distinctive but often unrecognized syndrome. | journal=Ann Intern Med | year= 1993 | volume= 118 | issue= 11 | pages= 883-8 | pmid=8480962 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8480962 }} </ref><ref name="pmid18317034">{{cite journal| author=Schubach A, Barros MB, Wanke B| title=Epidemic sporotrichosis. | journal=Curr Opin Infect Dis | year= 2008 | volume= 21 | issue= 2 | pages= 129-33 | pmid=18317034 | doi=10.1097/QCO.0b013e3282f44c52 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18317034 }} </ref><ref name="pmid27051706">{{cite journal| author=Chung E, Pulitzer MP, Papadopoulos EB, Papanicolaou GA, Babady NE, Marchetti MA| title=Lymphangitic papules caused by Nocardia takedensis. | journal=JAAD Case Rep | year= 2015 | volume= 1 | issue= 3 | pages= 126-8 | pmid=27051706 | doi=10.1016/j.jdcr.2015.03.001 | pmc=4808715 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27051706 }} </ref><ref name="pmid11472559">{{cite journal| author=Taylor MJ, Cross HF, Ford L, Makunde WH, Prasad GB, Bilo K| title=Wolbachia bacteria in filarial immunity and disease. | journal=Parasite Immunol | year= 2001 | volume= 23 | issue= 7 | pages= 401-9 | pmid=11472559 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11472559 }} </ref><ref name="pmid20739055">{{cite journal| author=Taylor MJ, Hoerauf A, Bockarie M| title=Lymphatic filariasis and onchocerciasis. | journal=Lancet | year= 2010 | volume= 376 | issue= 9747 | pages= 1175-85 | pmid=20739055 | doi=10.1016/S0140-6736(10)60586-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20739055 }} </ref><ref name=harrison>lymphanitis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on October 12,2016</ref><ref name="pmid8930034">{{cite journal| author=Bruce DM, Heys SD, Eremin O| title=Lymphangitis carcinomatosa: a literature review. | journal=J R Coll Surg Edinb | year= 1996 | volume= 41 | issue= 1 | pages= 7-13 | pmid=8930034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8930034 }} </ref> | ||
| Line 30: | Line 30: | ||
There are no diagnostic lab findings associated with lymphangitis. The presence of certain non-specific laboratory findings, in the presence of lymphangitis, may be suggestive of certain underlying causes. Examples of tests that may demonstrate abnormal findings include [[CBC]], [[ESR]], [[CRP]], and serology titers.<ref name=lymphangitis>lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016</ref> | There are no diagnostic lab findings associated with lymphangitis. The presence of certain non-specific laboratory findings, in the presence of lymphangitis, may be suggestive of certain underlying causes. Examples of tests that may demonstrate abnormal findings include [[CBC]], [[ESR]], [[CRP]], and serology titers.<ref name=lymphangitis>lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016</ref> | ||
==X-Ray== | ==X-Ray== | ||
There are no diagnostic | There are no diagnostic X-ray findings associated with lymphangitis. | ||
==CT== | ==CT== | ||
There are no diagnostic CT findings associated with lymphangitis. | There are no diagnostic CT findings associated with lymphangitis. | ||
==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
There are no diagnostic findings associated with lymphangitis. | There are no other diagnostic findings associated with lymphangitis. | ||
==Medical Therapy== | ==Medical Therapy== | ||
The mainstay of therapy in lymphangitis is antimicrobial therapy. Supportive therapy includes [[analgesics]], [[anti-inflammatory]] agents, and warm compresses. Specific anitmicrobial treatment for individual infections are discussed in detail separately. | The mainstay of therapy in lymphangitis is antimicrobial therapy. Supportive therapy includes [[analgesics]], [[anti-inflammatory]] agents, and warm compresses. Specific anitmicrobial treatment for individual infections are discussed in detail separately. | ||
==Surgery== | ==Surgery== | ||
Certain cases of nodular lymphangitis that are complicated by [[abscess]] and [[lymphedema]] require surgical intervention | Certain cases of nodular lymphangitis that are complicated by [[abscess]] and [[lymphedema]] require surgical intervention in addition to appropriate medical therapy. | ||
==Secondary Prevention== | ==Secondary Prevention== | ||
Lymphangitis is most often caused by recurrent skin infections due to group A beta-hemolytic streptococci and prophylactic administration of antibiotics can reduce the risk of these skin infections complicating into lymphangitis. | Lymphangitis is most often caused by recurrent skin infections due to group A [[beta-hemolytic streptococci]] and prophylactic administration of antibiotics can reduce the risk of these skin infections complicating into lymphangitis. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 18:03, 11 April 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Vishal Devarkonda, M.B.B.S[2]
Overview
Lymphangitis is an inflammation of the lymphatic channels. Lymphangitis is an ancient disease. The exact origins of the disease are not clearly known. There is no classification system established for lymphangitis. However, based on the etiology, lymphangitis can be broadly classified into infectious and non-infectious causes. The etiology varies depending on the clinical form of lymphangitis. Lymphangitis is inflammation of the lymphatic system, a system that is comprised of small vessels of the immune system that carry lymphatic fluid. The fluid is filtered in the lymph nodes and spleen, drained into the subclavian veins through thoracic duct and finally returned back to the circulatory system. Differential diagnosis of lymphangitis includes contact dermatitis, cellulitis, thrombophlebitis, fasciitis and myositis. Incidence, prevalence and demographics of lymphangitis are poorly studied. Trauma, chronic disorders and infections of the skin are the common risk factors involved in the development of lymphangitis. Depending on etiology, lymphangitis has a broad spectrum of natural history, complications, prognosis, clinical presentation and physical findings. The presence of certain non-specific laboratory findings, in the presence of lymphangitis, may be suggestive of certain underlying causes. Examples of tests that may demonstrate abnormal findings include CBC, ESR, CRP, and serology titers. The mainstay of therapy in lymphangitis is antimicrobial therapy. Supportive therapy includes analgesics, anti-inflammatory agents, and warm compresses. Surgery is indicated in certain cases of nodular lymphangitis that are complicated by abscess and lymphedema in addition to appropriate medical therapy. There is no established primary prevention for lymphangitis.
Historical Perspective
Lymphangitis is an ancient disease. The exact origins of the disease are not clearly known. Specific historical perspective for individual infections are discussed in detail separately.
Classification
There is no classification system established for lymphangitis. Based on the etiology, lymphangitis can be broadly classified into:
- Lymphangitis due to infectious etiology
- Lymphangitis due to non-infectious etiology
Causes
The etiology varies depending on the clinical form of lymphangitis.
Pathophysiology
Lymphangitis is inflammation of the lymphatic system, a system that is comprised of small vessels of the immune system that carry lymphatic fluid. The fluid is filtered in the lymph nodes and spleen, drained into the subclavian veins and finally returned back to the circulatory system.
Differentiating Lymphangitis from other Diseases
The presentation of red streaks on the skin in lymphangitis can also be a presentation of conditions such as contact dermatitis, cellulitis, thrombophlebitis, fasciitis and myositis. Clinical findings like red linear streaks proximal to a distal site of infection, tender regional lymphadenopathy and fever, along with a history suggestive of infection by causative organisms of lymphangitis helps in differentiating lymphangitis from other conditions.[1]
Epidemiology and Demographics
Incidence, prevalence and demographics of lymphangitis are poorly studied. Specific epidemiological and demo-graphical data for individual infections are discussed in detail separately.
Risk Factors
Trauma, chronic disorders and infections of the skin are the common risk factors involved in the development of lymphangitis.
Natural History, Complications and Prognosis
Depending on etiologies, lymphangitis has a broad spectrum of natural history, complication, and prognosis. Specific natural history, complications and prognosis for individual infections are discussed in detail separately.
History and Symptoms
Depending on etiologies, lymphangitis has a broad spectrum of clinical presentation. Specific history and symptoms for individual infections are discussed in detail separately.[1][2][3][4][5][6][7][8]
Physical Examination
Depending on etiologies, lymphangitis has spectrum of physical findings. Specific physical examination findings for individual infections are discussed in detail separately.[1][4][5][6][7][8][2][9]
Laboratory Findings
There are no diagnostic lab findings associated with lymphangitis. The presence of certain non-specific laboratory findings, in the presence of lymphangitis, may be suggestive of certain underlying causes. Examples of tests that may demonstrate abnormal findings include CBC, ESR, CRP, and serology titers.[1]
X-Ray
There are no diagnostic X-ray findings associated with lymphangitis.
CT
There are no diagnostic CT findings associated with lymphangitis.
Other Diagnostic Studies
There are no other diagnostic findings associated with lymphangitis.
Medical Therapy
The mainstay of therapy in lymphangitis is antimicrobial therapy. Supportive therapy includes analgesics, anti-inflammatory agents, and warm compresses. Specific anitmicrobial treatment for individual infections are discussed in detail separately.
Surgery
Certain cases of nodular lymphangitis that are complicated by abscess and lymphedema require surgical intervention in addition to appropriate medical therapy.
Secondary Prevention
Lymphangitis is most often caused by recurrent skin infections due to group A beta-hemolytic streptococci and prophylactic administration of antibiotics can reduce the risk of these skin infections complicating into lymphangitis.
References
- ↑ 1.0 1.1 1.2 1.3 lymphanitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016
- ↑ 2.0 2.1 lymphanitis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on October 12,2016
- ↑ Füeßl HS (2016). "[Emergency checklist: Acute lymphangitis]". MMW Fortschr Med. 158 (11): 65. doi:10.1007/s15006-016-8384-9. PMID 27271418.
- ↑ 4.0 4.1 Kostman JR, DiNubile MJ (1993). "Nodular lymphangitis: a distinctive but often unrecognized syndrome". Ann Intern Med. 118 (11): 883–8. PMID 8480962.
- ↑ 5.0 5.1 Schubach A, Barros MB, Wanke B (2008). "Epidemic sporotrichosis". Curr Opin Infect Dis. 21 (2): 129–33. doi:10.1097/QCO.0b013e3282f44c52. PMID 18317034.
- ↑ 6.0 6.1 Chung E, Pulitzer MP, Papadopoulos EB, Papanicolaou GA, Babady NE, Marchetti MA (2015). "Lymphangitic papules caused by Nocardia takedensis". JAAD Case Rep. 1 (3): 126–8. doi:10.1016/j.jdcr.2015.03.001. PMC 4808715. PMID 27051706.
- ↑ 7.0 7.1 Taylor MJ, Cross HF, Ford L, Makunde WH, Prasad GB, Bilo K (2001). "Wolbachia bacteria in filarial immunity and disease". Parasite Immunol. 23 (7): 401–9. PMID 11472559.
- ↑ 8.0 8.1 Taylor MJ, Hoerauf A, Bockarie M (2010). "Lymphatic filariasis and onchocerciasis". Lancet. 376 (9747): 1175–85. doi:10.1016/S0140-6736(10)60586-7. PMID 20739055.
- ↑ Bruce DM, Heys SD, Eremin O (1996). "Lymphangitis carcinomatosa: a literature review". J R Coll Surg Edinb. 41 (1): 7–13. PMID 8930034.