Lymphangitis: classification, symptoms and treatment
Mar 22, 2018
Lymphangitis is a disease characterized by inflammation of large and small lymph vessels of different locations. The pathological process always develops a second time;It can proceed both acutely and chronically.
With this pathology, local manifestations in the form of reddening and swelling in the projection of the affected lymphatic trunks and capillaries are noted.The acute form is accompanied by a pronounced general intoxication of the body. Most often, doctors have to observe lymphangitis of the extremities, which is explained by their relatively frequent damage followed by infection. Treatment involves the opening of primary purulent foci, the appointment of antibiotics and the conduct of physiotherapy procedures.
Quite often, symptoms of secondary lymphadenitis are detected in parallel with lymphangitis.Table of contents: Why does lymphangitis occur?Classification Clinical manifestations of the diagnosis Diagnosis How is lymphangitis treated?
Why does lymphangitis occur?
The direct cause of the defeat of lymphatic vessels is the spread of infection from a purulent-inflammatory focus.
To development of lymphangitis result:
- furuncles( purulent necrotic lesions of hair bulbs);
- carbuncles( accumulation of boils);
- abscesses( abscesses);
- bone felon;
- trophic ulcers;
- infected wounds and scratching.
The disease is provoked by pathogens such as beta-hemolytic streptococcus and Staphylococcus aureus, and in some cases - Proteus and E. coli .In the laboratory study of bacterial inoculation, several pathogens can be detected simultaneously.In patients with diagnosed tuberculosis, urethritis and STD( genital herpes and primary syphilis), specific lymphangites are often diagnosed.
Note: in rare cases reveals a non-venereal lipofitis of the penis due to mechanical trauma of local tissues.
Factors affecting the development and progress of the process:
- Localization and area of the outbreak;
- specifics of local lymph circulation;
- virulence of a strain of microorganisms;
- state of general human immunity.
From the primary focus, the bacteria and the toxins they produce migrate to interstitial spaces and lymphatic capillaries.Then, with a current of lymph, infectious agents move along large trunks in the direction of the lymph nodes.
This process has a pronounced vascular reaction.Swells the endothelium( inner layer of cells) and increases the permeability of the walls of the vessels .In parallel, fibrin clots form, and a tendency to form clots appears, leading to stagnation of lymph( lymphostasis). If the inflammation progresses, the risk of septic decay of thrombi and purulent lymphadenitis is high.Inflammatory process often passes to nearby tissues, and perilymphangitis develops with damage to muscles, cartilage and blood vessels.
Two types of lymphangitis are distinguished by the nature of the discharge:
- simple( serous);
Depending on the depth of location of patients with lymphatic trunks distinguish between deep and surface forms.According to the clinical course of the process, the disease is acute and chronic.
Note: can cause cancerous lymphangitis against a background of malignant tumors.
There is also a classification according to the diameter of the affected vessels.In the reticular form, a number of capillaries are affected, and in the truncular form, large lymphatic trunks are affected( one or several at a time).
Clinical manifestations of the disease
Common symptoms that indicate an organism's intoxication include:
- high temperature( up to 39.5-40 ° C);
- febrile reaction( chill);
- cephalalgia( headache);
- general malaise and weakness;
- increased sweating.
Local signs of reticular lymphangitis:
- surface hyperemia in the projection of the primary focus;
- is a specific "marble"( net) pattern on the background of pronounced erythema;
- burning sensation in the affected area.
Note: The symptomatic of the mesh form has some similarities with the signs of erysipelas( a skin disease of infectious genesis), but at the erysipelas the borders of the hyperemia are clear, and with lymphangitis - blurred.
Local symptoms of stem lymphangitis:
- narrow red stripes on the skin( along the course of large vessels in the direction of the lymph nodes);
- local tenderness in palpation;
- tension of adjacent tissues;
- signs of regional lymphadenitis.
In the course of the examination, the convex painful seals in the form of a cord( strand) are determined during palpation. When lesions of deeply located trunks of local reddening of the skin are usually not noted, but swelling and pain are pronounced.As the process progresses, the outflow of lymph is disturbed, which is manifested by significant edema of the limbs.
If surrounding tissues are affected, an abscess or phlegmon can form under the fasciae of the muscles.When they are opened, sepsis( contamination of the blood) is not excluded.
Important: for chronic lymphangitis current clinical symptoms erased.Against the backdrop of lymphostasis and blockage of the stem vessels, persistent puffiness develops.In severe cases, cracks and trophic ulcers appear on the skin.
An indication of non-venereal lymphangitis of the penis is the appearance of a tight strand along its trunk or coronal sulcus.It lasts from several hours to 2-3 days, after which it spontaneously "dissolves".The appearance of densification is not accompanied by painful sensations.
The mesh( reticular) lymphangitis specialist can detect at visual inspection.Differential diagnostics of this form with erysipelas and phlebitis of superficial veins is carried out.
It is somewhat more difficult to detect deep lymphangitis.The diagnosis of lymphology takes into account the history, examination, instrumental studies, as well as laboratory tests.
When analyzing peripheral blood, a significant leukocytosis is revealed, which indicates an acute inflammatory process.
During ultrasonic dopplerography and duplex scanning, the narrowing of the lumen and the heterogeneity of the vessel structure are determined.In regional nodes there are jet changes, and around the affected vessels a specific hyperechoic "rim" is visualized.
A very informative instrumental research method is the computer thermography .It allows you to objectively assess the depth and severity and extent of the pathological process.
The obtained data allow to differentiate lymphangitis from deep thrombophlebitis, diffuse suppurative inflammation of tissues and osteomyelitis.
Important: for a complicated course of the disease for the elimination of sepsis, the blood is examined for sterility.
A sample of a discharge from an abscess( abscess) or other primary focus is sent to a laboratory for bacteriological inoculation.With its help, the type of pathogenic microflora that provoked the process and the degree of its sensitivity to certain antibacterial drugs are determined.
How is lymphangitis treated?
Patients with this pathology are hospitalized.If acute lymphangitis is diagnosed, then at the first stage the primary infectious focus must be eliminated.
Infected wounds must be thoroughly sanitized.Panaritium, abscesses and phlegmon are opened, subjected to antiseptic treatment and drained to ensure an unimpeded outflow of pus.
It is important to fix the patient's limb in an elevated position.The patient should be limited to motor activity( bed or half-bed regime is necessary).
Important: conducted on its own initiative, patient warming, massage and rubbing ointments into problem areas are absolutely unacceptable!Such self-treatment often leads to a worsening of the condition and the development of complications.To reduce swelling, you can only attach a piece of ice to the sore spot.
For lymphangitis, antibiotics must be prescribed( taking into account the sensitivity of the microflora).
The most commonly used drugs are the following groups:
- penicillins( semisynthetic);
- cephalosporins( 1st and 2nd generation).
Antihistamines and anti-inflammatory pharmacological agents are also prescribed. To combat common intoxication of the body, infusion therapy is necessary.
From hardware treatment methods the most effective are the effects on the blood of ultraviolet or laser radiation. In the first case, a multiple intake and return of blood from the vein is performed.It passes through a special apparatus in which it is exposed to UV irradiation.The second technique( VLOK) involves intravenous injection of a special fiber.Laser radiation activates the metabolism of the elemental elements and improves the rheological properties of the blood.
In a low-active chronic process, compresses( with dimethylsulfoxide) and ointment dressings are shown.Physiotherapeutic procedures are performed;Especially effective are ultraviolet irradiation and mud therapy.If conventional conservative methods do not give a positive effect, resort to radiation therapy, involving intravenous administration of radionuclides.
Note: if non-venous lymphangitis of the trunk of the penis is diagnosed, medical attention is not required.It is only necessary to protect the organ from mechanical effects for a certain time.When the pathology is caused by venereal infections, the main disease is treated.
The disease does not pose a threat to life, provided that the necessary measures are taken.With early diagnosis and timely onset of complex therapy, in most cases the prognosis for complete recovery is quite favorable.
Chronic form over time causes obliteration of vessels, and lymphostasis often leads to elephantiases( "elephantiasis").
Impaired lymph drain prevents natural clearance of body tissues.
Prevention of lymphangitis requires compliance with personal hygiene, timely sanation of purulent foci and wounds, as well as rational antibiotic treatment of infectious complications.
Vladimir Plisov, doctor, medical reviewer