Superficial acute lymphadenitis and lymphangitis
Introduction
Introduction to superficial acute lymphadenitis and lymphangitis Lymphadenitis and lymphangitis are acute suppurative infections caused by the invasion of the lymphatic pathogen and can occur anywhere in the body. The area of superficial acute lymphadenitis is mostly in the neck, armpits and groin, and some can occur in the inner side of the elbow or in the armpit. The pathogen invades the lymphatic space through the damaged skin, which in turn causes lymph nodes, lymphatic vessels and surrounding acute suppurative inflammatory lesions. The lymph nodes of the infected area are swollen, and there is a red line of the cord, which may be accompanied by symptoms of general malaise. If the development is not controlled in time, a multi-luminal abscess may be formed. basic knowledge Proportion of disease: Infectious diseases, the incidence of this disease is about 0.03% - 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: bacteremia
Cause
Shallow acute lymphadenitis and the cause of lymphangitis
Infection (32%):
The pathogens are mainly hemolytic streptococcus and staphylococcus aureus. The lymphadenitis in the neck is mostly caused by inflammation of the oropharynx, such as gingivitis, tonsillitis, mumps, stomatitis and the like. Infections between the toes, such as athlete's foot, are often the cause of lower extremity lymphadenitis. Infections of the upper limbs, chest wall, back and ventral wall above the umbilicus can cause axillary lymphadenitis. Lower limbs, abdominal wall below the umbilicus, perineum, buttocks infection, inguinal lymphadenitis can occur, superficial acute lymphangitis in the subcutaneous connective tissue layer, the cause is the same as acute lymphadenitis.
Route of transmission (20%):
The pathogenic bacteria invade from the damaged skin or other infected lesions, enter the lymphatic vessels through the lymphatic space of the tissue, causing acute inflammation of the lymphatic vessels and its surroundings, acute lymphangitis continues to spread to the local lymph nodes, or purulent lesions through the lymphatic vessels Spread to the lymph nodes of the region, causing acute lymphadenitis, lymph node congestion, swelling, leukocyte infiltration, inflammatory exudation, enlarged lymph nodes, central necrosis, infection continues to develop, can spread to the surrounding lymph node inflammation, more The lymph nodes adhere to a hard mass and can form a double-chamber or multi-lumen abscess.
Lymphatic vessels and surrounding diseased tissue are congested and swollen, causing lymphatic reflux.
Cancer and other diseases (20%):
Tumor, cyst or thyroid dysfunction.
Prevention
Shallow acute lymphadenitis and lymphangitis prevention
Keep the skin and mucous membranes of the mouth, perineum, and feet clean, and timely detect and actively treat various infectious diseases.
Complication
Shallow acute lymphadenitis and lymphangitis complications Complications bacteremia
The toxic product of the infection enters the bloodstream and can cause a systemic inflammatory response.
Symptom
Shallow acute lymphadenitis and lymphangitis symptoms common symptoms lymphadenopathy, loss of appetite, fever, abscess, chills, lumps
1. Lymph node enlargement, pain and tenderness. Acute lymphadenitis. Local lymphadenopathy, pain and tenderness can be distinguished from surrounding soft tissue. The surface skin is normal. When the lesion is aggravated, a mass is formed and it is difficult to distinguish the number of lymph nodes. Pain and tenderness are aggravated, the surface of the skin is red, fever, and there is a sense of fluctuation when the abscess is formed, and a few even break down the pus.
2. Cord-like red line, hard and tender acute lymphangitis, the lesion has one or more red lines extending to the proximal side of the limb, hard and tender, deep lymphangitis, no red line, but the limb swelling There is a strip of tenderness area (Figure 1).
3. Patients with systemic symptoms may have symptoms such as chills, fever, headache, general malaise and loss of appetite.
Examine
Examination of superficial acute lymphadenitis and lymphangitis
Peripheral blood
(1) White blood cell count: The change of white blood cell count depends on the toxicity and degree of infection of the pathogen, and is often closely related to the original infection.
(2) White blood cell classification and counting: In general, neutrophils are positively correlated with white blood cell count.
2. Bacteriology examination
(1) Pus smear.
(2) Bacterial culture.
(3) Drug sensitivity test.
Tuberculin test: as a reference for the identification of lymphatic tuberculosis.
Diagnosis
Diagnosis and diagnosis of superficial acute lymphadenitis and lymphangitis
diagnosis
1. Patients with medical history have infected lesions in the corresponding parts of the lymphatic drainage area.
2. Clinical manifestations of typical symptoms and signs of acute lymphadenitis and lymphangitis.
3. Laboratory examination of white blood cell count increased, neutrophil count increased.
Differential diagnosis
1. The secondary infection of the parotid gland is more common in newborns. It exists after birth. The mass is located in the anterior border of the sternocleidomastoid muscle, and the puncture fluid is a thin mucus.
2. Tuberculous lymphadenopathy is slow onset, tenderness, swelling is not as obvious as acute lymphadenitis, OT test is positive, puncture smear can find acid-fast bacteria, tuberculosis culture positive.
3. Cat scratching patients have a history of cat scratching, neck, axillary lymph nodes, tenderness, and finally purulent, no more bacterial growth in pus culture, positive antigen test.
