Lymphadenitis

lymphadenitisLymphadenitis is an inflammation of the lymph nodes. Acute lymphadenitis almost always occurs as a complication of a local source of infection furuncle, infected wound or abrasion, etc., Pathogens (usually Staphylococcus) penetrate into the lymph nodes and lymph flow through the lymphatic vessels, often without inflammation of the latter, i.e., without the lymphangitis (see).
Purulent foci on lower limb complicated by the defeat of inguinal, at least - popliteal nodes; on the top - axillary, less - elbow; on the head, in the oral cavity and pharynx - neck. By the beginning of the acute lymphadenitis caused him a small focus of infection can disappear (for example, heal the festering wash the feet).
Acute lymphadenitis superficial lymph nodes appears first little pain in the groin, armpits, and so on, where probed increased and summarized, a bit painful node with clear contours, well-mobile ("rides" under the skin). Then the pain and swelling site increase, the contours of his lost its sharpness, mobility is limited (Poriadina - transition inflammation of the capsule site and adjacent tissue). Temperature can increase. With the further development of the process of the site is subject purulent melt with the formation of an abscess and the emergence of fluctuations (see Zublena), and at the break of pus in surrounding tissue occurs cellulitis (phlegmonous adenitis), followed by high fever, severe General condition, significant swelling, redness of the skin. Very dangerous spektralnaya cellulitis (see) Potential acute lymphadenitis multiple nodes of this group, which affects one after the other or simultaneously. In the first case after the breaking or opening one of the abscess near to it there is a new, second inflamed nodes merge into a "package", and in his festering of a large purulent cavity, sometimes separated by several partitions.
Observed and the consequent defeat of several groups of lymph nodes (for example, first the elbow, then the armpit). Such a trend is particularly dangerous - threatening sepsis (see).
Diagnosis of surface acute lymphadenitis simple. When the pop-swelling and tenderness of the lymph nodes in the presence of the source of infection or at least his traces indicates acute lymphadenitis.
To detect the first signs of lymphadenitis need to feel the regional lymph nodes at each purulent wound, abrasion, the ulcer on the foot, brushes, and so on Recognition deep acute lymphadenitis is often difficult. The only symptom may be a feverish state; in such cases, requires inpatient examination of a patient.
Prevention: prevention of infection in minor cuts, abrasions (iodine alcohol solution, aseptic bandage), abrasions, immediately remove splinters, treatment of angina, removal of carious teeth, etc.
Treatment of acute lymphadenitis: first, calm, warm (warm compress, warm heating pad), according to doctor - antibiotics. Processing primary site of infection is opening the abscess, chronic bladder, remove crusts from festering surface, etc. When fluctuations, and especially with the development of cellulitis - immediately cut, and then treatment, as with an infected wound (see the Wound, injury).
Chronic lymphadenitis is often tuberculosis. Tubercle bacilli penetrate into the lymph nodes through the blood or lymph from tuberculous lesion (mainly from a lesion in the lung). From superficial lymph nodes most often affects the neck. Slowly at first, almost painless increases their swelling, units gradually merge into "packages"that are further subject to melt with the formation of "cold" (without significantly increasing temperature) abscess. The skin is red, thin, abscess breaks through emitting cheesy (cheesy) masses and education persistently festering fistula. The disease lasts from several months to several years. Under favorable for the fistula with time heals, infiltration resolved.
Treatment: use protivomaljarijnye means (ftivazid, PAS and other) by a physician, improved food and other restorative measures, sometimes shows the removal of the affected sites. Every patient with chronic lymphadenitis is subject to examination in the hospital, especially because slowly progressive enlargement of the lymph nodes, a gradual merging them into the overall "package" without acute inflammatory events observed and the sarcoma lymph nodes, with chlamydia (see) and other Tuberculous lymphadenitis bronchial lymph nodes - see Bronchogenic. Cm. also the Lymph system.

Lymphadenitis (lymphadenitis; lymph+ GK. aden - iron) is an inflammation of the lymph nodes. Lymphadenitis is more likely to occur as a complication of acute, subacute and chronic inflammatory processes (boils, cellulitis, ulcers, fistulas, and so on). Lymphadenitis is accompanied by enlargement of the lymph nodes.
Pathogenesis. The infection enters the lymph nodes and lymph flow of primary purulent, can occur without prior lymphangitis, sometimes the primary focus will be so insignificant, that the occurrence of L. discover a place of infection is not possible. In rare cases, infection is possible to lymph nodes hematogenous route.
Lymphadenitis should be considered as a manifestation of the barrier function of the lymphatic system, limiting the spread of infection and toxins, but in some cases L. may cause the development of severe purulent process (sepsis).
Pathological anatomy. Acute lymphadenitis see the blood and serous soaking parenchyma site, the proliferation of elements reticular tissues and leukocyte infiltration. Further increases infiltration polinucleari, and exudate can take purulent. There are three forms of acute L.: simple, or catarrhal, hyperplastic and purulent. During the initial phase of catarrhal and hyperplastic L. inflammatory process may subside or take a chronic course. During suppurative lymphadenitis comes the destruction of the lymph node and its purulent fusion. Pus may long remain within the capsule of lymph node, limited pyogenic membrane, forming an abscess. Sometimes there is rapid collapse of capsules, and pus breaks in surrounding tissue.
In introducing HP usually develops Poriadina - inflammation of the surrounding tissue. In introducing the melt of fibre formed an abscess, surrounding the remains of the lymph node, or it can develop cellulitis (phlegmonous adenitis). It is especially putrid phlegmonous adenitis.


Acute lymphadenitis. Acute L. begins with pain in the area of regional lymph nodes and their increase in serous and hyperplastic forms. Enlarged lymph nodes is well palpated, tenderness them insignificant. With the development of purulent process pain increase is determined by a dense infiltrate, masking the contours of the lymph nodes, fever, hyperemia and edema sharply increase. Ill spare the affected area (especially sharp pain notes when lymphadenitis the groin area). Then in the field of infiltration appears fluctuation. If the abscess will not be opened, pus comes out or occurs phlegmonous adenitis, grows dense and painful infiltrate into the subcutaneous and intramuscular fat. A transition process to nearby lymph nodes.
Of purulent complications L., except abscess and adenomegaly may develop a common infection, tromboflebitov related vein, discontinuities of the walls of blood vessels, followed by bleeding.
Diagnosis of surface lymphadenitis is no problem. When deep L. limbs are marked spontaneous pain and swelling. The diagnosis to be confirmed upon detection of primary inflammatory focus, which served as a source of development L.
The prognosis for surface festering L., promptly treated favorable, with the transition purulent inflammation of the surrounding tissue is serious.
Treatment of serous forms L. conservative: recommended rest, heat, intramuscular penicillin, procaine blockade by A. C. Vishnevskaya. At the same time it is necessary treatment of primary tumor (opening the abscess, wound drainage and others).
During suppurative lymphadenitis shown surgery - incision, remove pus, dead tissue, drainage opened purulent cavities, antibiotics, sulfanilamides.
Chronic lymphadenitis develops with infections caused slabovrajenne pathogens (for example, infectious eczema, liderii and others). Chronic L. specific origin often-tubercular etiology, it affects the cervical lymph nodes, less bronchial and retroperitoneal. Chronic L. observed also in congenital or acquired syphilis.
Chronic lymphadenitis is characterized by enlargement of the lymph nodes. When nonspecific infections are identified some are moving enlarged lymph nodes, painless at a palpation. Tuberculosis palpable packages nodes average density; with syphilis increased nodes is very dense. Suppuration in chronic nonspecific L. are rare. For tuberculosis L. typical cheesy melting lymph nodes, which takes place in the absence of expressed General phenomena. At diagnosis is sometimes difficult to decide about the etiology of chronic lymphadenitis (tuberculosis, syphilis, chlamydia), which is of great importance for the correct treatment.
Important differential diagnosis HP metastases of malignant tumors in the lymph nodes. Bumpy surface of the infiltrate for chronic HP may cause the suspected tumor, and therefore to diagnose sometimes have to resort to puncture or biopsy.
In tuberculous lymphadenitis with caseous decay can develop fistulas, join purulent infection with the development of phlegmon and even sepsis or the process ends with the sequestration of tissues and scarring.
The outcome of chronic non-specific lymphadenitis origin often scarring and gradual atrophy of lymphoid tissue. Sometimes the growth of connective tissue in the lymph nodes of the extremities chronic L. may cause persistent stasis with the development of dense swelling in a limb and often elephantiasis.
Treatment of chronic lymphadenitis should be directed at eliminating the underlying disease. Deleting nodes are not shown, except tuberculosis HP cheesy decay, fistula and acceding purulent infection. In the prevention L. are important measures to prevent infection with small damages (lubrication iodine, aseptic bandage, security patches and other) and timely treatment of the primary foci of infection (opening and drainage of purulent foci, peace).