Lymphadenitis is a disease accompanied by an inflammatory lesion of the lymph nodes, often infectious etiology.
Lymph nodes are the most important components in the lymphatic system. They are involved in protecting the body. Lymphatic capillaries direct interstitial fluid into the lymph node system, which consists of large-dispersed proteins, fragments of dead cells, microorganisms and products of their vital activity. In addition, the lymph nodes include in their composition specific cells that are related to lymphocytes and macrophages. When an infection gets into the body, the defense system breaks down and the lymph nodes become inflamed, which leads to the development of lymphadenitis. This suggests that the immunity is weakened for various reasons.
The pathological process is influenced by the age of patients, infectious diseases, the presence of physical and psychological traumas in a patient's anamnesis and many others. Also, an increase in the lymph nodes leads to a disruption in their drainage function, namely, signs of hypertrophy of the lymph node, due to an overabundance of antibodies produced by it on foreign proteins that enter the human lymphatic system.
Lymphadenitis is a secondary condition, preceded by a primary disease, which gives rise to an inflammatory process. It is very difficult to diagnose lymphadenitis and this requires a thorough analysis of the collected anamnestic data and conducting the procedures necessary for setting up an accurate diagnosis.
So, the cause of specific lymphadenitis can be pulmonary tuberculosis , actinomycosis, yersiniosis, syphilis and human immunodeficiency virus. If a person discovers an enlarged lymph node, then he needs a specialist consultation.
Diagnosis of lymphadenitis is carried out according to the disease the physician is inclined to. For example, if lymph nodes are inflamed in the neck, lower jaw, or in the armpit, and there are clinical symptoms such as increased sweating, fatigue, and adhesions of the lymph nodes, this suggests that the patient has tuberculosis. To confirm the diagnosis, a chest X-ray is performed, the state of the respiratory organs is analyzed by the introduction of a bronchoscope, a general blood and urine test is administered.
But there are cases when it is quite easy to identify the causes of lymphadenitis. When the enlargement of the lymph nodes corresponds to only one or one zone, then the cause of the pathological process in the area of a certain area of the lymph drainage. For example, if there is a suppuration of the hand, this indicates that the lymph nodes of the armpit have become inflamed, since lymph from this part of the human body accumulates in these nodes. But it happens that the lymph nodes that carry out the barrier function do not allow microorganisms to penetrate the lymphatic system and then the inflammatory process is insignificant.
Furunculosis , carbuncles, erysipelas, osteomyelitis, thrombophlebitis , trophic ulcers are invariable companions of lymphadenitis. Enlargement of lymph nodes occurs in the same way with diseases of ENT organs ( tonsillitis , tonsillitis, pharyngitis, otitis), with childhood infections (parotitis, diphtheria , scarlet fever) and skin diseases ( pyoderma , diathesis of different etiology, eczema ). These causes of lymphadenitis are non-specific, because the disease causes ordinary streptococci and staphylococci, which are always present in the patient's body, but are activated only after negative influences have been influenced.
The clinic depends on the type of lymphadenitis. It happens: chronic and acute, nonspecific and specific.
Nonspecific lymphadenitis causes streptococci or staphylococci, their toxic substances and products of decomposition of the tissues of the primary focus. To the primary focus include purulent wounds, felonts, furuncles , carbuncles , necrosis of the osseous system, trophic ulcers and other processes. Toxic substances of microorganisms enter the body through lymph or blood, as well as by contact of the microbe with the lymph node as a result of its damage. In this case, this pathology is a primary disease.
If we take into account the nature of the exudate, then lymphadenitis is serous, hemorrhagic, fibrinous and purulent. The progress of the inflammatory process leads to the formation of destructive forms of lymphadenitis, such as abscess and necrosis, and when the cause leading to an increase in lymph nodes is a putrefactive infection, they are putrefied. The initial stage of lymphadenitis is characterized by minimal damage and sloughing of the epithelium. Then the tissue of the lymph nodes becomes saturated with serous fluid and an infiltrate is formed. In the final stage of lymphadenitis, lymphatic cells grow as a result of leukocyte migration.
With simple lymphadenitis, the focus of inflammation does not extend beyond the boundaries of the lymphocapsule. And the destruction of surrounding tissues leads to paralymphadenitis, which in turn can cause purulent inflammation, which differs from other forms by a more severe course of the disease.
Acute lymphadenitis has the following clinical signs: lymph node enlargement, headache , weakness, fever, inflammation of the vessels of the lymphatic system. The degree of severity of lymphadenitis symptomatology depends on the form of the disease and the nature of the inflammatory processes.
Serous lymphadenitis has almost no effect on the overall picture of the disease, only the clinic at the site of the enlarged lymph node is noted, which, first of all, consists in the painfulness of compaction during palpation. The progression of lymphadenitis leads to destructive changes. The pain intensifies, the skin in the area of the lymph nodes is hyperemic, with the palpation of the nodes there is a sharp soreness. Clear boundaries of seals are not present, they are prone to draining and the formation of one large fixed element. The temperature becomes subfebrile, the patient is concerned about heart palpitations, severe headache.
Chronic lymphadenitis is divided into primary-emerged, as a result of penetration into the body of a weakly infectious microflora and acute lymphadenitis, which took a protracted form. Clinic of these forms of lymphadenitis includes the following symptoms: lymph nodes are dense and painless when palpated, have no adhesions. Often their own cells are replaced by connective tissue, this leads to violations of lymphatic circulation, lymphostasis and extensive edema.
The group of specific lymphadenitis is lymphadenitis, caused by mycobacterium tuberculosis, pale treponema and others. So lymphadenitis in tuberculosis repeats the clinic of the underlying disease. Affected, as a rule, lymph nodes around the periphery, the patient notes their inflammatory-necrotic changes. The tuberculous intoxication of the organism progresses, namely: the patient is irritated, quickly tired, the appetite is lowered, the body temperature indices fluctuate from the norm to the low-grade figures.
Lymphadenitis of the submaxillary is a secondary disease. The root cause is inflammation of another organ, which leads to an infectious process in the lymph nodes. Often submaxillary lymphadenitis causes mechanical damage to the mandibular node with penetration into its wound of pathogenic microorganisms, namely streptococci and staphylococci. In addition, the focus of infection can be carious teeth and inflammation of the gums, through which microbes enter the lymphatic drainage. The source of infection is also chronic diseases of ENT organs: tonsillitis, inflammation of the maxillary sinuses and others, or pathogens of pulmonary and syphilis tuberculosis.
Lymphadenitis of the submaxillary is easily diagnosed. The lymph node is inflamed, the patient notes pain and redness in the area of compaction, locally hyperthermia is observed. If pus accumulates in the node, then the swelling of the tissues surrounding the knot is attached. The patient is weakened, his skin is pale, there is no appetite. In the analysis of blood, the leukocyte formula shifts to the left. At ultrasound examination, the presence of purulent contents in the node is revealed, with puncture it is easy to find out to which group of pathogens the bacterium that caused inflammation belongs.
With an acute process, a single lymph node always grows, rarely a group of nodes. Pus in this case accumulates in the closed compaction space and evenly applies pressure in all directions. This process is called fluctuation, which can lead to rupture of the lymph node and to the release of the contents into the surrounding tissues, which is fraught with the progression of inflammation. In this case, pain is noted not only in the area of the affected node, but also in the neck, which prevents the full opening and closing of the mouth.
Improper treatment of submandibular lymphadenitis translates the disease into a chronic form. Clinical symptoms are similar to those in acute lymphadenitis, but the seals become immobile, the patient experiences severe fever and chills. Also affected are adjacent to the knot tissue.
In children, the pathological process occurs with the same frequency as in the adult population. But up to three years submaxillary lymphadenitis can not arise, since the lymphatic system in the child is not yet developed. A small patient complains of soreness when palpating the cervical or submandibular lymph node. Parents with ease themselves can grope for seals, they become soft and mobile with further inflammation.
The cause of inguinal lymphadenitis are various infections, fungal, bacterial and viral etiology, malignant processes of the pelvis and abdominal cavity, furuncles, trophic ulcers and abscesses of the legs. Taking certain medications can also cause inguinal lymphadenitis.
Anatomically inguinal lymph nodes participate in the mechanism of lymph flow into the gluteal muscles, abdominal wall, anal canal, genitals and lower limbs. According to this, the lymph nodes of the inguinal zone are divided into three types: upper lymph nodes (buttocks and abdominal cavity), middle lymph nodes (anus, genitals and perineum) and lower lymph nodes (lower limbs). Inflammatory process can capture as one lymph node, and their group. There is serous lymphadenitis, which proceeds without necrosis of certain areas of the seals, and purulent lymphadenitis, leading to abscessing of the lymph node and surrounding tissues.
The clinic of inguinal lymphadenitis is diverse. Lymph nodes increase in size, there is pain, both at rest and during their palpation. When walking, patients feel a feeling of discomfort in the lower abdomen and a sharp soreness. Symptoms include fever, weakness, and chills. The inguinal lymphadenitis is complicated by localized edema and skin flushing. This suggests that puff is formed in the compaction, which is the main factor in rupturing the lymph node and releasing the contents into the interstitial space.
The acute form of inguinal lymphadenitis is characterized by a sudden onset of the inflammatory process, which manifests itself in the increase in lymph nodes and the concomitant symptomatology. The rapid development of inflammation passes into the formation of phlegmon , which leads to necrotic decay. This is fraught with the development of sepsis, therefore requires immediate medical intervention.
Women suffer inguinal lymphadenitis as often as men. Only they have lymphadenitis due to reasons related to the anatomical features of the female body. These can be ovarian cysts , infections caused by fungi of the genus Candida, cancer of the pelvic organs. The pathological process can provoke the formation of lymphogranulum - small sores, leading to the development of adhesions and fistulas, with a purulent discharge.
Men suffer from inflammation of the lymph nodes for reasons related to metastases in the internal and external genital organs, with venereal and infectious diseases. So, when a malignant tumor is formed, there is a need for surgical treatment, because the mechanism of metastasis of tumors to the lymph nodes starts. The speed of such a phenomenon is quite high and can lead to aggravation of the patient's condition. As a result, the prognosis of inguinal lymphadenitis is unfavorable.
Children are prone to increase this group of seals less often than adults. This is because the percentage of cases of infection with sexually transmitted diseases is low and the development of oncology of the inguinal region in children is not common. The causes leading to childhood inguinal lymphadenitis include: intrauterine infections, weakening of the immune system, disturbance of the lymphatic fluid flow and microtrauma of the adjacent neonatal tissues. These factors can be fatal for babies, as they lead to early mortality and develop concomitant pathology.
The clinical signs of inguinal lymphadenitis of all three age groups do not differ significantly and correspond to those listed above.
Cervical lymphadenitis is an inflammatory lesion of lymph nodes in the neck. To its provoking factors carry causative agents of a flu, a tonsillitis, a tonsillitis, a rhinitis and an otitis. Germs, getting into the body, try to hit the human immunity, but the protective system of lymph nodes blocks and localizes them. In response to this, the cervical lymph nodes increase and thicken. And with the progression of cervical lymphadenitis, other clinical signs come to the fore. The patient marks a headache, body temperature above 39 ° C, loss of appetite and increased fatigue. With timely treatment of cervical lymphadenitis, the swelling completely disappears on the 4th day. But if the lymphadenitis is acute or chronic, symptomatic treatment may be slightly different.
In the acute version of the disease, there are signs of severe suppuration of the lymph nodes, accompanied by high temperature and local changes. First, the seal has the appearance of a large furuncle, then its boundaries become less distinct and the lymph node loses mobility. Such a tumor can develop into an adenoma or cause sepsis. Chronic form of cervical lymphadenitis is prone to relapse. Sufficient is the transfer of a minor catarrhal infection on the legs and the inflammatory process will again manifest itself. In addition, chronic seals are a common symptom of pulmonary tuberculosis.
Children suffer from inflammation of the cervical lymph nodes with lymphadenitis quite often, but this does not, as a rule, have serious consequences. In the history of such a child there may be an allergy of different etiology, thyroid disease, pathological manifestations of connective tissue. Clinically, lymphadenitis is manifested by symptoms of intoxication, insomnia, lack of appetite and severe edema in the neck, which does not bring the baby any pain. With adequate treatment of cervical lymphadenitis, the risk of complications for the child is minimal, in neglected cases it can cause myocarditis , which is manifested by lethargy and dyspnea.
This is a pathological process that occurs against the background of catarrhal or purulent inflammation of the axillary lymph nodes and is not an independent disease. Serous form of axillary lymphadenitis is characterized by sensitivity and sharp soreness at the site of localization of the compaction, local changes are insignificant, adhesion processes are absent. The general condition of the patient does not suffer.
A purulent version of axillary lymphadenitis is described as a serious form of pathology. Inflammation of multiple lymph nodes and form among themselves, the so-called conglomerate, which in turn leads to adhesions. The patient becomes worse, he notices fever, tachycardia and severe headache. In the absence of therapy, the fused elements of the nodes tend to abscess and form adenoflegmona, with an unfavorable prognosis, this is the cause of sepsis.
The mechanism of triggering the development of the lymphadenitis of the axillary region causes all sorts of microorganisms, beginning with the more common staphylococci, streptococci, intestinal and pseudomonas aeruginosa, ending with the less common types of pneumococcus and diplococcus.
There are three ways of infection of the lymph nodes: through the lymph, blood and on contact of the wound surface with the bacterium. Clinic of lymphadenitis does not depend on the type of infection of a person with an infection. All three forms of axillary lymphadenitis are characterized by strong pulling of the armpit, redness and hyperthermia of the seals, in the late stage - inflammation, chills, fluctuation and leukocytosis. The pain syndrome with axillary lymphadenitis is so pronounced that the patient takes a forced position for the upper limb from the side of the lesion. In the area of inflammation in palpation, there may be crepitation - a characteristic sound reminiscent of "snow crunching". This is a serious clinical sign, indicating that the purulent process is spreading further.
Children's axillary lymphadenitis occurs in older age groups (children from 10 years old). Infection enters the bloodstream through various damages to the skin, resulting from rubbing and irritation of the skin in the armpits. To such infections carry: measles , scarlet fever, diphtheria and others. The disease develops very quickly, therefore the symptoms of acute and chronic stage of axillary lymphadenitis are not differentiated. In addition to a clinic similar to adults, children have insomnia, headache, and lack of appetite. In this case, the node, in view of the extensive inflammation of the adjacent tissues, is practically not palpable. It becomes dense and even more increases in size. To avoid surgical treatment, urgent specialist consultation and therapy of the underlying disease is needed.
Lymphadenitis in children
Lymphadenitis in children ranks first among diseases of infectious genesis, according to pediatric data. The explanation for this is that the physiological children's lymphatic system is not yet developed. Statistics estimated that most often lymphadenitis sick children from one to six years. Diagnose the disease in the office of a pediatrician, otolaryngologist, dentist, surgeon, immunologist or rheumatologist.
Children's lymphadenitis is classified into specific and non-specific forms, each of which has a sharp, subacute and chronic stage. According to the fluid that accumulates inside the compaction, lymphadenitis is infiltration, purulent or necrotic.
Lymphoid formations develop in children under nine years of age. In this period, the susceptibility of the child's organism to infectious agents is increased due to the reduced functional capacity of the protective system. Thus, the lymph nodes are involved in all the pathological processes taking place in the child's body. The cause of lymphadenitis in childhood are diseases of ENT organs, skin infections, dental pathology, childhood viral infections, which peak in autumn or winter. A specific form of lymphadenitis develops against a background of mononucleosis, brucellosis , actinomycosis, tuberculosis or syphilis.
The catarrhal stage of compaction begins with a painful increase in the regional lymph node, which loses mobility and develops a local skin reaction. The condition of a small patient worsens as the purulent infection becomes attached. This characterizes the onset of the second stage of lymphadenitis. The affected lymph node is sharply painful on palpation, visually mark swelling and swelling of the surrounding tissue. There is a possibility of a foci of fluctuations, which leads to the release of purulent contents into interstitial space. The third stage of lymphadenitis is the chronization of the process, when the node is dense, but the pain symptom is absent. In this case, the general condition of the child remains satisfactory until the underlying disease worsens.
The diagnosis is based on clinical data, collected anamnesis, laboratory studies of biological fluids and instrumental diagnostic methods.
Since the primary cause of lymphadenitis is a microbial infection, as a rule, antimicrobials are prescribed for inflammation. Antibiotics for lymphadenitis are Azithromycin, Amoxicillin or a combined preparation containing Amoxicillin and Clavulonic acid.
Azithromycin, or Sumamed is a broad-spectrum antibiotic. It is prescribed for various infectious diseases caused by pathogenic microflora. The convenience of using it is that it is enough to take it once a day, preferably at the same time, about an hour before a meal. The course of treatment of this drug for three days. Careful in its appointment should be a patient who has a history of diseases of organs such as the liver and kidneys. There may be side effects: dyspeptic disorders, abdominal pains, small punctual rash on the skin.
Amoxicillin is an antibacterial drug of the penicillin series. It is also relevant in the treatment of bacterial infections. Multiplicity of administration three times a day for 500 milligrams. The course of treatment is five to seven days. Contraindicated in pregnancy and in the presence of an allergic reaction to drugs of this group. Side effects include: allergies, the development of anaphylactic shock and fever.
The combination drug "Amoxiclav" contains such substances as Amoxicillin and Clavulonic acid. This is a dispersible dosage form, that is, it is necessary to dissolve in water before use. Assign one tablet three times a day, lasting not more than a week. Patients suffering from hepatitis or having an individual intolerance to penicillin antibiotics, the drug is contraindicated. Side effects include: dyspepsia , local allergic reactions, feelings of anxiety, dizziness and anemia.
Treatment with antibiotics for lymphadenitis is carried out under the compulsory supervision of the doctor who prescribed the drug. This method of therapy is mandatory for all forms of the disease. Specific signs characterize the treatment of various types of lymphadenitis. Thus, the acute nonspecific form is treated with conservative methods: physioprocedures, homeopathic remedies and removal of the primary focus. To fizioprocedures include ultra-high-frequency therapy and semi-alcohol compresses (sometimes, if purulent inflammation is absent, ichthyol ointment or dimexide is added to the compresses). Homeopathy includes the use of the drug Lymphomyosata. This is a liquid dosage form and is prescribed 25 drops three times a day for up to ten days. Surgical removal of the compaction is performed by a surgeon. Under local anesthesia, the wound is cleared of pus and necrotic areas of the lymph node. Then it is washed and put drainage, for further outflow from the wound purulent contents. Drainage is removed after seven days and clean bandages are continued until the wound is fully healed.
Treatment of chronic lymphadenitis consists in the therapy of the underlying disease. Thus, in the detection of pulmonary tuberculosis, Tubazide, Prothionamide or Ethionamide is used. Take the drug for a long time, up to a year and a half. Often, splinting of seals and compression dressings impregnated with Streptomycin are used.
Treatment of lymphadenitis in children significantly from the treatment of adults is no different. Take the same antibiotics and in the process of progressing resort to surgical intervention. Prevention of lymphadenitis is of great importance in children. It is necessary to monitor the hygiene of the child, avoid wearing tight clothing, which can cause surface wounds; in due time to address to experts in occasion of treatment of the chronic centers of infections, such as caries, a tonsillitis and many other things.