Overview

Lymphangitis is an inflammatory condition involving the lymphatic vessels, usually caused by a bacterial infection. It commonly presents with red streaks on the skin that extend from the site of an infection toward the nearest group of lymph nodes. Lymphangitis is considered a medical urgency because it can spread quickly and lead to serious complications like cellulitis, abscess formation, or sepsis if left untreated. Prompt diagnosis and treatment are essential to control the infection and prevent systemic illness.

Causes

The primary cause of lymphangitis is a bacterial infection that enters the lymphatic vessels through a break in the skin. The most common causes include:

• Bacterial Infections: Streptococcus pyogenes (Group A Streptococcus) is the most frequent causative organism, followed by Staphylococcus aureus.
• Skin Injuries: Cuts, insect bites, puncture wounds, or abrasions can introduce bacteria into the skin.
• Skin Infections: Conditions like cellulitis, abscesses, or infected wounds can progress to lymphangitis.
• Animal Bites: Bacteria from animal saliva may infect the skin and lymphatics.
• Fungal Infections: In rare cases, fungal organisms can cause lymphangitis, especially in immunocompromised individuals.
• Other Infections: Less commonly, parasitic infections such as filariasis can cause chronic lymphangitis, especially in tropical regions.

Symptoms

Lymphangitis typically develops rapidly and presents with noticeable local and systemic symptoms, including:

• Red Streaks on the Skin: Linear red streaks extending from the infected area toward nearby lymph nodes.
• Tenderness and Swelling: Pain, warmth, and swelling along the course of the lymphatic vessels.
• Fever and Chills: Systemic symptoms like fever, chills, and malaise are common as the infection spreads.
• Swollen Lymph Nodes: Enlargement and tenderness of nearby lymph nodes, known as lymphadenitis.
• Pain at the Infection Site: Localized pain or discomfort at the primary site of infection.
• Fatigue: Generalized tiredness and weakness may accompany more severe infections.

Diagnosis

Diagnosing lymphangitis typically involves clinical evaluation supported by laboratory tests when needed:

• Medical History: A detailed history of recent skin injuries, infections, or animal bites provides important diagnostic clues.
• Physical Examination: Observation of red streaks, lymph node enlargement, and systemic signs of infection.
• Blood Tests: Elevated white blood cell count and inflammatory markers (CRP, ESR) indicate systemic infection.
• Wound Culture: If a wound is present, culturing the area helps identify the specific bacteria responsible.
• Ultrasound: Used in some cases to rule out underlying abscesses or deep vein thrombosis if symptoms are severe.
• Blood Cultures: May be ordered if there are signs of sepsis to identify bacteria in the bloodstream.

Treatment

Treatment of lymphangitis focuses on controlling the infection, alleviating symptoms, and preventing complications.

Antibiotic Therapy

• Oral Antibiotics: Mild cases are treated with oral antibiotics effective against streptococcal and staphylococcal species, such as penicillin or cephalexin.
• Intravenous Antibiotics: Moderate to severe cases, or those with systemic symptoms, may require hospitalization and intravenous antibiotics.

Supportive Care

• Pain Management: Analgesics such as acetaminophen or ibuprofen to relieve pain and reduce fever.
• Hydration and Rest: Maintaining hydration and rest to support recovery.
• Elevation of Affected Limb: Elevating the affected area can help reduce swelling and promote lymphatic drainage.

Surgical Intervention

• Drainage of Abscesses: If an abscess forms, surgical drainage may be necessary.

Prognosis

With prompt and appropriate treatment, the prognosis for lymphangitis is excellent. Most patients recover completely within a few days of starting antibiotics. Delayed treatment, however, can lead to serious complications such as abscess formation, cellulitis, or sepsis, which can be life-threatening if untreated.

Patients with recurrent lymphangitis, especially those with underlying lymphedema or chronic skin conditions, may require long-term management strategies, including prophylactic antibiotics. Overall, early recognition, timely medical care, and proper wound hygiene are key to preventing complications and ensuring a full recovery.