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Discussion Lymphangitis

Often confused with and called cellulitis; lymphangitis is an inflammation or infection of the lymphatic channels from an infection beginning elsewhere in the body. Due to the immuncompromised limb, lymphedema patients are quite susceptible to this infection.


Most commonly lymphangitis is caused either by the group A beta-hemolytic streptococcal bacteria or by Staph Aureus. Other bacterial causes include Pseudomonas, Aeromonas hydrophila, in the filarial regions lymphangitis is often caused by Wuchereria bancrofti.

Invasive bacteria enter throught a cut, scratch, insect bite, surgical wound or other skin injury.


Symptoms include red streaks extending from the primary infection sites through the affected area. These streaks may be painful and tender. Note tjat this is different then the “patches” or “splotches” of tend red areas associated with generalized cellulitis.

  • If the infection is in an arm or leg, you may have generalized limb swelling.
  • These symptoms may be accompanied by fever, chills, rapid hear rate and headache.


Diagnoses is generally achieved through the symptoms. A blood test also may be done to determine the exact pathogen, and or to determine if the bacterium has actually entered the bloodstream.

Risk Factors

Patients with any of the following disorders are more at risk for developing serious and or life threatening lymphangitis

Lymphedema, Diabetes, immunodeficiency(of any type), Varicella (cellulitis as a complication of), chemotherapy patients, venous insufficiency or venous stasis, chronic steroid users, post surgical patients, individuals with edema and finally age may also be a factor with infants and the elderly more susceptible to infections.


Complications can include bacteremia, septicemia, tissue necrosis, gangrene, amputation of the affected limb, death. It should be noted also that lymphangitis causes further damage to the lymphatics and thereby makes lymphedema worse. Other complications include skin abcesses.

In compromised patients, physicians must be careful to observe for a complicating gram-negative super infection that can accompany regular gram-positive bacteria. This can occur asa result of the even further depletion of the body's immune system.


Immediate treatment with appropriate antibiotics is the accepted therapy. These antibiotics can include Dicloxacillin, Cephlalexin (Keflex), Nafcillin; Bactrim; Augmentin, oxacillin.

IV antibiotics can include Unasyn, Gentamicin, Vancomycin.

In addition to the antibiotics, pain medication and anti-inflammatory medicines may be prescribed.


With early diagnosis and subsequent rapid treatment the outcome is actually excellent with the overwhelming number of patients making full recovery. In special risk groups however, there is a heightened risk of complication and morbidity.

It should also be noted that the medical literature reports secondary lymphedema can be and is caused by infections, including lymphangitis.

lymphangitis, lymphangeitis, lymphangiitis, lymphatic system, inflammation of the lymphatic channels, bacteremia, cellulitis, septic thrombophlebitis, superficial thrombophlebitis, glossary:necrotizing fasciitis|necrotizing fasciitis]], myositis, sporotrichosis


Lymphadenitis and lymphangitis

Medline Plus

Alternative names

Lymph node infection; Lymph gland infection; Localized lymphadenopathy


Lymphadenitis and lymphangitis are infection of the lymph nodes (also called lymph glands) and lymph channels, respectively.

Causes, incidence, and risk factors

The lymphatic system is a network of vessels (channels), nodes (glands) and organs. It functions as part of theimmune system to protect against and fight infection, inflammation, and cancers. It also functions in the transport of fluids, fats, proteins, and other substances within the body.

The lymph glands, or nodes, are small structures that filter the lymph fluid. There are many white blood cells in the lymph nodes to help fight infection.

Lymphadenitis and lymphangitis are common complications of bacterial infections.

Lymphadenitis involves inflammation of the lymph glands. It may occur if the glands are overwhelmed by bacteria, virus, fungi, or other organisms and infection develops within the glands. It may also occur as a result of circulating cancer cells or other inflammatory conditions.

The location of the affected gland(s) is usually associated with the site of the underlying infection,tumor, or inflammation. It commonly is a result of a cellulitis or other bacteria infection (usually infection by streptococci or staphylococci).

Lymphangitis involves the lymph vessels/channels, with inflammation of the channel and resultant pain and systemic and localized symptoms. It commonly results from an acute streptococcal or staphylococcal infection of the skin (cellulitis), or from an abscess in the skin or soft tissues.

Lymphangitis may suggest that an infection is progressing, and should raise concerns of spread of bacteria to the bloodstream, which can cause life-threatening infections. Lymphangitis may be confused with a clot in a vein (thrombophlebitis).



  • lymph nodes feel smooth or irregular to touch, or soft and “rubbery” if an abscess has formed
  • the skin over a node may be reddened and hot


  • red streaks from infected area to the armpit or groin
  • may be faint or obvious
  • throbbing pain along the affected area (common)
  • may involve the lymph nodes (see above)
  • fever of 100 to 104 degrees Fahrenheit and/or chills
  • individuals may have a general ill feeling (malaise), with loss of appetite, headache, and muscle aches

Signs and tests

An examination shows affected lymph nodes and/or lymph vessels and may indicate the cause. The health care provider may look for evidence of trauma around enlarged or swollen nodes.

A biopsy and culture of the affected area or node may reveal the cause of the inflammation. Blood cultures may reveal spread of infection to the bloodstream.


Lymphadenitis and lymphangitis may spread within hours. Treatment should begin promptly.

Specific antibiotics are used to control infection, when this is diagnosed as the underlying cause of lymphadenitis. Analgesics may be needed to control pain with lymphangitis.

Anti-inflammatory medications may help reduce inflammation and swelling. Aspirin may be recommended as an analgesic, anti-inflammatory, and fever reducer. (Consult the health care provider before giving aspirin to children!)

An abscess may require surgical drainage. Hot moist compresses may help to reduce inflammation and pain.

Expectations (prognosis)

Prompt treatment with antibiotics may result in complete recovery, though it may take weeks, or even months, for swelling to disappear. The amount of time until recovery occurs will vary depending on the underlying cause.


  • abscess formation
  • cellulitis
  • sepsis (generalized or bloodstream infection)
  • fistula formation (seen with lymphadenitis due to tuberculosis)

Calling your health care provider

Call your health care provider or go to the emergency room if symptoms indicate lymphadenitis or lymphangitis


Good general health and hygiene are helpful in the prevention of any infection

Update Date: 8/15/2003


Erysipelas and lymphangitis in patients undergoing lymphedema treatment after breast-cancer therapy.

Jun 2009

Pereira de Godoy JM, Azoubel LM, Guerreiro Godoy Mde F.


Department of Medical School in São José do Rio Preto-FAMERP, Godoy Clinic in São José do Rio Preto-Brazil, Rua Floriano Peixoto, 2950, São José do Rio Preto-SP, 15020-010.



The aim of this study was to evaluate the prevalence of erysipelas and lymphangitis in a group of patients under treatment for lymphedema after breast-cancer therapy.


A random observational prospective study of the incidences of lymphangitis and erysipelas was performed for 66 patients with arm lymphedema after breast-cancer treatment. The study was carried out between March 2006 and December 2007 at the Godoy Clinic in Sãoo José do Rio Preto, Brazil. The clinical evaluation of the participants was performed weekly before the start of treatment, with patients being required to immediately report any complications to the attending service.


The mean time of follow-up of the patients between their treatment for breast cancer and the start of this study was 12.3 months, and three complications (4.5%) occurred; two cases of lymphangitis were reported after insect bites and one case of erysipelas after a hand injury, with repeat episodes reported by all three patients.


In spite of prophylactic advice regarding lymphangitis and erysipelas during treatment for lymphedema after breast-cancer therapy, patients are subject to complications; however, this in itself does not justify the use of prophylactic antibiotic therapy.


Herpetic recurrent upper limb lymphangitis

Rev Med Interne. 2008 Feb

Cendras J, Sparsa A, Soria P, Turlure P, Bordessoule D, Bonnetblanc JM, Bedane C. Service de dermatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France.

Upper limb lymphangitis often complicates varied wounds on the hand or forearm and improvement is obtained in a few days with adapted antibiotic therapy. A 28-year-old woman presented since few years episodes of lymphangitis of the arm associated with vesicles on an erythematous base, on the palmar face of the first phalanx of the index finger, spontaneous relief within 10 days, without antibiotic therapy. Herpetic origin was confirmed on viral culture. No primary infection neither recurrence was noted. Because of the recurrences, a prophylactic treatment with valaciclovir was instituted. There was no reported recurrence at two years follow-up. Upper limb lymphangitis rarely complicates herpetic whitlow in immunocompetent patient. Clinicians should be aware of viral lymphangitis, which is often overlooked and associated with diagnostic errors and treatment delay.

Elsevier - Science Direct

Lymphangitis - Antibiotic Guide

Johns Hopkins


Paul Auwaerter, M.D. 05-16-2007


  • Streptococcus pyogenes (Group A Streptococcus)
  • Pasteurella multocida
  • Nocardia
  • Atypical Mycobacteria
  • Sporothrix schenckii
  • Filariasis
  • Group A streptococci and S. aureus are the most common bacterial causes. Others less common to rare.


Frequently hx of trauma or skin lesion distal to the affected area followed by acute onset of symptoms.

Painful/tender erythematous linear streak on the skin progressing towards draining regional lymph nodes. Tender lymphadenopathy commonly with fever, chills and malaise.

Lymphangitis of hands and arms associated with higher morbidity since infection can bypass elbow nodes progressing directly to subpectoral nodes.

Ddx: thrombophlebitis, contact dermatitis, linear bruises, other infections with lymphangitic spread such as sporotrichosis and atypical mycobacterial infections.

Lab: Gram stain and cx of pus if infected wound or suppurative lymph node present. Leukocytosis with marked increase in PMN's.

Subacute disease or lack of clinical response to routine antibiotics should prompt consideration of fungal, mycobacterial pathogens or potentially carcinomatosis-related lymphangitis all best evaluated by biopsy.


Systemic-bacterial lymphangitis, empiric

  • Penicillin G benzathine 1.2 mil.U IM x1 or penicillin G 1-2 mil.U IV q4-6h followed by amoxicillin 500mg PO q6h to complete 10-14d
  • Cefazolin 1g IV q6-8h followed by amoxicillin or cefuroxime 500mg PO bid to complete 10-14d.
  • Clindamycin 600mg IV q8h followed by 300mg PO qid to complete 10-14d.
  • MRSA rarely described as cause of lymphangitis.
  • Animal-bite related (see Bite wound module for details): ampicillin-sulbactam 1.5-3.0gm IV q6h or amoxicillin-clavulanate 500mg PO tid or 875mg PO bid.
  • If culture positive, use results to guide therapy.

General Care

  • Immobilization.
  • Elevation of the affected area.
  • Hot packs or hot compresses q4h.


Lymphangitis is a potentially serious disease with frequent development of bacteremia, sepsis and metastatic infection

Therapy has to be instituted promptly and parenterally when systemic symptoms are present. Consider evaluate for deeper tissue process, especially necrotizing fasciitis.

Animal bites are a common cause of lymphangitis and, in this setting, Pasteurella multocida, S. aureus and anaerobic bacteria can also be involved

Pathogen Specific Therapy

Basis for Recommendations

Sadick NS; Current aspects of bacterial infections of the skin.; Dermatol Clin; 1997; Vol. 15; pp. 341-9; ISSN: 0733-8635; PUBMED: 9098643

Rating: Basis for recommendation

Comments: Lymphangitis is a potentially serious infection therefore treatment should be aggressive and parenteral in most instances. Treatment can be switched to oral medications once the disease is stable.



Erysipelothrix rhusiopathiae Wucheria bancrofti Streptococcus pyogenes (Group A)

Johns Hopkins

Acute Lymphangitis


Acute lymphangitis is an inflammatory process involving the subcutaneous lymphatic channels. It is due most often to group A streptococcus (GAS) but occasionally may be caused by Staphylococcus aureus; rarely, soft tissue infections with other organisms, such as Pasteurella multocida herpes simplex virus may be associated with acute lymphangitis.


Acute lymphangitis affects a critical member of the immune system—the lymphatic system. Waste materials from nearly every organ in the body drain into the lymphatic vessels and are filtered in small organs called lymph nodes. Foreign bodies, such as bacteria or viruses, are processed in the lymph nodes to generate an immune response to fight an infection.

In acute lymphangitis, bacteria enter the body through a cut, scratch, insect bite, surgical wound, or other skin injury. Once the bacteria enter the lymphatic system, they multiply rapidly and follow the lymphatic vessel like a highway. The infected lymphatic vessel becomes inflamed, causing red streaks that are visible below the skin surface. The growth of the bacteria occurs so rapidly that the immune system does not respond fast enough to stop the infection.

If left untreated, the bacteria can cause tissue destruction in the area of the infection. A pus-filled, painful lump called an abscess may be formed in the infected area. Cellulitis, a generalized infection of the lower skin layers, may also occur. In addition, the bacteria may invade the bloodstream and cause septicemia. Lay people, for that reason, often call the red streaks seen in the skin “blood poisoning.” Septicemia is a very serious illness and may be fatal.

Symptoms of Acute Lymphangitis: fever, chills, a rapid heart rate, a headache, Rash, Red blotchy skin,Itching of the affected area, Discoloration, Increase of swelling and/or temperature of the skin, Heavy sensation in the limb (more so than usual), Pain

In many cases a sudden onset of high fever and chills

See: and


ICD Codes

ICD-9 - 189.1 - Lymphangitis


· NOS · chronic · subacute

Excludes: acute lymphangitis ( L03.- )

2008 ICD-9-CM Diagnosis 457.2

Lymphangitis 457.2 is a specific code that can be used to specify a diagnosis 457.2 contains 6 index entries View the ICD-9-CM Volume 1 457.* hierarchy

457.2 also known as: Lymphangitis: NOS chronic subacute

457.2 excludes: acute lymphangitis (682.0-682.9)

External Links

Successful treatment of nodular lymphangitis due to Mycobacterium chelonae in two immunosuppressed patients.


Last Updated: July 1, 2003

Synonyms and related keywords: lymphangeitis, lymphangiitis

Author: Raymond D Pitetti, MD, MPH, Medical Director of Fast Track, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine




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lymphangitis.txt · Last modified: 2012/10/16 14:40 (external edit)