Ultrasound of the lymph nodes. Reactive lymphadenitis

Lymphadenitis is an inflammatory process lymph nodes, specific and non-specific. Occurs when staphylococcal and streptococcal infections enter the patient's body. The disease is observed both in adults and in children and adolescents.

Pathology can be divided into two main groups:

• non-specific;
• specific.

The causative agents of the non-specific form of the disease are, as a rule, all kinds of pyogenic microbes that enter the lymph nodes from the foci of inflammation, accompanied by purulent processes, along with the blood stream or with close contact.

This disease is divided into purulent and non-purulent, according to the form of the course, it is divided into acute and chronic. Purulent lymphadenitis forms a focus of suppuration, called adenophlegmon.

A specific form of lymphadenitis is caused by pathogens of such well-known diseases as: tuberculosis, syphilis, gonorrhea, actinomycosis, plague, anthrax, tularemia and other similar infections.

Lymphadenitis in children is caused by diseases of the throat, nose and ears, common childhood infections and skin diseases.

Especially often, lymphadenitis in children manifests itself in autumn and winter, when chronic diseases worsen and respiratory infections are present.

The main symptoms indicating this disease may be the appearance of swelling and painful sensitivity, in the vicinity of inflamed lymph nodes.

Acute lymphadenitis manifests itself rather quickly, initially the lymph node increases with subsequent painful sensations, the mobility of the place where lymphadenitis has formed is often limited.

The symptoms of this type of disease are continuous headache, the patient develops weakness, malaise, fever.

Chronic lymphadenitis begins with an enlarged lymph node, it is easily palpable, does not cause pain. The increase in the size of the node does not affect the well-being of a person, and the body temperature remains unchanged.

Regional lymphadenitis is manifested by an inflammatory reaction that collects lymph from this zone, usually observed in the presence of small wounds in a certain area.

Purulent lymphadenitis is characterized by intense and throbbing pain. Lymph nodes are connected to the surrounding tissues, and after that they become immobile.

Mesenteric lymphadenitis or mesadenitis causes inflammatory processes in the mesenteric lymph nodes, especially often observed in children and adolescents. Manifested by pain in the abdomen with localization in the navel, accompanied by nausea, in rare cases, vomiting.

Tuberculous lymphadenitis - a disease caused by tuberculous inflammation of the lymph nodes, is considered a type of tuberculosis. Tuberculous lymphadenitis can develop as a complication of pulmonary tuberculosis, often the disease captures the cervical and supraclavicular lymph nodes, which increase in size, but do not hurt.

Reactive lymphadenitis may occur due to local disorders. Reactive lymphadenitis, after the elimination of the causes that caused it, is quickly treatable.

Symptoms of the disease: mild, fever and headache are not observed.

Acute serous lymphadenitis is manifested by an increase in the size of the lymph node, which remains mobile, has a round and oval shape, the body temperature rises.

Submandibular lymphadenitis is the most common form of inflammation of the lymph nodes located under the jaw. This pathology can occur due to diseases of chronic tonsillitis, gum inflammation or advanced caries.

This disease is characterized by a gradual increase in symptoms, therefore, it is so important to establish a diagnosis at the very beginning of the disease in order to quickly cure submandibular lymphadenitis.

Axillary lymphadenitis characterizes inflammation of the lymph nodes and involves the collection of lymph from the face, neck, collarbone, shoulder girdle and chest. Metastases of a breast tumor spread to the lymph nodes of the base of the neck.

Granulomatous lymphadenitis is characterized by the presence of granulomas or groups of histiocytes. Granulomatous inflammation occurs if the patient's body contains mycobacteria, spirochetes, chlamydia, micrococci.

Node magnification sizes and degree pain depends on the course of inflammation and the causes of its occurrence.

Diagnosis of the disease involves a primary examination of the lymph nodes with the help of palpation. If the patient is healthy, the nodes are quite soft, do not hurt and are not enlarged.

Then, depending on the results of the survey, a decision is made to use other tests:

• general analysis blood, indicating a change in its composition;
• ultrasound examination of lymph nodes and organs abdominal cavity;
• computed tomography;
• examination by an ENT doctor;
• opening and drainage of purulent wounds;
• conduct tests that exclude the diagnosis of Quincke's edema in children;
• at the diagnosis of specific lymphadenitis: skin-allergic tests, microscopic examination of sputum, blood test, X-ray examination are carried out, the presence of contact with patients with tuberculosis is checked.

Depending on the causes contributing to the development of lymphadenitis, a treatment method is chosen. The disease should be treated immediately after diagnosis.

Therapy of lymphadenitis is dictated by the reasons contributing to its development. Treatment of pathology should begin immediately, when the first signs of it appear.

Usually, if lymphadenitis is caused by respiratory infections, a viral infection is treated first, and then the underlying disease.

To establish a diagnosis and prescribe accordingly proper treatment, you need to know which doctor to contact?

As a rule, the patient initially turns to a general practitioner, and if necessary, he refers to narrow specialists - a surgeon, an oncologist, an endocrinologist.

At initial signs lymphadenitis, conservative treatment is used.

• rest conditions are created for the diseased area;
• physiotherapy treatment is carried out;
• medicines and ointments are used to relieve inflammation;

When the infectious cause of lymphadenitis is confirmed, it is treated with antibiotics, to which the causative agent of the disease that caused the occurrence of lymphadenitis is sensitive.

When a tuberculosis infection is diagnosed, treatment is carried out in a hospital with the use of anti-tuberculosis therapy.

In the case of a diagnosis of purulent lymphadenitis, an opening and drainage of the festering cavity is performed. After that, the patient is recommended systematic treatment of the wound surface and its dressing.

For the treatment of lymphadenitis can be prescribed different kinds drugs:

• antibiotics that eliminate the infection;
• analgesic drugs that reduce painful manifestations;
• anti-inflammatory drugs that relieve swelling and inflammation.

When diagnosed with purulent or acute lymphadenitis, you should not self-medicate, this can lead to disastrous results, the most correct decision in this situation is to contact a medical institution where you will be prescribed an effective treatment that will contribute to a speedy recovery.

Traditional medicine in combination with medicines, will also help in the treatment of lymphadenitis. Best result in the treatment of a disease carried out at home, the following folk remedies can provide:

Decoction of aloe

• a decoction made from aloe leaves is mixed with crushed walnuts and honey;
• drink a decoction 3 times a day, 1 tbsp. spoon just before eating.

• soak gauze with celandine infused with alcohol;
• at night we apply to the knot on the neck;
• we cover the celandine compress with a warm scarf.

In the treatment of the disease, echinacea has a positive result, which can be taken orally and make compresses from it.

Treatment of lymphadenitis with medication and folk remedies give positive effect, the symptoms of the disease decrease, the long-awaited recovery occurs.

After recovery, take any wounds seriously and avoid infection in them. If the infection has entered the body, it must be treated. To do this, you need to consult a doctor - a surgeon, here the abscesses will be opened and processed. Do not forget about personal hygiene, which will protect against the penetration of infection into the body. Limit contact with infected patients, and if it does happen, take antiviral drugs.

> > > Lymphadenitis - causes and treatment

The increase in the size of the lymph nodes is based on various pathological processes, which determines the clinical interdisciplinarity of the LDP syndrome. In this regard, doctors of various specialties (internists, infectious disease specialists, oncologists, hematologists, morphologists, etc.) can become real participants in the diagnostic process in a patient with LDP. At the same time, the successful solution of the differential diagnostic problem largely depends on the constructive interaction of many specialists and their awareness of diseases manifested by an increase in LU.

Main problem differential diagnosis in LDP is primarily in the similarity of the clinical picture of tumor and non-tumor LDP. Lymphadenitis and reactive LN hyperplasia are an important component of the LDP syndrome. According to a study at the Hematological Research Center of the Ministry of Health and Social Development of Russia, non-tumor LDP account for 30% of the reasons for primary visits to a hematologist for enlarged lymph nodes. Nosological diagnosis is established only in 50% of cases in patients with non-tumor LDP.

Diseases and pathological processes accompanied by LDP

The main pathological processes that cause an increase in LU are infections, tumor lesions (primary or metastatic), immunoproliferative and dysmetabolic processes (Fig. 1).

LDP of infectious origin can be caused by a direct infectious lesion of the LN with the introduction of an infectious agent by the hematogenous or lymphogenous route into the tissue of the LN (tuberculosis, actinomycosis, purulent lymphadenitis, viral infections) or reactive inflammation in response to an infectious focus in the corresponding zone (axillary lymphadenitis with panaritium, inguinal lymphadenitis with erysipelas of the lower limb or genital infection, submandibular lymphadenitis with oropharyngeal infection, etc.). A clear distinction between these 2 forms is to a certain extent conditional and is associated with the level of diagnostic examination (morphological, immunological, the use of PCR, etc.). With the same infection, LDP can be both infectious and reactive in nature (primary tuberculous affect, LU tuberculosis).

Tumor lesions of the lymph nodes can be primary (lymphoproliferative tumors) or secondary - with leukemia or cancer (metastatic process). Tumor LDP account for about 70% of all patients' visits to specialized departments for an increase in the LU.

Immunoproliferative LDP. This term is not generally accepted and can be used in cases where the increase in LU is not associated with either infection or tumor process. At the same time, proliferation of immunocompetent cells or granulomatous inflammation occurs in the LU due to various disorders in the system of cellular, humoral and nonspecific immunity.

Dysmetabolic LDP is due to the proliferation of phagocytic mononuclear cells in the lymph nodes or the deposition of amyloid in the corresponding diseases.

Diagnostic search in patients with LDP

The direction of diagnostic search in LDP is determined primarily by clinical situations, i.e., information obtained during the initial examination of the patient (history, physical examination), routine laboratory data - mainly peripheral blood indicators. In the differential diagnosis of LDP, the main guidelines are:

• age of patients;
• anamnestic information;
• the nature of the LDP (localization, prevalence, size, texture, pain, mobility of the lymph nodes);
• the presence of other clinical signs (enlarged spleen, fever, skin rashes, articular syndrome, lung damage, etc.);
• indicators of peripheral blood.

Each of the above signs has a different and ambiguous diagnostic value. So, fever or anemia in a patient with LDP can be a manifestation of not only an infectious and tumor process, but also some systemic vasculitis (systemic lupus erythematosus (SLE), Still's disease, etc.). At the same time, the detection of blast cells in the peripheral blood almost unequivocally indicates the presence of acute leukemia in the patient and requires only clarification of its morphological variant. Diagnostic search for LDP can conditionally include several stages, each of which solves specific tasks to achieve the ultimate goal - nosological diagnosis in a patient with the presence of LDP syndrome.

I stage of diagnostic search. Revealing

enlarged LU and its difference

from non-lymphoid formations

At this stage of the diagnostic search for primary examination the patient should develop skills and abilities to detect enlarged LU. At the same time, the ability to distinguish an enlarged LN from non-lymphoid formations of various localization is important. Such non-lymphoid formations, which present difficulties in differential diagnosis, include neck cysts, fibromas, lipomas, additional lobules of the mammary gland, thyroid nodules, hidradenitis, parotid enlargement. salivary glands and more rarely occurring non-lymphoid nodules (Weber-Christian panniculitis, etc.). Non-lymphoid volumetric formations in the cervical and axillary regions occur in almost 5% of cases among patients referred to specialized institutions due to "increased LU".

II stage of diagnostic search.

Localization and prevalence of LDP

After verifying the identified formation of an enlarged LN, it is necessary to determine various localization and assess the prevalence of LDP. This may be important in determining the direction of further diagnostic search.

The localization of enlarged LUs makes it possible to suspect a range of diseases in order to conduct further targeted research. Thus, posterior cervical lymph nodes usually increase with scalp infections, toxoplasmosis, and rubella, while anterior (parotid) lymph node enlargement suggests infection of the eyelids and conjunctiva. Often detected local increase in the cervical lymph nodes is a consequence of infections of the upper respiratory tract, nasopharynx, infectious mononucleosis, however, it is also necessary to exclude both lymphoproliferative tumors (lymphogranulomatosis) and metastases in the lymph nodes of tumors of various localization (head and neck, lungs, milk and thyroid gland). At the same time, the increase in supraclavicular and prescalene LNs is almost never reactive, but is more often associated with lymphoproliferative tumors (lymphogranulomatosis), metastatic tumor process (tumors of the stomach, ovaries, lungs, mammary glands).

Depending on the prevalence, the following variants of LDP should be distinguished:

• local - an increase in one LU in one of the areas (single cervical, supraclavicular LU);
• regional - an increase in several LUs in one or two adjacent areas (supraclavicular and axillary, supraclavicular and cervical, occipital and submandibular LUs, etc.);
• generalized - an increase in the LU of three or more areas (cervical, supraclavicular, axillary, inguinal, etc.).

With all the relativity of such a division, the prevalence of LDP may be important when putting forward a preliminary diagnostic hypothesis after the initial examination of the patient.

The anatomical position of the LN in localized LDP makes it possible in many cases to narrow down the differential diagnostic search. So, for example, cat scratch disease is characterized by damage to the cervical and axillary, and in sexually transmitted infections, inguinal LU. An increase in one LU often requires the exclusion of a primary or metastatic tumor process; may be a reactive response to a local infectious and inflammatory process in the relevant area (reactive inguinal lymphadenitis in genital infections, an increase in submandibular lymph nodes in acute tonsillitis, etc.). Regional LDP with a predominant increase in the occipital and posterior cervical lymph nodes is more characteristic of infectious mononucleosis. Generalized LDP is detected in various diseases: infectious (viral infections, toxoplasmosis), systemic (SLE), lymphoproliferative tumors (chronic lymphocytic leukemia).

Along with the prevalence of LDP, it is necessary to assess the size and consistency of the LN. This is not a defining feature, but it can serve as a rationale for the advancement of a preliminary diagnostic hypothesis (suspicion of a tumor process in the presence of a dense LN larger than 1 cm, pain during inflammation, fluctuation during abscess formation, etc.).

III stage of diagnostic search.

Identification of additional signs in patients with LDP

When determining the direction of the diagnostic search, it is important that the patient has additional clinical signs detected during the initial examination (anamnestic, clinical) and routine laboratory and instrumental studies (chest x-ray, complete blood count).

The age of patients can be one of the guidelines that determine the direction of the diagnostic search, since a number of diseases manifested by LDP have a certain “age attachment”. It is known that infectious mononucleosis is more common in childhood and adolescence, and chronic lymphocytic leukemia - in the elderly and the elderly. Of course, the age of the patient cannot be decisive in making a diagnosis; it only serves as one of the guidelines.

Anamnestic information (extremity injury, surgical interventions, the presence of an implant, travel, contact with some patients, etc.) make it possible to determine the direction of the diagnostic search, and in some cases can become decisive in the differential diagnosis of LDP (the presence of a disease in the patient, manifested by an increase in the LU, taking certain medications).

Clinical signs. Careful clinical examination of a patient with LDP in order to identify various additional symptoms, among which the most important diagnostically are:

• lesions of the skin and mucous membranes (macular-papular rashes, hemorrhages, scratches, bites, ulcers, etc.);
• liver enlargement;
• splenomegaly;
• articular syndrome;
• fever;
• respiratory symptoms;
• changes in the ENT organs;
• urogenital symptoms.

The detection of an enlarged spleen in a patient with LDP is more typical for viral infections (infectious mononucleosis), acute and chronic lymphocytic leukemia, systemic diseases (SLE, Still's disease in adults). Articular syndrome is more often associated with systemic diseases ( rheumatoid arthritis, SLE, Still's disease). The presence of skin rashes primarily requires the exclusion of viral infections, SLE, Still's disease.

IV stage of diagnostic search.

Peripheral blood test

Among routine laboratory methods differential diagnosis in patients with LDP mandatory is the study of indicators of peripheral blood. When interpreting the revealed changes in peripheral blood, it is necessary to take into account their unequal specificity. So, persistent absolute lymphocytosis with the presence of Gumprecht cells is pathognomonic. laboratory sign chronic lymphocytic leukemia, and the presence of blast cells in the blood may indicate either lymphoblastic leukemia or leukemization of lymphomas. Signs such as neutrophilic leukocytosis, leukopenia (neutropenia), thrombocytopenia are not specific, since they can occur in a wider range of diseases accompanied by LDP (Table 1).

Along with a general analysis of peripheral blood during the initial treatment of a patient with LDP, mandatory studies are: x-ray examination chest, ultrasound of the abdominal organs, immunoserological studies (syphilis, HIV infection, hepatitis B and C). Figures 2 and 3 show diagnostic search algorithms for local (regional) and generalized LDP.

Difficulties in differential diagnosis in local or regional LDP lie primarily in the ability to detect a local inflammatory process of an infectious (more often) or non-infectious nature and associate the identified local pathology with an increase in the LU of the corresponding area. The most frequent local inflammatory processes, accompanied by an increase in regional LU, which should be identified, are the following:

• acute tonsillitis (tonsillopharyngitis);
• stomatitis;
• otitis media;
• eczema of the face, limbs;
• conjunctivitis;
• acute thrombophlebitis of the extremities;
• erysipelas (face, limbs);
• boils, carbuncles;
• felons;
• scratches, bites;
• inflammation of the external genitalia.

When a local inflammatory process in patients with an increase in regional lymph nodes, the situation is regarded as reactive lymphadenitis. Methods of cytological and histological diagnostics in the acute phase of the disease are not very informative due to the difficulties in interpreting the morphological picture against the background of reactive hyperplasia of the lymphoid tissue. For the final verification of the nature of LDP, it is necessary to assess the dynamics of local inflammation and regional LDP against the background of ongoing therapy (antibiotics, surgery) or spontaneous reverse development. In cases of persistent LN enlargement, despite the regression of the local inflammatory process, especially in the presence of dense LNs, a LN biopsy is indicated for histological examination. Figure 4 shows the diagnostic value of additional clinical signs detected during the initial examination in patients with LDP.

Literature

Williamson M.A.J. Lymphadenopathy in family practice: A discriptives study of 240 cases // J. Fam. Pract. 1985 Vol. 20. R. 449.

Dvoretsky L.I. Differential Diagnosis with lymphadenopathy. Handbook of practical doctor. 2005. V. 3. No. 2. S. 3-12.

Vorobyov A.I. (ed). Guide to hematology. M., 1990. T. 1. S. 423-426.

Henry P, Longo D. Enlarged lymph nodes and spleen. In the book: Internal illnesses by Tinsley R. Harrison. M.: Practice, 2002. S. 410-417.

Pangalis G.A. et al. Clinical approuch to lymphadtnopathy // Semin. oncol. 1993 Vol. 20. R. 57.

Cohen J. Infectious mononucleosis and other Epstein-Barr virus infections. In: Internal Diseases by Tinsley R. Harrison. M.: Practice, 2002. T. 1. S.1330-1338.

Melikyan A.L. Algorithm for the diagnosis of non-tumor lymphadenopathies // Clinical oncohematology. 2009. No. 4. S. 306-316.

Ferrer R. Lymphadenopathy: differential diagnosis and evaluation // Am Fam Physician. 1998 Oct 15 Vol. 58(6). R. 1313-1320.

Reactive lymphadenitis (inflammation lymph glands) is a non-independent disease. This pathological process is a concomitant symptom of various diseases, both bacterial and viral etiology.

Reactive lymphadenitis characterizes the initial phase (reactive) of disorders, in the form of a primary reaction to the focus of infection in the human body.

Treatment of lymphadenitis itself will not be effective without determining the exact cause that caused pathological condition.

What is reactive lymphadenitis

Reactive lymphadenitis is part of a general chain of painful changes that are almost asymptomatic. Accordingly, a reactive change in the lymph nodes is initial manifestation disease, the first sign of the body's fight against infection.

For example, with a latent form of tuberculosis (latent), the pathogen (Koch's wand) can remain in an inactive phase for a long time. It can be completely neutralized by the body's defenses without causing any harm to a person.

However, often as a result of a number of negative influences, a dormant infection can become active. Then, with a high probability, the lymph nodes, as an integral part of the immune system, will be the first to take the hit.

The following factors can provoke the appearance of reactive lymphadenitis:

• Chronic inflammation.
• Low immunity.
• Frequent colds.
• Hypothermia.
• Long stay in a stuffy, unventilated room.
• Lack of sunlight.
• Chronic emotional overstrain, severe stress, can trigger the mechanisms of a dormant infection, for example, Koch's bacillus in tuberculosis.
• Malnutrition, mono-diets.
• Frequent fatigue.
• Sedentary lifestyle.
• Bad habits(alcohol abuse, smoking).
• Avitaminosis.
• Often, reactive lymphadenitis occurs in children under 6 years of age due to immature immunity, as a reaction to any focus of inflammation in the child's body. It can be rhinitis, otitis and acute respiratory viral infections.

Clinical manifestations of reactive lymphadenitis

Reactive inflammation in the lymph nodes is concomitant symptom one disease or another.

Often the zone of inflamed lymph nodes indicates a local pathological process in the same area, that is, it is nearby, near the focus of inflammation.

The initial sign of reactive lymphadenitis is reactive lymphadenopathy, as the very first reaction of the body in response to infection.

It can manifest itself by an increase in a different number of lymph nodes and their mild soreness.

Left unattended, this pathological process is aggravated by lymphadenitis, which can be recognized by the following signs:

• Enlargement, swelling of the lymph nodes.
• Lymph glands are painful on palpation and pressure.
• Swelling and redness skin over the affected lymph nodes.
• The glands are not soldered to the skin and to each other, dense to the touch.

Depending on the factors that triggered the development of reactive lymphadenitis, it may be accompanied by the following manifestations:

• General weakness.
• Elevated or subfebrile (37 ° C) body temperature.
• Headache.
• Sleep disturbance.
• Cough.
• Rhinitis.

Important! When severe pain in the area of ​​​​one lymph node or a whole group of them, an increase in body temperature of more than 38.5 ° C, rapid breathing and heart rate (signs of purulent lymphadenitis), you must urgently consult a doctor

The fact is that with reactive lymphadenopathy after treatment of the underlying disease, the lymph nodes almost always return to normal on their own.

However, if the primary pathology is left without appropriate therapy or the treatment is insufficient, the process may be complicated by painful changes in the lymph glands themselves.

In this case, there may be a proliferation of lymphoid tissue, with the development of reactive hyperplasia in the lymph nodes, with a violation of their function.

This can cause their suppuration or the spread of infection to nearby tissues and the entire human body.

What diseases and conditions can be accompanied by reactive inflammation of the lymph glands

Reactive lymphadenitis may accompany diseases such as:

• Tuberculosis. Parotid and axillary nodes often become inflamed. Lymphadenopathy of the cervical lymph nodes may also occur.
• Angina.
• Tonsillitis.
• pathological process in oral cavity(caries, stomatitis).
• Acute mastitis caused by staphylococcus and streptococcus bacteria.
• AIDS.
• Syphilis.
• Diseases of the female and male genitourinary system. For example, hyperplastic (tissue growth). Abnormal changes in the mucous membrane of the uterus (polyps, endometrial hyperplasia). A woman often manifests an increase in inguinal lymph nodes.
• Enterocolitis.
• Flu.
• Otitis.
• Sinusitis.
• Teething in infants.
• Adenoiditis in children.
• Bubonic plague.

Which specialist should be contacted if the lymph nodes are enlarged or inflamed for no apparent reason

Reactive hyperplasia of the lymph nodes is dangerous because it can go unnoticed by the patient.

With general weakness, increased fatigue, subfebrile body temperature, sweating, as well as with any ailment, it is necessary to pay attention to the lymph nodes.

With their increase, pain during palpation, first of all, you need to consult a general practitioner.

After the examination, the doctor can give a referral to such specialists as:

• Urologist.
• Gynecologist.
• Dentist.
• Gastroenterologist.
• Infectionist.
• Mammologist.
• Surgeon.

What research can a doctor prescribe

If reactive lymphadenitis is detected, in order to understand the cause of the disease and determine the state of the lymph glands themselves, the doctor may prescribe the following tests:

• General analysis of urine and blood (with formula).
• Blood for syphilis, HIV, viral hepatitis.
• Bacteriological examination of blood, urine. To identify pathogens, to sensitivity to antibiotics.
• Tumor markers.
• Blood for hormones.
• Biochemistry.
• Cytological and bacteriological analysis of discharge from the vagina, urethra.
• Bacteriological culture of sputum.
• Puncture of the lymph node with subsequent cytological examination.

Also, a doctor may recommend that a patient with reactive lymphadenitis undergo such instrumental diagnostics, How:

• X-ray (fluorography, mammography, urography).
• Computed tomogram (CT).
• Magnetic resonance imaging (MRI).
• Gastroduodenoscopy.
• Sigmoidoscopy.
• Bronchoscopy.

Treatment

Reactive lymphadenitis can be initial symptom many diseases. Accordingly, his treatment will be based on the elimination of the source of infection itself.

If the bacterial flora acts as an infectious agent of the pathological process, then antibiotic therapy is used first of all.

A fungal infection is treated, for example, with drugs such as:

• Fluconazole.
• Rumikoz.
• Orungal.
• Nizoral.

To combat a viral infection, the following antiviral agents will be effective:

• Interferon.
• Tsitovir.
• Kagocel.
• Amiksin.
• Remantadin.
• Arbidol.

Important! You can not self-medicate reactive lymphadenitis. This pathology can be a manifestation of various diseases, which can only be determined by a doctor. All of the above drugs are prescribed exclusively by a doctor.

Prevention

Preventive measures for reactive lymphadenitis include the following:

• For any symptoms of malaise (subfebrile body temperature, sweating, chills, fatigue) that last more than 5 days, consult a doctor.
• Women visit a mammologist and gynecologist once a year. After forty years, undergo a mammogram every 12 months, visit a gynecologist every six months.
• Men undergo preventive examinations by a urologist once a year.
• With prolonged weakness, persistent cough see a doctor.
• In wet slushy weather, during epidemics, to increase immunity, you need to take decoctions and tinctures of herbs that strengthen the body's defenses. For example, such as:
  • Tinctures of echinacea, eleutherococcus can be purchased at the pharmacy. Take after consultation with the doctor in accordance with the attached instructions.
  • Rosehip decoction. This drink can be prepared using a thermos in the following way:

1. Rinse a thermos with boiling water.
2. Place in it 2 tablespoons of rose hips washed with running water.
3. Pour in a liter of freshly boiled water.
4. Insist 8 hours.
5. Then strain through 4 layers of gauze into a liter glass container.
6. Fill in the missing volume with boiled water.

The berries left in the thermos do not need to be thrown away. They can be poured a second time with boiling water and used according to the above scheme.

Also, for the normal functioning of the immune system, the prevention of various diseases, it is necessary to conduct healthy lifestyle life. It is necessary to avoid physical and emotional overstrain, engage in feasible physical education, eat well, do not neglect rest, sleep, and be outdoors as often as possible.

Lymphadenitis is an inflammatory disease of the lymph nodes. They become sharply painful and increased in size. This article contains information about what lymphadenitis is, its symptoms and treatment, the main signs, the causes of its occurrence.

How does the pathological process develop?

When there is a bacterial or viral infection, then part of its pathogens penetrates into the lymphatic vessels and lymph nodes. The infection can also spread through the blood. In some cases, pathogens are found in these organs as a result of contact with nearby tissues. Finally, infection can occur as a result of injury to the area of ​​the body where the lymph node is located and infection of the wound.

In this part of the body, antigens begin to interact with lymphocytes, which contributes to the formation of antibodies. This is how inflammation progresses. Other cells enter the organ, which destroy foreign agents and contribute to the development of a specific reaction.

Such cells are actively involved in the disease process.

1. Lymphocytes. They are the first of all cells to take the brunt of the infection. These cells are able to regulate the number of other types of leukocytes.
2. Neutrophils. These are leukocytes capable of phagocytosis, that is, of absorbing other pathological microorganisms. After they absorb biologically active toxic substances and microorganisms, they die. In this case, pus is formed.
3. Eosinophils provide antibacterial protection in the body. Cells absorb foreign enzymes and produce the necessary antibodies to bacteria.
4. Basophils are the main cells that are responsible for the development of allergies. They contain a significant amount of substances that support the development of inflammation.
5. Monocytes contribute to the purification of the inflammatory focus from dead masses. They have the property of phagocytosis, absorb bacteria of considerable size, dead lymphocytes and parts of tissues.

If it penetrates into the inflammatory focus a large number of leukocytes and at the same time the growth of the number of lymphocytes is activated, then the lymphatic tissue grows. This process is called hyperplasia. Soreness, hypertrophy and sensitivity of the focus is due to the release of a significant amount of active substances.

Causes of the disease

Lymphadenitis can be nonspecific and specific. The causes of a non-specific type of disease are as follows.

1. Pathological activity of bacteria and the release of toxins in the process of their vital activity. Inflammatory phenomena begin when streptococci, staphylococci, Escherichia enter the nodes. Excreted toxins contribute to the development characteristic symptoms.
2. Virus penetration. The DNA of this organism, when it enters the body, is introduced into the cell, and it begins to produce new copies of it. This process is accompanied by the release of toxin and the defeat of all new cells.
3. Entering the lymph node of fungal organisms. They can cause severe damage to all organs.

When certain types of microbes enter the lymph node, specific lymphadenitis develops. The following organisms can cause manifestations of this type of disease:

• tuberculosis sticks;
• treponema;
• plague sticks;
• actinomycetes;
• brucella;
• tularemia microorganisms.

It is not uncommon to develop a disease of the lymphatic system if a person is infected with HIV.

What types of lymphadenitis are diagnosed

Acute lymphadenitis occurs due to the defeat of the lymph node with a highly active infection. Often this can be observed after a sore throat. It is characterized by the rapid development of symptoms. If left untreated, lymphadenitis can turn into a purulent form. It is dangerous because it can cause purulent fusion of the organ.

Chronic lymphadenitis begins with the addition of a weakly active infection. Often it is the result of an acute form of the disease. The disease can have a protracted course.

Depending on the stage of the pathological process, it is customary to distinguish between such types of disease.

1. catarrhal lymphadenitis. It is inherent in the initial stage. In this case, the permeability of capillaries is disturbed, and blood penetrates into the tissue of the node.
2. Hyperplastic lymphadenitis occurs when the tissue of the lymph node grows. It is infiltrated by leukocytes.
3. Purulent lymphadenitis is the final stage of the bacterial process. With it, the gradual destruction of the organ occurs. The consequences of this disease are the formation of a purulent abscess, adenophlegmon, necrosis. There are frequent cases of the appearance of a generalized process.

Finally, the following types of the course of the inflammatory process are distinguished, depending on its nature:

• abscessing lymphadenitis is characterized by the formation of abscesses, with the addition of a purulent infection;
• regional lymphadenitis is characterized by an increase in one or more lymph nodes in one part of the body;
• reactive lymphadenitis occurs due to local disorders due to a general disease;
• mesenteric - occurs due to damage mainly to the lymph nodes of the intestine;
• granulomatous - characterized by the presence of granulomas due to the presence in the human body of mycobacteria, spirochetes, etc.

Symptoms of inflammation of the lymph nodes

All symptoms of lymphadenitis are due to the presence of microbes and viruses in the lymph node. Depending on the affected area, inflammation of the lymph nodes is characterized by different symptoms.

Signs of submandibular lymphadenitis

Manifestations of submandibular lymphadenitis are as follows.

1. Enlarged lymph nodes on the face and under the jaw. In a patient, the lymph nodes are enlarged under the jaw, they are dense when palpated. This is clearly visible in the photo.
2. Expressed pain.
3. The appearance of redness and swelling in the submandibular region.
4. When a microbial infection is attached, suppuration occurs.
5. Hyperthermia up to 39 - 40 degrees, weakness, sleep disturbances, pain in the joints and muscles.

Sometimes such lymphadenitis in adults can be complicated by the occurrence of an abscess. Such acute inflammation submandibular lymph nodes in adults it can cause swallowing disorders, loss of appetite, symptoms of general intoxication.

Signs of cervical lymphadenitis

With cervical lymphadenitis develop:

• a significant increase in lymph nodes;
• soreness;
• skin change;
• severe restrictions of movement (pain during head turning with damage to the jugular lymph nodes, squeezing vocal cords, difficulty swallowing, respiratory distress).

With the defeat of the lymph nodes in the parotid region, there may be a decrease in hearing. Lymphadenitis of the neck can often cause dizziness, blue skin due to increasing oxygen starvation.

Signs of axillary lymphadenitis

This type of disease of the lymphatic system is characterized by the appearance of such signs.

1. Increase axillary nodes.
2. Severe soreness under the armpits.
3. With the onset of a purulent lesion, the skin on the hands acquires a red tint.
4. Movement disorders that lead to limitation of the patient's daily activities.
5. Swelling of the upper limb (it occurs if the lymph nodes compress the veins of the shoulder).
6. In the case of acute lymphadenitis, there is a decrease in the sensitivity of the hand.

Axillary lymphadenitis can lead to damage to the breast in women.

Unilateral or bilateral inguinal lymphadenitis is manifested by the following symptoms:

• a sharp increase in the node;
• pain not only in the groin, but also in the lower abdomen, in the thigh;
• in men, there is discomfort in the scrotum;
• skin tension;
• gait disorders;
• swelling of the leg, if the enlarged node compresses the venous vessels;
• with suppuration, the temperature can rise to 38 - 40 degrees, there is a pronounced weakness.

This type of disease can be complicated by abdominal lymphadenopathy. This is a serious disease that requires immediate treatment.

Damage to the popliteal lymph nodes

With inflammation of the popliteal nodes, such characteristic symptoms appear.

1. Jump in body temperature.
2. Soreness in the head and general weakness.
3. The appearance of swelling under the knee and on the legs, pain during movements.

In the case of a purulent process under the knee, constant pains of a pulling nature are observed. A serous effusion sometimes accumulates in the knee. Pain may worsen in the evening. Active movements in the knee are sharply limited, a person can hardly walk.

Lymphadenopathy of the mammary glands

With this disease, there is an increase in the lymph nodes in the chest area. Lymphadenopathy of the breast is characterized by the following symptoms:

• node enlargement;
• increased sensitivity of the gland during palpation;
• hyperemia of the affected area;
• loss of appetite;
• enlargement of the liver and spleen;
• lowering blood pressure, tachycardia;
• increased night sweating and jumps in body temperature.

How the disease is diagnosed

Usually, the doctor can make an accurate diagnosis already on the basis of the characteristic symptoms and complaints of the patient. To identify the causes, the following diagnostic methods are used:

• blood and urine tests;
• ultrasound examination;
• radiography;
• puncture of the lymph node.

Sometimes culture of the material obtained from a biopsy on a nutrient medium can be used. If it contains bacterial infection, then in a short time you can get a colony of microorganisms. In this case, the diagnosis can correctly establish the type of microorganism that caused the disease.

Treatment

Used to treat lymphadenitis drug therapy, physiotherapy. If they do not give results, then they resort to surgery.

Drug therapy is carried out by prescribing such drugs.

1. Non-steroidal anti-inflammatory drugs - Nimesil, Ibuprofen in the form of tablets and ointments.
2. Antibiotics - Amoxicillin, Azithromycin, Amoxiclav, Sumamed, Augmentin.
3. Antihistamines - Cetirizine and its analogues.
4. Antiviral medicines - Remantadine, Ethambutol.
5. Antifungal agents - Fluconazole, Amphotericin.
6. Local anesthetics - Dimexide and others

Treatment with antibiotics is carried out only as prescribed by a doctor and often in a hospital setting.

The use of physiotherapy significantly improves general state human, reduces the intensity of inflammatory processes, promotes the restoration of affected tissues. These are the most commonly prescribed procedures.

1. UHF therapy. In its course, the affected areas of the body are exposed to high-frequency magnetic field. This contributes to the development of local protection and the end of the inflammatory process.
2. Laser therapy uses light waves at a specific frequency. This method has a strong anesthetic and anti-inflammatory effect.
3. Exposure to a weak direct current contributes to the cessation of pain.

During pregnancy, such procedures are prohibited. The use of echinacea tincture, infusion of dandelion roots, aloe juice is shown. These drugs gently affect the affected area and do not allow the development side effects and complications.

Treatment of lymphadenitis in children is carried out with the same drugs as in adults. Their dosage is selected somewhat smaller to eliminate the risk of side effects. If a child develops a purulent process, surgical treatment is indicated.

To cure a purulent complication, an abscess, surgical treatment is indicated. The opening of the foci is carried out under the influence of local or general anesthesia.

Prevention of pathology

In order to prevent lymphadenitis, the following recommendations should be observed:

• treat any skin lesions and chronic infections in a timely manner;
• monitor the condition of the oral cavity;
• maintain the immune system in good condition;
• treat angina in a timely manner and prevent the development of its complications;
• monitor nutrition: do not use spicy, salty, marinades and smoked meats, as they can in some cases increase the inflammatory reaction.

It is quite possible to prevent the development of lymphadenitis. You should be attentive to the manifestations of this disease and begin to treat lymphadenitis as early as possible. This will avoid the development of its complications.

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The inflammatory process in the lymph nodes, often of a purulent nature, is called lymphadenitis. A common disease among children and adult patients, more often detected in the axillary, submandibular, inguinal zone or in the neck.

Based on the severity of the course, lymphadenitis is divided into the following subspecies:

• with the formation of pus and non-purulent;
• acute and chronic type;
• single and multiple foci (by the number of affected lymph nodes);
• specific and non-specific form.

A nonspecific form of the disease is caused by strepto-, staphylococci, as well as other pyogenic microflora. The clinical picture is exacerbated by the release of toxins and decay products from the primary lesion. The causative agents can be microorganisms from boils, carbuncles, infections of the upper respiratory tract (tonsillitis, pharyngitis, bronchitis, etc.), bacteria with erysipelas or trophic ulcers.

A specific pathology is caused by "cat-scratch disease", tuberculosis, syphilis, etc. In this case, lymphadenitis provocateurs are specific infectious agents: Candida fungi, Koch's bacillus, actinomycetes, and so on.

Lymphadenitis: ICD-10 code

The international classification of diseases of the tenth revision includes class XII - "Infections of the skin and subcutaneous tissue" with a rubricator in which acute lymphadenitis corresponds to the coding L04. If there is a need to indicate the causative agent of infection, use additional identification with the code B95-B97.

In turn, acute lymphadenitis μb is subdivided:

• L04.0 - pathological foci are located in the face, neck, on the head;
• L04.1 - lymph nodes of the body are inflamed;
• L04.2 The disease is found on upper limbs(shoulders, armpits);
• L04.3 - detection of affected nodes (the pathology is acute) on the lower extremities (pelvic region);
• L04.8 - localization in other zones;
• L04.9 Acute lymphadenitis, type unspecified

The nonspecific form of lymphadenitis I88 is included in the heading "Diseases of the veins, lymphatic vessels and nodes", class IX:

• I88.0 - mesenteric lymphadenitis of nonspecific type (acute / chronic);
• I88.1 - chronic course of the disease, excluding mesenteric;
• I88.8 - other nonspecific lymphadenitis;
• I88.9 - nonspecific process of an unspecified nature.

ICD-10 code

I88 Nonspecific lymphadenitis

L04 Acute lymphadenitis

I88.1 Chronic lymphadenitis, other than mesenteric

Causes of lymphadenitis

Lymphadenitis is a consequence of infection of the lymph node with pathogens, as a primary and independent disease develops extremely rarely. Bacteria provocateurs of pathology are: streptococcus, staphylococcus, Pseudomonas aeruginosa, E. coli, pneumococcus. The lymph node increases as a result of the accumulation of cells in the zone of inflammation. The entry of microorganisms into the lymph node is also possible through lymphatic flow from the original lesion. For example, as a result of caries, purulent rash on the skin, boils, etc.

Often the causes of lymphadenitis lie in diseases of the internal organs. The presence of inflammatory bowel processes, infections in the ovaries, various liver diseases is dangerous by the hematogenous spread of disease-causing particles (through the bloodstream) that settle in the lymphatic system and cause inflammation of the lymph node.

The contact method of injury is the rarest, when microbes enter the lymph node directly, which is possible if the integrity of the skin (for example, injury) of the lymph node is lost.

Nonspecific infection is the most common cause compaction, growth and inflammatory reaction from the lymph nodes. Caused by conditionally pathogenic microorganisms, lymphadenitis is typical for: submandibular, cervical, elbow, inguinal, axillary, femoral, popliteal zones. Favorable conditions for the reproduction of pathogenic microorganisms there will be injury, hypothermia, a stressful or painful condition, etc.

Lymph nodes are protective filters that prevent the penetration and reproduction of pathogenic microflora in human body. When the level of infectious particles (elements of dead cells, microorganisms, tumor components, etc.) is excessively high, the lymphatic system may not be able to cope and an inflammatory process develops. Lymphadenitis indicates a weakening of the immune system due to various factors - an elderly or vice versa young, not strong organism, mental or physical fatigue, previous illnesses, etc.

An increase in lymph nodes and an inflammatory process in their tissues should not be confused. The growth of the lymph node is due to the production of more lymphocytes, in which antibodies are produced to fight the potential threat, which in itself indicates the fulfillment of the lymphatic system's protective function and does not apply to pathology.

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How long does lymphadenitis last?

Remembering the types and features of the course of lymphadenitis, you can answer the question: “How long does lymphadenitis last?” An acute process is characterized by a sudden onset with severe symptoms and a duration of up to two weeks. Inflammation of the lymph nodes of a chronic type is a sluggish, latent pathology without clear manifestations, which develops for more than a month.

It should be noted that non-purulent and purulent lymphadenitis can occur in both acute and chronic forms. Although the formation of suppuration is more often due to a sharp deterioration in the general condition characteristic of the acute course of the disease. The purulent process requires sanitation and cleansing of the affected tissues. When the lymph node is melted after opening the abscess, the cavity is drained. The rate of healing of the wound surface also affects the duration of recovery.

As for specific lymphadenitis, therapeutic effect achieved in at least eight months. Depending on the severity of the primary inflammatory process, treatment can reach one and a half years.

Symptoms of lymphadenitis

The symptomatology of the disease largely depends on the type of lymphadenitis and helps the specialist to make the correct diagnosis, as well as to choose the right medical tactics. Common features are: edema, local reddening of the skin, temperature, limitation of limb mobility, chills, the quantitative content of leukocytes in the blood increases.

The following symptoms of lymphadenitis are distinguished:

• nonspecific chronic inflammation is a sluggish, latent process, long time not showing himself. It is characterized by a slight swelling of the skin adjacent to the affected lymph node, and subfebrile temperature (37 o C);
• acute lymphadenitis - has a pronounced symptomatology, namely: sharp pain and an increase in nodes that limit motor ability. Often the condition is aggravated by a dull or aching headache, general weakness, temperature;
• the state of the purulent process is determined by a jerking, sharp pain syndrome. On palpation, the patient feels pain. Skin is red. As the disease progresses, the affected lymph nodes grow together with each other and with adjacent tissues, forming fixed seals;
• pathology of the serous type - dull pain syndrome is localized in the region of regional lymph nodes, which are enlarged and dense. The initial stage is characterized by the absence of signs of inflammation on the skin, only after destructive processes in the tissue of the lymph node and accumulation of purulent contents, necrotic areas appear;
• adenophlegmon - the stage into which it passes purulent inflammation without proper therapy. The skin with signs of hyperemia, puffiness has blurred boundaries with softening foci. Among the obvious signs of pathology - heat, palpitations, chills, severe weakness, headache.

It must be remembered that lymphadenitis is a secondary disease that can mask serious problems (plague, tumors, tuberculosis, etc.). Only a competent specialist can differentiate a pathological condition, so it is important to seek advice in a timely manner.

Cervical lymphadenitis

An increase in cervical lymph nodes occurs as a result of infectious and inflammatory processes of the upper respiratory tract (tonsillitis, pharyngitis, purulent otitis media, etc.). Cervical lymphadenitis occurs mainly in children, as a result of influenza, SARS, pneumonia. In adulthood, it can indicate serious diseases such as tuberculosis or syphilis.

Submandibular lymphadenitis

In clinical practice, the most common cases of inflammation of the submandibular lymph nodes. This pathology develops due to chronic tonsillitis, gum disease or advanced caries. Submandibular lymphadenitis is characterized by a gradual increase in symptoms. If at the first signs of pathology it is possible to determine the source of infection, then recovery occurs quickly.

Inguinal lymphadenitis

Acute lymphadenitis

The presence of an infection in the body, such as a boil, a purulent wound or a scratch, contributes to the entry of bacteria into the lymphatic channel. Lymph brings pathogenic flora to the lymph nodes, which become inflamed. This is how acute lymphadenitis occurs, manifesting itself as a sharp, increasing soreness, fever and deterioration in the general condition.

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Subacute lymphadenitis

A very rare disease - subacute lymphadenitis in clinical manifestations in many ways resembles an acute inflammatory process in the lymph nodes. This pathology is differentiated by the primary immune response. The subacute variety is characterized by a more intense red color of the skin in the area of ​​​​the infected lymph node, which has a dense texture than in the acute course of lymphadenitis. Visual examination is not enough to confirm the diagnosis, therefore, cytological and histological examination is used.

Cytology reveals macrophages with a large number cell particles and leukocytes, as well as follicular hyperplasia on cellular level. The analysis reveals single mastocytes, basophilic cells and a huge number of lymphoblasts. The histological method allows you to determine the sharp outline of the lymphatic follicles, increase blood vessels filled with blood.

In the subacute form, a significant increase in body temperature is possible if pus is formed. In other cases, the temperature is close to subfebrile.

Chronic lymphadenitis

The chronic course of lymphadenitis is a consequence of an acute process or occurs as an independent disease, bypassing acute stage. This difference is associated with pathogenic microorganisms.

Generalized lymphadenitis

Simultaneous inflammation of several lymph nodes or their sequential defeat is a generalized lymphadenitis. A rather rare disease is the result of a primary infectious process, for example, generalized tuberculosis. Quite often the illness is shown and proceeds brightly with the expressed intoxication, and also quickly progresses. In this case, all groups of lymph nodes are significantly enlarged, inflammation rapidly covers nearby tissues, spreading to internal organs. The generalized form can acquire a chronic course, gradually depleting the body's defenses.

Inflammation of the lymph nodes of a generalized type is possible with the following diseases:

• bacterial infections - tuberculosis, syphilis, sepsis, etc.;
• malignant / benign tumors - leukemia, lung cancer, sarcoidosis, etc.;
• autoimmune problems - dermatomyositis, rheumatoid arthritis, lupus, etc.;
• accumulation diseases - Niemann-Pick and Gaucher diseases;
• reactions to medicines and chemical compounds - hay fever, allergic manifestations to drugs.

Hemorrhagic lymphadenitis

Hemorrhagic lymphadenitis is a special form of inflammation of the lymph nodes, in which dysfunction of capillary permeability entails saturation of the lymph node with blood. Similar is observed with the defeat of anthrax or plague.

Anthrax inflammation is characterized by lymphangitis and regional lymphadenitis, but the enlargement of the lymph nodes occurs painlessly. The inflammatory process has a long course. Initially, nodes that are in close proximity to the carbuncle are affected, and then distant ones. However, suppuration of the lymph nodes is extremely rare.

Granulomatous lymphadenitis

Granulomatous lymphadenitis is characterized by the presence of granulomas or the formation of groups of histiocytes. Along the course, the disease is divided into granulomas with epithelioid histiocytes and a purulent process.

The diagnosis is confirmed by bacteriological, immunohistochemical or serological methods, as well as specific skin tests and molecular method (PCR).

The lesion often covers regional lymph nodes, into which the pathogenic flora collects from the entrance gate of infection, but disseminated infection can develop. The degree of enlargement of the node, the intensity of pain depends on the course of the inflammatory disease, its characteristics and the clinic of the primary focus.

Specific lymphadenitis

Such serious diseases as: tuberculosis, syphilis, HIV, plague and others cause infection of the lymphatic system, which is manifested by an increase in lymph nodes. Moreover, the underlying disease may still be at the stage of inception, and the lymph nodes in a timely manner “signal” about a hidden problem.

Specific lymphadenitis is classified into:

• viral;
• tuberculosis;
• actinomycotic;
• fungal;
• syphilitic;
• vaccinal, etc.

A specific form of inflammation of the lymph nodes is inherent wide range clinical manifestations. The defeat of the cervical nodes often indicates tuberculous lymphadenitis, an increase in nodes in the inguinal zone indicates specific peritonitis. Supraclavicular nodes react if the primary infection is localized at the pulmonary apex. Pathology of regional lymph nodes is observed after vaccination. The tumor is found on one or both sides. "Children's pruritus" or scrofula also causes generalized growth of nodes.

Specific lymphadenitis often has a chronic form with characteristic periods of exacerbation. The symptoms of the disease vary depending on the type of infection. The causative agent is identified on the basis of a blood test.

Tuberculous lymphadenitis

Tuberculosis penetration into lymphatic system causes an increase in the nodes of the neck and submandibular zone. Over time, the lymph nodes soften, the pathological process covers nearby cells, and when the capsule of the lymph node is opened, a gray, purulent mass of a crumbly consistency is found. Often, tuberculous lymphadenitis, which develops against the background of primary or secondary tuberculosis, is the cause of symmetrical inflammation of the lymph nodes. The tuberculous form of inflammation rarely spreads to the inguinal lymph nodes.

When differentiating the disease, it is necessary to exclude fistulas on the neck, non-specific type of lymphadenitis, metastasis of malignant tumors, lymphosarcoma. Microscopic analysis of intracapsular pus helps to establish an accurate diagnosis.

Symptoms of inflammation of the lymph nodes largely depend on the progression of tuberculosis and the degree of damage to the tissues of the node. Palpation in the initial phase of the lesion does not reveal the pain that is characteristic of the caseous period of decomposition and the formation of a fistula.

Caseous lymphadenitis

Caseous lymphadenitis is a form of tuberculous lymphadenitis, characterized by caseous disintegration of the tissues of the lymph node. In order to understand aspects of the formation of this process, one should refer to the concept of primary tuberculosis, which develops when microbacteria enter the lungs. Infection is possible both aerogenic and alimentary way. Primary tuberculosis is more common in childhood and is divided into stages:

• the occurrence of a primary lesion in the lung;
• lymphangitis - the spread of infection to the efferent lymphatic vessels;
• lymphadenitis - defeat of regional nodes.

In the area of ​​inflammation, tissue necrosis is observed, serous edema gradually develops, leading to pneumonia of the caseous type. The size of the primary tuberculous area depends on the affected area (alveolitis, lobe, acinus, or segment). Specific inflammation pretty soon covers the lymphatic vessels adjacent to the primary focus. Formed to lung root, lymphostasis and characteristic swelling with tubercles in the peribronchial and perivascular tissue make hilar nodes accessible to infection. This is how the second stage begins - lymphangitis, which spreads to regional lymph nodes, where caseous necrosis soon appears. The growth of lymph nodes in size determines the total defeat and the onset of caseous lymphadenitis.

Nonspecific lymphadenitis

Staphylococcal and streptococcal infection are the cause of nonspecific lymphadenitis. The primary focus of inflammation is a festering scratch or wound, erysipelas, boils, skin ulcers, etc. Pathogenic microorganisms infect the lymph nodes, spreading with the flow of lymph, blood, or directly when the node is injured.

Nonspecific lymphadenitis is classified according to the type of flow into:

• acute - more often, as a serous form. Perhaps an increase in one or a group of lymph nodes that are painful and elastic in consistency;
• chronic - acts as a primary disease (the result of inflammatory chronic processes: tonsillitis, dental problems, etc.) or is a consequence acute inflammation lymph nodes.

The acute course is characterized by the absence of symptoms or a slight change in the general condition of the patient. The severity of inflammatory signs of lymph nodes largely depends on the primary focus. The development of the disease from the serous form to the purulent stage causes an increase in temperature, weakness, and malaise. The next signs of the progression of inflammation will be pain and immobility of the lymph node.

The chronic type of nonspecific process is not characterized by the formation of pus. Lymph nodes remain enlarged for a long time, practically painless and not soldered to surrounding tissues. Sometimes spread connective tissue in the lymph node is fraught with problems of lymph circulation, swelling, lymphostasis, elephantiasis.

Reactive lymphadenitis

Reactive lymphadenitis is a stage of inflammation of the lymph nodes, which is caused by local disorders in the body. The reactive form is characterized by the development of a pathological focus in the absence of predisposing factors. For example, in tuberculous lymphadenitis, the pathogenic bacillus did not give any symptoms (hidden process), only the diagnosis of enlarged lymph nodes revealed the pathogen.

We can say that often the reactive phase accompanies the acute course of inflammation. However, it also occurs in chronic disease period of exacerbation, characterized by an active reaction from the body.

Reactive lymphadenitis is manifested as a result of the failure of the immune forces of children or because of a prepared organism that already knows the microorganism and has antibodies to suppress it. Recall, a mantoux test, showing the body's response to a tubercle bacillus. The presence of a skin globule indicates the recognition of an infection. A similar mechanism of immune response is displayed by the lymph nodes.

The reactive course of inflammation is always a rapid process, meaning the fight against the source of infection, when the rest of the body's defense system has not yet had time to “join in the confrontation”. The reactive phase changes rather rapidly. So recovery can occur if the infectious agent was suppressed in time by the immune forces of the body.

Lymphadenitis behind the ear

Quite often there is inflammation of the lymph nodes behind the ears. The reason for the increase in the size of the node is the complication of purulent and inflammatory processes in the body during the reproduction of pyogenic agents. Predisposing factors are colds (tonsillitis, pharyngitis, runny nose, etc.), pathologies of the eyes, ears (fungal infections, herpes, etc.) or allergic reactions.

Lymphadenitis behind the ear can be of a purulent / non-purulent nature, proceed in an acute / chronic form, cover one or a group of nodes. The clinical picture of the disease manifests itself with the formation of a behind-the-ear bump, which is painful and the pain spreads into the ear, which often confuses the patient. The general condition worsens: a headache appears, the temperature is observed during the purulent course of the disease, the pain syndrome acquires a “shooting” character, and in some cases reddening of the skin of the area of ​​​​the inflamed lymph node is possible.

The growth of behind-the-ear nodes in size sometimes causes lymphoma, various cancers of the lymph nodes. Active hair loss on the head, annoying itching and the presence of peeling of the skin often indicate fungal infection. In any case, you should not independently establish a diagnosis and prescribe treatment for yourself. A timely appeal to a specialist will save you from mistakes that provoke irreparable complications.

Behind the ear lymphadenitis

The growth of lymph nodes behind the ears signals the need to undergo an examination. Inflammation of the nodes can indicate both the reaction of the body's defenses and the presence of an infectious agent. Diseases of the throat, ears, eyes, some allergic manifestations cause the spread of pathogenic flora with lymph flow. A large amount of pathogens that settle in the lymph nodes often provoke behind-the-ear lymphadenitis. The inflammatory process may be a harbinger serious illnesses such as cancerous tumors.

Lymphadenitis has a direct relationship with the primary lesion of a viral, fungal or viral nature. So, peeling of the scalp, severe hair loss and incessant itching are symptoms fungal disease. frequent colds, various diseases the upper respiratory tract make it possible for microorganisms to enter the lymphatic system. Problems with the oral cavity, untreated or neglected caries, diseases of the organs of vision are also the cause of inflammatory enlargement of the lymph nodes.

The presence of a primary and secondary focus in the immediate vicinity of the brain poses a danger to the patient in the form of complications, severe disease and long-term recovery. Only timely appeal medical care will avoid all negative consequences and restore health in a short time.

Lymphadenitis of the face and neck

The face is the site of localization of the buccal, mandibular, chin, parotid, as well as the smallest lymph nodes located near the nasolabial fold and in the inner corners of the eyes. On the neck are chains of superficial and deep (pharyngeal) lymph nodes. The pharyngeal nodes receive lymph from the posterior parts of the nasal cavity, partly from the palate. In the lymph nodes of the cheeks, lower and submandibular, chin lymph flows from: the oral cavity, paranasal sinuses nose, teeth, mucosa, jaws, salivary glands. Diseases of these organs contribute to the spread of infection through the lymphatic system and cause lymphadenitis of the face and neck.

Inflammation of the nodes of the submandibular, chin and cervical zones can be odontogenic or non-odontogenic in nature. Odontogenic processes are characterized by a pathological relationship with the dentition, often develop against the background of periostitis of the period of exacerbation, chronic periodontitis, acute pericoronitis. Inflammation of the lymph nodes of the non-odontogenic type includes otogenic, rhinogenic and stomatogenic (formed as a result of stomatitis, otitis media, glossitis, gingivitis, etc.).

Throat lymphadenitis

Viruses that provoke various diseases of the upper respiratory tract (tonsillitis, pharyngitis, laryngitis, etc.) or the oral cavity (stomatitis, diphtheria, etc.) can cause inflammation of the lymph nodes in the neck, as well as in the submandibular zone. As a secondary pathological process, throat lymphadenitis often disappears when the underlying cause is treated. For example, cervical lymph nodes return to normal with appropriate therapy for angina.

Symptoms of inflammation of the lymph nodes in the throat area:

• node growth in size - the value varies from a small pea to a chicken egg;
• the presence of pain syndrome - discomfort is felt during swallowing or palpation;
• general malaise - weakness, fever, headache, etc.

The defeat of the lymph nodes of the throat area is possible without a concomitant disease, against the background of a significant weakening of the body's immune forces. In this case, the clinical picture is mild: there is a slight increase in the lymph nodes, during the examination and when swallowing, there may be a slight soreness. The patient's body is usually weakened by frequent colds.

Occipital lymphadenitis

Identification of the reasons why occipital lymphadenitis develops helps to eliminate the primary disease in the shortest possible time and cope with inflammation of the lymph nodes. For example, infections of the scalp, occurring against the background of dermatophytosis or pediculosis, create conditions for damage to the occipital lymph nodes.

Viruses of a generalized type serve as an important diagnostic factor in occipital lymphadenitis that accompanies measles rubella. With this pathology, inflammation of the posterior cervical nodes is also possible, sometimes a generalized type of lymphadenopathy is formed. Symptoms of a secondary pathological process appear earlier than skin rashes differentiate. In the case of occipital lymphadenitis, the nodes are slightly enlarged, have a soft-elastic consistency, are easily displaced by probing, without pain.

Diseases that cause the growth of the occipital lymph nodes include chicken pox. Characteristic manifestations of the disease will be fever, skin rash, disorders of the upper respiratory tract. Specific infections of syphilis and tuberculosis rarely affect the cervical and occipital lymph nodes.

Posterior cervical lymphadenitis

Lymphadenitis of the neck is dangerous due to its close proximity to the brain, so it is important to diagnose the disease on early stage and receive appropriate treatment.

Posterior cervical lymphadenitis is a common occurrence in rubella. In addition to enlarged lymph nodes, patients complain of limited neck movement due to severe pain. In parallel, there is inflammation of the nodes near the ears, as well as the occipital region. An interesting fact is that the pathological growth of lymph nodes occurs earlier than the appearance of a characteristic red rash.

In most cases, it is difficult to identify the causes of the inflammatory process and the growth of the volume of lymph nodes located on the back of the neck. This is due to the fact that not only an infectious disease can act as a provocateur of inflammation, but also more serious illnesses, such as tuberculosis. In the process of differential diagnosis, it is necessary to provide for the ability of the formation of lymphoma, the development of lymph node metastases due to malignant neoplasms necks and heads.

Mesenteric lymphadenitis

The disease of the lymph nodes of the mesentery of the intestine develops more often in children, occurs with signs of intoxication and characteristic pain in the abdomen. There can be many reasons for the occurrence of pathology:

• viruses of acute respiratory processes (adeno-/enteroviruses);
• cytomegalovirus;
• causative agent of tuberculosis;
• intestinal infections(Campylobacter, Salmonella, etc.);
• staphylo- and streptococci;
• Epstein-Barr virus.

It should be noted that a large number of lymph nodes are located in the abdominal cavity, therefore, mesenteric lymphadenitis can occur when any pathogens of a viral or bacterial nature enter them from the primary focus of inflammation.

The disease begins with an acute pain syndrome to the right of the navel, but the general condition of the patient remains stable. As the inflammation progresses, nausea, vomiting, which does not bring relief, the patient has a fever. The clinical picture is complemented by a violation of the chair. These symptoms last for several days and require immediate medical attention, as the lack of proper treatment can lead to serious complications.

Intestinal lymphadenitis

Mesadenitis is called intestinal lymphadenitis, which is classified into the following forms:

nonspecific inflammation:

• simple / purulent;
• pseudotuberculous/tuberculous.

by flow type:

• chronic/acute.

Inflammation of the lymph nodes of the peritoneal zone occurs hematogenously (through blood flow), directly through the intestines (saliva, sputum). The causative agents of the pathology are infections of the upper respiratory tract, inflammatory processes of the appendix and other departments. digestive tract. When making a diagnosis using the differential diagnosis method, it is necessary to exclude:

• attack acute appendicitis;
• helminth infection;
• abdominal vasculitis hemorrhagic type;
• lymphogranulomatosis.

Intestinal lymphadenitis is manifested by pain in the lower abdomen near the navel. The disease is accompanied by fever, nausea, a slight increase in temperature, impaired excretory function(constipation or diarrhea). If the main focus is in the upper respiratory tract, then the symptoms of a cold (runny nose, cough, etc.) aggravate the pathological condition.

Among the complications of the disease, there are suppuration of the mesenteric nodes, leading to an abscess, sepsis, intestinal obstruction due to adhesive processes.

Lymphangitis and lymphadenitis

The secondary inflammatory process in the capillaries and trunks of the lymphatic channel is called lymphangitis. Pathology is observed in purulent-inflammatory diseases as a result of superficial (scratch, wound) or deep damage (carbuncle, boil). Infectious agents in most cases are strepto-, staphylococci, but in clinical practice there are such pathogens as: Proteus, Escherichia and tubercle bacillus and other microorganisms.

Quite often, lymphangitis and lymphadenitis of the regional type are simultaneously detected, accompanied by swelling, hyperemia along the lymphatic vessels, pain, fever, chills and general weakness. Manifestations of superficial lymphangitis outwardly resemble erysipelas, along the vascular bed, seals in the form of a cord or rosary are palpated. The defeat of the deep vessels of the lymphatic system is not accompanied by severe hyperemia, but swelling is clearly visible and pain persists.

For diagnostic purposes, computer thermal scanning, ultrasonic angioscanning, determination of the source of infection and isolation of the pathogen are used. In the treatment of lymphangitis, an important place is occupied by the elimination of the primary focus of suppuration and the use of antibiotics. Compresses and ointment dressings are applied locally, mud therapy and X-ray treatment are used.

Odontogenic lymphadenitis

Acute serous inflammatory process in the submandibular lymph nodes without necessary treatment transforms into a new stage called odontogenic lymphadenitis. The lymph node is enlarged, the pain syndrome is of a shooting nature. Often the body temperature rises, the appetite and general condition of the patient worsens. In the case of the formation of pus, the face is able to acquire asymmetry due to the accumulated infiltrate. The cover of the skin becomes swollen with a red tint. Palpation causes discomfort. An acute purulent process covers nearby tissues, symptoms of intoxication appear.

The cause of the pathology is dental disease. Infection of the oral cavity penetrates not only into the maxillary nodes, but also into the parotid, buccal, chin, superficial and deep cervical lymph nodes. Pain in the area of ​​the affected nodes increases with head movement. Difficulty opening the mouth is observed only if the purulent process extends to the masticatory muscles.

A complication of odontogenic lymphadenitis is an abscess or adenophlegmon.

Lymphadenitis of the cervical lymph nodes

specific character cervical lymphadenitis tuberculous nature has a number of distinctive features:

• the affected lymph nodes are soldered together, but do not involve nearby tissues in the pathological process;
• often proceeds without pain, which is confirmed by palpation;
• inflammation in most cases is asymmetrical.

Tuberculous lymphadenitis of the cervical lymph nodes most often acquires a chronic course. And only in half of the cases, the primary focus is found in the lungs. In clinical practice, there are atypical forms of mycobacteria that are difficult to respond to traditional therapy, so often the lymph nodes have to be excised.

The presence of a primary syphiloma on the head (as a rule, this is the region of the tongue / lips) causes the appearance of cervical lymphadenitis, in which the nodes are densely elastic, not fused with each other and the surrounding tissue, and mobile. During the examination of patients, the latter note the absence of pain, and the size of the inflamed lymph nodes varies in each case.

The cervical nodes of children under 5 years of age become inflamed with Kawasaki disease, accompanied by fever, skin rash, erythema on the soles and palms. A feature of the disease is that it cannot be treated with antibiotics.

Lymphadenitis of the lower extremities

The lower limbs contain two groups large nodes: popliteal and inguinal, which in turn are divided into superficial and deep located. Lymph from the abdominal region, genital area and gluteal zone enters the inguinal nodes, so the presence of infection in these organs provokes their inflammation. Viruses and bacteria that cause a pathological focus in the legs (for example, a purulent wound) can also spread to the popliteal and inguinal nodes. Malignant tumors can metastasize to the nodes of the groin area, thereby causing their growth.

The onset of the disease is determined by an increase in lymph nodes, pain when pressed. Purulent lymphadenitis lower extremities causes an increase in temperature, swelling of the affected area. The spread of pus on nearby tissues is dangerous by the formation of phlegmon.

Therapy includes the use of antibacterial complexes under the supervision of a specialist. Lack of treatment threatens to spread the infection to neighboring lymph nodes, as well as throughout the body.

Femoral lymphadenitis

The growth of the femoral and inguinal lymph nodes is observed in the bubonic form of the plague. The disease is accompanied by severe fever, as well as signs of intoxication. A week later, suppuration of the node develops and a lymphatic fistula is formed.

Femoral lymphadenitis is sometimes diagnosed with cat scratch disease, although axillary and ulnar lymph nodes are more commonly inflamed. If the pathological process is started, then fluctuation with purulent softening of the nodes is revealed.

The popliteal lymph nodes receive lymph from the feet, so wounds, abrasions should be treated on them in a timely manner, abscesses and other purulent formations should be opened.

Inguinal lymph nodes become inflamed due to chlamydia, infections of the genital area (venereal disease, syphilis, AIDS, Nicolas-Favre disease) cause pathology. Moreover, a group of nodes soldered to each other and to the surrounding tissues is often involved in the lesion.

The cause of femoral lymphadenitis is carbuncles, boils, thrombophlebitis of the lower extremities. Infections are not only bacterial in nature, but are caused by viruses and protozoa. If it is impossible to determine the root cause of inflammation, then inflammation continues in the lymph node, which can lead to suppuration and melting of the node.

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Abdominal lymphadenitis

Infectious practice indicates the widespread nonspecific mesenteric lymphadenitis, which is most common in childhood, but also detected in adult patients.

Mesadenitis or lymphadenitis of the abdominal cavity is formed during acute respiratory processes, under the influence of pathogens of intestinal diseases, and also as a result of the presence of bacteria that provoke mononucleosis and tuberculosis. The peritoneal zone is a favorite breeding ground for pathogens. If the immune system can not cope with the number of viruses, the main blow falls on the lymph nodes of the mesentery.

The first signs of pathology are easily confused with the usual indigestion or symptoms of intoxication. The pain is localized near the navel on the right, more down the abdomen. The pain syndrome intensifies as inflammation develops, acquiring a aching, cramping character of varying intensity. The condition is supplemented by fever, nausea, vomiting, impaired excretory function. The formation of pus in the capsule of the affected lymph node is expressed by chills, fever, tachycardia and a sharp deterioration in well-being.

Abdominal lymphadenitis requires qualified treatment, otherwise complications are possible - peritonitis, adhesions of the organs of the peritoneal zone, abscess and sepsis.

Lymphadenitis of the lungs

Inflammation of the intrathoracic lymph nodes is a form of primary tuberculosis that develops immediately after infection. Such a disease has become widespread, especially among children, in adolescence, which is associated with vaccination and insufficiently strengthened immunity in patients of this age group.

Lymphadenitis of the lungs manifests itself in different ways, depending on the location of the inflammation, the degree of spread of the pathological focus and the enlargement of the lymph nodes. Symptoms of the disease:

• cough, as in whooping cough, especially tormenting the patient at night;
• the development of a dry, unproductive cough into a wet one with sputum;
• noisy breathing;
• irritability;
• night chills;
• feverish state;
• pain in chest;
• signs of intoxication;
• weakness.

Clinical practice knows cases of an asymptomatic course of the disease, when pulmonary lymphadenitis is diagnosed only during a routine examination. Help in differentiating the pathology is provided by an increase in superficial nodes.

Inflammation lung tissue often combined with lymphadenitis and lymphangitis. The defeat of the lymph nodes is detected by x-ray methods.

Lymphadenitis of the mammary gland

The mammary gland is conditionally divided into four parts:

• two quadrants outside;
• two quadrants inside.

Lymphatic drainage from the outer quadrants enters the axillary lymph nodes. The inner quadrants of the chest communicate with the parasternal lymph nodes. It should be noted that the mammary gland undergoes changes in various stages. menstrual cycle during pregnancy and breastfeeding.

Regional inflammation is understood as a local lesion of the lymph nodes. Symptoms of the disease begin with a pathological process in the nodes of the armpit, the region of the mammary glands, sub- and supraclavicular lymph nodes. Lymphadenitis of the mammary gland is most often provoked by strepto- and staphylococci, less often by gono- and pneumococci. The infection enters from the primary foci of inflammation located directly on the chest (purulent wounds, skin diseases), or by the lymphogenous / hematogenous route from other affected organs and systems.

The clinical picture includes: enlargement and soreness of the lymph nodes, the skin over the affected node is hyperemic and tense. The patient's condition worsens with the formation of purulent discharge in the focus of inflammation.

Left-sided lymphadenitis

Lymphadenitis is a disease that causes a single inflammation of a lymph node (local lesion) or a group of nodes (regional lesion). Pathology can be detected on one or both sides simultaneously, more often in the armpits and groin. Active growth of lymph nodes in size and sharp pain indicates the development of a pathological focus.

A complication after BCG vaccination is considered tuberculous inflammation of the lymphatic system, which affects babies. The cause of the disease are:

• decrease in the body's resistance forces as a result of frequent colds, with severe diathesis, rickets, etc.;
• vaccination of premature babies;
• administration of an excessive amount of vaccine.

The consequence of vaccination will be axillary left-sided lymphadenitis with a characteristic pain syndrome, often accompanied by lymphangitis.

Atypical mycobacteria of the face and oral cavity provoke unilateral inflammation of the lymph nodes mandible. The defeat of the cervical nodes on the left or right is observed due to the infectious and inflammatory process in the body (tonsillitis, influenza, tonsillitis, pneumonia, etc.).

Right-sided lymphadenitis

Right-sided lymphadenitis occurs in various pathologies. For example, the culprits of inflammation of the lymph nodes to the right below the navel are infections of viral etiology, such as: gastroenteritis, ENT diseases. Attacks proceed in an acute form, resembling inflammation of the appendix with severe symptoms of intoxication.

An increase in the submandibular lymph nodes on the right side causes pathologies of the oral cavity of the same part of the face (untreated caries, gum disease, various chronic diseases).

The only sign of mononucleosis of an infectious nature is inflammation of the cervical lymph nodes on one side or symmetrically. With odontogenic lymphadenitis, the patient's face becomes skewed to the side where the pathological process of the lymph node has formed. If there is an infected tooth on the right side of the jaw, then right-sided lymphadenitis develops. Inflammation begins with nearby nodes (the area of ​​​​the main collector), in the future, signs of the disease are detected along the course of the lymph flow or spread through the bloodstream.

Bilateral lymphadenitis

Pronounced bilateral lymphadenitis is formed as a result of:

• infectious mononucleosis;
• syphilis of the secondary type;
• infiltrative lesion;
• detection of toxoplasma;
• therapy with phenytoin and other diseases.

When infected with primary syphilis, a symmetrical inflammatory process of the inguinal and submandibular nodes is widespread up to the size of a large bean or nut. In parallel, the pathology is found in the lymphatic vessel leading to the affected lymph node.

A disease such as rubella provokes an increase in behind-the-ear, posterior-cervical and occipital nodes more often on both sides. Growth of lymph nodes is noted in the absence of a characteristic red rash. Complaints of patients are reduced to pain when turning the neck.

The odontogenic source of infection in acute or chronic leukemia, as a rule, is localized in the lymph nodes of the neck, submandibular zone and on the face. In this case, the inflammation is more often unilateral, but there is also a bilateral lesion due to a decrease in the body's defenses.

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Supraclavicular lymphadenitis

When the supraclavicular lymph nodes become inflamed, lymphoma, infectious and tumor processes of the chest organs, infections and tumor neoplasms of the peritoneal organs should be excluded. Tumors of the gastrointestinal tract often cause an increase in lymph nodes above the collarbone, mainly on the left. Neoplasms of the genital area can also give metastases to the region of the supraclavicular lymph nodes, mammary glands, lungs.

An important differential sign is supraclavicular lymphadenitis. For example, the growth of a node in the right supraclavicular fossa is found in a malignant lower lobe lesion of the lung.

Inspection and diagnosis of inflammation of the supraclavicular nodes is performed as follows:

• the patient is in a sitting position with his hands down, his gaze is directed forward;
• the doctor stands behind the patient;
• the chance of detecting enlarged nodes in the supraclavicular fossa increases in the supine position;
• a Valsalva maneuver is performed to help move the angle closer to the surface of the skin (sometimes even a slight cough helps).

Lymphadenitis in adults

The body of an adult is able to resist various viruses and bacteria. This is made possible by the lymphatic system, which provides protection and drainage function. An increase in lymph nodes indicates the presence of an infection in the body and that the immune system has reacted by providing the production of antibodies to pathogens.

Lymphadenitis in adults is often asymptomatic or against the background of a slight deterioration in well-being. First of all, the cervical, submandibular, axillary and inguinal nodes become inflamed. The cause of the pathology is purulent processes various bodies(furuncle, erysipelas, etc.), serious diseases (tuberculosis, plague, etc.). Factors provocateurs of lymphadenitis in adult patients are: stress, hypothermia, lowering of protective forces. As a primary disease, inflammation of the lymph nodes is extremely rare with direct infection of the node when damaged (trauma).

Lymph nodes in the groin area become inflamed more often in adulthood and indicate problems with the organs of the genital area, may portend the presence of a sexually transmitted disease. Lymphadenitis of the cervical nodes is considered a rather serious pathology in adults and requires immediate consultation with a dentist, an otolaryngologist.

Lymphadenitis in children

Inflammation of the lymph nodes in childhood is much brighter and more intense than in adult patients. Lymphadenitis in children is provoked by various infections, most often of the upper respiratory tract. Diseases such as: tonsillitis, SARS, tonsillitis, caries, etc. contribute to an increase in submandibular lymph nodes. In clinical practice, cases of damage to the cervical, popliteal, axillary nodes are much less common. Inguinal lymphadenitis in babies is an even rarer phenomenon, differentiated as a result of infringement of the inguinal hernia.

Lymphadenitis in pregnant women

Inflammation of the lymph nodes during the bearing of the baby occurs due to infectious and inflammatory processes and a decrease in immunity. Lymphadenitis in pregnant women mainly occurs in a catarrhal and purulent form.

Purulent inflammation is dangerous for its consequences:

• lymphangitis - the disease spreads to the walls of the lymphatic vessels;
• thrombophlebitis - defeat circulatory system;
• violation in the work of the organs or systems of the body of the expectant mother.

Chronic processes often appear during pregnancy, for this reason, women are advised to be examined before conception. A visit to the dentist and otolaryngologist is considered mandatory.

Detection of lymphadenitis after the onset of pregnancy requires immediate contact with a specialist. Therapy is carried out with the help of antibiotics, more often cephalosporins or macrolides. Purulent formations in the lymph nodes are subject to surgical treatment.

The lack of proper and timely treatment threatens with irreparable consequences for the fetus (developmental delay, infection, etc.). Availability chronic inflammation may affect future pregnancies.

Why is lymphadenitis dangerous?

The progression of the inflammatory focus in the lymph nodes often entails hemorrhagic, fibrinous, serous purulent changes. Lymphadenitis of an advanced stage without proper treatment provokes irreversible processes: tissue necrosis, abscess formation, ichorous destruction of the lymph nodes, sepsis (blood poisoning).

Simple inflammation does not extend beyond the lymphatic capsule. Pathology with destructive manifestations covers nearby tissues, increasing the affected area at times. It is common for a nonspecific form of the disease to develop into thrombophlebitis with the formation of metastatic foci of infection (septicopyemia, lymphatic fistula).

A chronic inflammatory process is dangerous because in most cases it proceeds hidden, without severe symptoms, indicating a decrease in the body's defenses and threatening degeneration of the lymph nodes. Characteristic complications of chronic non-specific lymphadenitis are: swelling, elephantiasis (overgrowth of connective tissue), lymphostasis, dysfunction of lymph circulation.

Consequences of lymphadenitis

Lymphadenitis is terrible with the possibility of spreading infection, cancer cells throughout the body through the bloodstream or lymphatic system. The lack of an effective and correct treatment regimen can lead to death.

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The initial diagnosis of lymphadenitis includes palpation of the inflamed nodes, after which instrumental and laboratory techniques are prescribed:

• study of the composition of the blood;
• histological analysis (taking a tissue sample from the affected node);
• with lymphadenitis of a specific type, they focus on the possibility of contact with a carrier of tuberculosis and make skin tests With laboratory research(blood, sputum), as well as X-ray;
• purulent inflammation requires surgical opening of the capsule of the lymph node, if necessary - drainage of the wound;
• an increase in inguinal nodes is a signal to exclude a hernia in the groin;
• examination of children begins with suspicions of Quincke's edema, tumor formations of the cervical zone and the exclusion of congenital cysts;
• often used - ultrasound, consulting an ENT doctor, CT scan, HIV test.
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Blood test for lymphadenitis

Quantitative and qualitative characteristics of the composition allows you to identify a blood test for lymphadenitis. In addition to the general analysis, the leukoformula and the level of LDH (lactate dehydrogenase), characteristic of leukemia and lymphoma, are counted. An excess of ESR indicates inflammatory and tumor processes. A mandatory study of a peripheral blood smear is required to determine infectious mononucleosis.

Uric acid and transaminases (indicative of hepatitis) in a blood test for biochemistry are the basic criteria for systemic pathologies (autoimmune diseases, malignant neoplasms).],

Lymphadenitis on ultrasound

Ultrasound examination helps to track the effectiveness of therapy antibacterial drugs. For this purpose, the size of the affected node is recorded before and at the end of treatment.

Lymph nodes are normally oval or bean-shaped, arranged in groups. The characteristics of the nodes (shape, size, structure, number, location) vary depending on the age, individual characteristics of the patient's body.

Lymphadenitis on ultrasound is noted by a number of features:

• nodes are enlarged;
• the capsule of the lymph node is tense;
• the vascular pattern is strengthened;
• the cortical and near-cortical zones are significantly expanded;
• puffiness is determined;
• anechoic areas may be present;
• hyperplastic and spliced ​​nodes are observed;
• sometimes metastatic changes are detected.

Which doctor treats lymphadenitis?

Inflammation of the lymph nodes is the reason for contacting a therapist who refers an endocrinologist, surgeon or oncologist for a consultation. The choice of a specialist largely depends on the nature of the course of lymphadenitis and the severity of the initial lesion. Often, an examination by an infectious disease specialist, hematologist or rheumatologist is required.

The duration of treatment for a specific type of lymphadenitis depends on the severity of the underlying disease and the correctness of the therapeutic regimen.

Prevention of lymphadenitis

Prevention of acute and chronic inflammation of the lymph nodes lies in timely therapy primary diseases: tonsillitis, tonsillitis, purulent skin lesions, osteomyelitis, rhinitis, gingivitis, boils, carbuncles and various infectious diseases (flu, SARS, etc.). Prevention of lymphadenitis also includes anti-caries measures: a systematic visit to the dentist in order to treat caries, stomatitis and other pathological foci of the oral cavity.

Nursing mothers are advised to carefully monitor the hygiene of the mammary glands, to prevent the development of lactostasis. In cases infectious diseases it is important to follow all the instructions of the attending physician regarding antibiotic therapy. You should not reduce the period of taking antibiotics on your own or replace the prescribed drug with another drug.

Preventive measures to prevent inflammation of the lymph nodes include the timely removal of splinters, the treatment of abrasions, microcracks and cuts with the application of antiseptic dressings.

Immunocorrective programs help to increase the body's defenses and more effectively fight pathogenic microflora.

Prognosis of lymphadenitis

Nonspecific acute lymphadenitis at the beginning of development, with the provision of high-quality treatment, most often has a favorable prognosis. The destructive course of the inflammatory process ends with the destruction of the lymph node, followed by scarring. Progression acute forms lymphadenitis of the extremities provokes a violation of lymphatic drainage, the formation of lymphostasis, and subsequently - to elephantiasis.

The purulent type of inflammation threatens with periadenitis (the pathology spreads to the surrounding tissues), an abscess or phlegmon / adenophlegmon is formed around the melted node, requiring long-term treatment. The outcome of the disease is often thrombophlebitis, lymphatic fistulas.

The prognosis of chronic lymphadenitis is favorable when establishing the root cause of inflammation and timely therapy. Negative consequences can be scarring, swelling of the tissue over the affected node. As a result of wrinkling and compaction of the lymph node, there is a proliferation of connective cells, impaired lymph circulation.

Lymphadenitis is able to go away on its own in case of timely and effective treatment the main purulent-inflammatory disease. Therefore, at the first symptoms of inflammation of the lymph nodes, it is necessary to visit a doctor and strictly follow his instructions.