Lymph nodes in syphilis often undergo a number of changes. These changes help the doctor to suspect the development of pathology, to choose the optimal diagnostic options.

Also, it is the problems with the lymphatic system that often become the first alarm bell, which forces the patient to seek medical help.

What lymph nodes change in syphilis, patients want to know from their attending physicians, and what symptoms accompany these changes. Why is the lymphatic system involved in the process, and which doctor will help in the diagnosis and treatment of the disease?

What is the role of lymph nodes in syphilis

Syphilis - difficult to treat disease. It develops in a person if pale treponema enters his body.

The disease proceeds rather slowly. Its symptoms are difficult to identify for a person who is not familiar with the features of STIs.

The transmission of syphilis occurs mainly through sexual contact. In exceptional cases, a contact-household transmission option is implemented. Also, a child can get infected from an infected mother during the prenatal period.

The disease, if not engaged in therapy, goes through 4 main stages. The lymphatic system is involved in each of the stages. After all, it is she who is responsible in the body for the fight against pathogenic microbes.

• Incubation

The incubation period lasts on average 3-4 weeks. The patient does not feel any changes. Since the concentration of bacteria is still insufficient to cause serious harm to the body. However, on close examination, you can notice a slight increase in lymph nodes during this period.

• Primary period

Primary syphilis is accompanied by the formation of a primary focus of contact, called a chancre.

Initially, during this period, changes in the lymphatic system may be absent. However, over time, the patient notes that the regional lymph nodes located closest to the focus have become larger in size.

• Secondary period

The secondary stage of the disease is often accompanied by vivid symptoms. Which makes a person seek help from a medical professional. At the same time, the human immune system can remain intact (the period of involvement has already come to naught). Or respond to the causative agent with inflammation of the lymph nodes in syphilis, changing their size.

• Tertiary syphilis

Also known as late syphilis.

It is accompanied by massive damage to all organs and systems. The involvement of the immune system does not matter.

A person becomes contagious during the incubation period, as soon as the pathogenic microorganism appears in the lymphoid formations. However, by the tertiary period, infectiousness completely disappears, a person does not pose a threat to others.

What are the symptoms of enlarged lymph nodes with syphilis

Many people believe that only an increase in lymph nodes with syphilis indicates the development of pathology. This opinion is wrong.

In fact, as practice shows, a person can notice a number of pathological changes in his body.

• Resizing

The most common symptom.

Normally, the lymphatic plexuses under the skin of a person are not only completely invisible, but also cannot be felt. If pale treponema gets into them, their size reaches 3-4 centimeters.
Because of what it becomes not only easy to feel them, but also to see with the naked eye from under the skin.

• Soreness

Often, patients are interested in the question of whether the lymph nodes hurt with syphilis.

Doctors note that most often unpleasant sensations are present. But there are patients who do not present such complaints. Pain can occur both with palpation, and without physical contact, by itself.

• Change in mobility

Normally, the plexus of the immune system is slightly mobile. It can be gently moved a few centimeters to the side during palpation.

If displacement does not occur, the doctor may think about the adhesion process. This process speaks of an inflammatory reaction, oncology and a number of other abnormalities that require medical advice.

• Inflammatory process

The normal reaction to the introduction of pale treponema into the body is an inflammatory process in the lymph nodes.
In this case, in addition to soreness, decreased mobility, changes in size, the local temperature of the skin may increase. There are complaints of redness.

All these symptoms allow one to suspect negative changes. However, they can testify not only to contact with treponema pale.

In this regard, compulsory medical advice is required for an accurate diagnosis.

Lymph nodes with syphilis: additional pathology options

Often among patients, the question is asked whether there are atypical forms of pathology of the lymphatic system. And how the lymphatic vessels react in parallel when bacteria enter the body, leading to the development of syphilis.

In some cases, a person not only inflames the lymphatic formation located in the immediate vicinity of the place through which the pale treponema penetrated. But the nearest vessels of the lymphatic system are also affected.

As a result, the patient complains of the appearance of purple stripes on the skin. They may protrude slightly above the surface, pain along their length. A similar phenomenon is called by doctors lymphangitis i.e. inflammation of the lymphatic vessels.

• Amygdalitis

The tonsils are another organ of the human body that takes part in the formation of normal immunity. Sometimes they are affected by pale treponema with the development of amygdalitis. Amygdalitis is accompanied by erosive and ulcerative changes in the amygdala, an increase in its size.

However, there is also an atypical form of pathology. When the amygdala just gets bigger without pain and enlargement. In this case, the patient, having consulted a doctor, may also complain that the lymph node began to be felt under the jaw and hurt.

• Sclerodenitis

In some cases, the body reacts to the appearance of a hard chancre with the development of sclerodenitis. With this pathology, not only the nearest lymph node and lymphatic vessels are involved in the process, but a whole group of lymphoid formations.

Whether there is pain with such a deviation from the norm, patients are interested. Most often, yes. Additionally, the cohesion of the formations with each other and with the surrounding tissue is noted.

Also, the doctor will note that one of the formations is larger in comparison with the others.

What groups of lymph nodes are most often affected in syphilis

Often, patients can ask their doctors a question about which areas are affected if treponema pallidum appears in the body.

There are several options.

1. Cervical

They react most often. From the size changes by 5-6 cm, which is simply impossible to ignore, given the thin skin of this area. You can feel them if you ask the person to tilt his head to the side a little. They are involved in the process if the infection has occurred through the oral cavity.

1. Submandibular

As in the case of cervical, they increase when pale treponema enters the body through the oral cavity or the face area. They usually increase up to 2-3 cm, but even so they can cause tangible discomfort.

1. Axillary

One of the few formations that can be felt even if syphilis is absent in the body. When in contact with treponema pale, they do not always increase in size. Most often, they are involved in the process even when the disease has reached a late stage, since a hard chancre in the armpit area is practically not found.

1. Inguinal

Lymph nodes in the groin with syphilis worry patients the most.
There is nothing surprising. After all, it is through the inguinal zone that treponemes enter the body most often.

When the size of the lymphoid formations in this area changes, it is quite easy to see and feel them. The main reference point when searching is the area of \u200b\u200bthe groin fold.

1. Popliteal

The inflammatory process in the lymph nodes located in the popliteal region is practically not found in medical practice. Their involvement can be found in the classic form of the disease. When initially a change in the size of the lymph nodes is noted in the groin area.

Changes in nodes with congenital syphilis

Sometimes people are interested in the question of when, after infection, the lymph nodes react in congenital syphilis.

There are several options for the development of events. In most cases, the disease in a newborn, infected from the mother, proceeds according to the classical scheme. An increase in the size of the formations in the first days of life can be noted.

In addition, a number of other symptoms will indicate a congenital form of pathology. Such as a wrinkled face, nasal lesions, constant plexus, etc.

As doctors note, the congenital form of the pathology is not accompanied by soreness of the lymph nodes. Children are born with an already affected system, since the pathogenic microorganism is in the body for some time even before birth.

The nodes are different:

• painlessness;
• the presence of very dense adhesions with the surrounding tissues, which do not allow them to be shifted when probed to the sides;
• dense, homogeneous, most often consistency, which can be determined by palpation;
• increased in comparison with the indicators of the norm in size.

Often, babies infected in utero do not live long after birth.

Also, syphilis can lead to the fading of pregnancy, miscarriages. Because of this, much attention is not always paid to the assessment of the lymphatic system in congenital pathology.

Lymph nodes for syphilis: where to go, and who will help

Often, patients want to know which doctor is treating the lymphatic system if it is affected by treponema pallidum.

In fact, there is no separate specialist dealing with this problem.

It is important to understand that syphilis is a disease that belongs to the group of sexually transmitted infections. Therefore, a venereologist will deal with the therapy of the disease.
In this case, the doctor will not only take measures to rid the patient's body of the pathogenic microbe, but also act on the symptoms.

And the symptoms include an increase in the size of the lymph nodes.

Patients want to know where to turn in case of suspicious changes in their body.

First of all, it is worth visiting a dermatovenerologic dispensary, to which a person is attached at the place of residence. An alternative for treatment will be a private diagnostic clinic, on the basis of which you can perform the necessary tests, get recommendations for treatment.

In the second case, anonymity is higher, which is what the patients like.

The question is often asked about how to diagnose syphilis with enlarged lymph nodes. Most of the diagnostic recommendations are standard.

First of all, the Wasserman reaction is performed as the main screening method. If necessary, the results of the reaction are confirmed using immunofluorescence, treponema immobilization reaction.

Wasserman's reaction alone is never diagnosed. The fact is that it can be positive even if the person has previously had syphilis and is now completely healthy.

How to distinguish from an increase in other diseases, changes in the lymphatic system when infected with treponema pale, patients want to know. This is exactly what analyzes should help.

Identification of the pathogen in the body is an indisputable fact that a person is sick and needs therapy. If the pathogen is absent, then there is a possibility that the pathological processes are provoked by other changes.

The lymphatic system and syphilis are closely related. Both patients and doctors should not forget this.

Swollen lymph nodes with syphilis

Syphilis is an infectious disease caused by treponema pallidum. It is spread mainly through sexual contact.

The main path of promotion the pathogen in the infected organism is the lymphatic system. Spreading in the primary period along the lymphatic tract, pale treponema affects them. Through the thoracic duct, they penetrate into the bloodstream and are carried to all organs and tissues.

Primary period of syphilis

The primary period of syphilis begins with the formation of primary syphiloma (hard chancre) at the site of the introduction of pale treponemas, 5-7 days after its onset, an increase in regional lymph nodes is found.

Secondary period of syphilis

The secondary period of syphilis, which develops about 2.5 months after infection, is characterized by the appearance of generalized rashes on the skin and mucous membranes, as well as an increase in lymph nodes. During this period, internal organs (liver, kidneys, cardiovascular and nervous systems) can be involved in the pathological process.

Lymph nodes with syphilis

Lymph nodes in syphilis reach a size from the size of a cherry to a pigeon's egg, have a dense elastic consistency, are not welded to each other and the surrounding tissues, are mobile, painless on palpation. The skin above them is not changed, normal color.

Regional lymphadenitis resolves very slowly, even with specific treatment.

Diagnosis of syphilis

The presence of a saucer-shaped ulcer on the genitals and regional lymphadenitis suggests syphilis.

To confirm the diagnosis, the presence of treponemas in the detachable chancre or in the punctate of the regional lymph nodes is determined, the reactions of Wasserman, Kahn, Sachs-Vitebsky and others are carried out.

To treat syphilis, see a lymphologist or venereologist. Endolymphatic therapy provides the fastest and most effective treatment result.

The active role of the lymphatic system in the development of infectious pathology in syphilis is known. The first manifest signs of its involvement in the pathological process are two of the three components that make up the clinical picture of the primary period of syphilis - regional lymphadenitis and lymphangitis of the vessels going from the solid chancre to the regional lymph nodes.

Clinically pronounced regional lymphadenitis (scleradenitis, accompanying bubo) occurs 5-8 days after the appearance of a hard chancre and, according to Ricord and Fournier's definition, serves as its constant and obligatory companion. Regional lymph nodes gradually, often unnoticed by the patient, increase to the size of a pea, plum, walnut and more, remaining painless. Usually, several lymph nodes react with anogenital localization of the chancre on both sides, but one of them increases more. On palpation, the lymph nodes have a dense elastic consistency, are not welded to each other and the surrounding tissues, and are mobile; the skin above them is not changed. Without treatment, regional lymphadenitis persists much longer than the primary chancre and gradually undergoes reverse development in the same time frame as polyadenitis in secondary fresh syphilis. In the process of specific treatment, regional lymphadenitis also resolves much later than the chancre. Regional inguinal scleradenitis occurs when the chancre is localized on the genitals, in the perigenital region; when the chancre is localized on the fingers, hands, palms, the ulnar and axillary nodes react, when the chancre is localized on the head, the submandibular, anterior, posterior cervical, occipital, preauricular.

Some changes in the clinical course of syphilis in recent years have affected the reaction of the lymphatic system to the introduction of pale treponemas. Fournier noted the absence of scleradenitis in only 0.06% of 5000 patients; P.S. Grigoriev - only 1% of patients with primary syphilis. According to M.A. Karagezyan et al., G.R. Karsybekova, T.V. Rychkova, R.S. Babayants, B.I. Zudin, inguinal lymphadenitis was absent in 5.2-8% of patients; according to our observations, it was absent in 4.4% of patients. We observed a unilateral reaction of regional inguinal lymph nodes in 26.7%, A.X. Abdullaev - 12.2%, M.A. Kapagezyan et al. -in 37.5% of patients with primary syphilis. In a number of cases, with the localization of a hard chancre in the anal region, rectum, on the cervix, the absence of a reaction of the inguinal lymph nodes can be explained by the fact that regional lymph nodes of the small pelvis, inaccessible to examination (palpation), are regional for a given localization of primary syphiloma.

Along with the insufficient response of the lymphatic system to the introduction of infection, a number of researchers note the possibility of a hyperergic reaction in primary syphilis with a sharp increase in lymph nodes fused into conglomerates, sharp pain, with symptoms of periadenitis, inflammation of the underlying tissues and even the formation of fistulas.

In some patients, regional scleradenitis preceded the hard chancre or occurred simultaneously with its appearance. Usually, such facts are combined with a lengthening of the incubation period as a result of patients taking small doses of antibiotics, metronidazole or intoxication.

The third component of the clinical picture of primary syphilis - specific lymphangitis - inflammation of the lymphatic vessel from the solid chancre to the regional lymph nodes is not constant and is currently observed rarely, in 7-8% of patients. More often, clinically pronounced lymphangitis is noted with localization of a hard chancre in men in the region of the glans penis, coronal groove and preputial sac. Lymphangitis is presented in the form of a palpable painless cord, sometimes distinct, not welded to the surrounding tissue, on the back of the penis (dorsal lymphangitis). Lymphangitis phenomena undergo reverse development, leaving no trace.

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  And here the question concerns an extremely rare biopsy diagnosis. An increase in regional lymph nodes is a constant sign of primary. With a typical localization of the primary affect in the genitals, regional lymphadenitis does not cause diagnostic difficulties and is usually not an object of biopsy.

  However, sometimes with atypical primary localization and with secondary syphilis, clinical searches may be difficult, which leads to the need for a biopsy study, as was the case in A. Fath (1961).

  In primary syphilis, morphological changes in the lymph node are nonspecific and correspond to changes in subacute hyperplastic lymphadenitis. They are expressed in edema and highly developed hyperplasia of the light centers of the follicles of the cortex, indistinctly delimited from the mantle zone of the follicle. The sinuses are dilated and filled with lymphocytes. Along with this, pronounced plasmacytic proliferation is observed.

  Plasmacytes are located either in groups around blood vessels, or are scattered among the parenchyma of the lymph node. The inflammatory process also covers the capsule and trabeculae, which become edematous and infiltrated by lymphocytes. Similar changes are observed in the surrounding loose connective tissue.

  An important sign that characterizes syphilitic inflammation is damage to the blood vessels. Thrombi and endothelial proliferation (endovasculitis) are observed in arterioles, venules and newly formed capillaries both in the parenchyma and in the capsule, trabeculae and in the hilus of the lymph nodes. The affected vessels are included in the clutch of plasma cells. As a result of vascular lesions, bleeding and necrosis develop.

  With secondary syphilis, the picture also remains nonspecific. Only in some cases can one detect the proliferation of epithelioid cells and the formation of granulomas with a centrally located focus of necrosis and giant cells of the Langhans type.

  This picture resembles tuberculosis, therefore the disease is referred to as granulomatous epithelioid cell lymphadenitis. In other cases, proliferation can become pseudo-malignant (G. Duhamel, 1969) and resemble lymphogranulomatosis or even lymphosarcoma.

  For differential diagnosis, detection of plasma cells and vascular changes is important.

  The diagnosis is facilitated by the identification of spirochetes, most often through the use of silver impregnation methods (for example, according to Levaditi). Spirochetes are found in the marginal sinus, in the walls of blood vessels, and in the periganlionic loose connective tissue.

  "Pathology of the lymph nodes", IN Vylkov

  Only the submandibular, axillary and inguinal lymph nodes can be identified. Among the many clinical classifications of lymphadenopathies, the most significant is the division of lymphadenopathies into:

  • localized
  • generalized.

  In patients visiting primary care, the frequency of localized and generalized lymph node lesions will be relatively constant: 75% of localized lymphadenopathies, 25% of generalized ones. In 1% of patients with lymphadenopathy, malignant disease is subsequently detected. [ ]

  Etiology and pathogenesis[ | ]

  Infectious diseases, most often occurring with the involvement of lymphoid tissue.

  Medicinal substances that cause lymphadenopathy syndrome:

  Clinic [ | ]

  The main symptom of lymphadenopathy is swollen lymph nodes, which can be localized or generalized. Additional symptoms may include:

  • night sweats;
  • weight loss;
  • concomitant prolonged increase in body temperature;
  • frequent recurrent upper respiratory tract infections (pharyngitis, tonsillitis, tonsillitis, etc.);
  • pathological changes on the radiograph of the lungs;
  • hepatomegaly;
  • splenomegaly.

  Anamnesis [ | ]

  Anamnesis is an important factor in determining the cause of lymphadenopathy. Careful history and epidemiological data collection often suggests a probable cause of lymphadenopathy.

  Features of the infectious history.

  Features of the professional history.

  Features of the migration history

  Clinical examination[ | ]

  In the presence of localized lymphadenopathy, it is necessary to examine the areas from which lymph flows into this group of lymph nodes, for the presence of inflammatory diseases, skin lesions, tumors. A thorough examination of all groups of lymph nodes, including non-contiguous ones, is also necessary to exclude generalized lymphadenopathy. This important stage of diagnosis should be carried out in all patients with localized lymphadenopathy, since during the initial examination only 17% of patients with generalized lymphadenopathy are detected. It is necessary to palpate the submandibular, anterior and posterior cervical, supraclavicular, axillary, inguinal lymph nodes. If enlarged lymph nodes are found, the following characteristics should be noted:

  • the size,
  • soreness
  • consistency,
  • communication with each other,
  • localization,

  The size [ | ]

  In most cases, the normal size of the lymph nodes is considered to be no more than 1 cm in diameter. The ulnar lymph node is more than 0.5 cm and the inguinal lymph node is more than 1.5 cm should be considered pathological. The size of the lymph nodes does not make it possible to assume the diagnosis, however, according to some data, the most suspicious of a malignant lesion are lymph nodes larger than 1 × 1 cm.In children, an increase in lymph nodes of more than 2 cm in diameter, along with the presence of changes on X-ray of the lungs and the absence of inflammatory diseases of the ear and nose , pharynx may indicate the presence of a granulomatous process (eg tuberculosis, cat scratch disease, sarcoidosis) or malignancy (mainly lymphoma).

  Soreness [ | ]

  With a rapid increase in the lymph node volume, its capsule is stretched, which causes pain. Pain also occurs during an inflammatory process with suppuration, but it can appear with hemorrhage into the necrotic center of the lymph node in a malignant lesion. The presence or absence of pain is not a diagnostic sign between benign and malignant diseases.

  Consistency [ | ]

  The lymph nodes are dense, like a stone, typical for cancerous lesions, are of a metastatic nature. Dense elastic lymph nodes are suspicious of lymphoma. Softer lymph nodes are more often the result of an infection or inflammation. With abscess formation, fluctuation appears. The term "buckshot" lymph nodes is used to characterize multiple small lymph nodes under the skin, usually found in children in the head and neck with viral diseases.

  Communication with each other[ | ]

  A group of lymph nodes that appear to be interconnected and shift as a whole is called a conglomerate. Lymph node conglomerates are found in benign (eg tuberculosis, sarcoidosis, lymphogranuloma venereum) and malignant (cancer metastases, lymphomas) diseases.

  Localization [ | ]

  The anatomical position of the lymph nodes in localized lymphadenopathy allows in many cases to narrow the search in differential diagnosis. For example, cat scratch disease is characterized by damage to the cervical and axillary lymph nodes, and with sexually transmitted infections - the inguinal lymph nodes.

  Localization	Drained area	Possible reasons
  Submandibular	Tongue, submandibular salivary gland, lips, oral cavity, conjunctiva.	Lesions of the head and neck, sinuses, ears, eyes, skin, pharynx
  Chin	Lower lip, floor of mouth, tip of tongue, cheek skin	Mononucleosis syndrome, Epstein-Barr virus, cytomegalovirus, toxoplasmosis.
  Jugular	Tongue, tonsils, auricle, parotid salivary gland	Pharyngitis, rubella
  Posterior cervical	Skin of the head, neck, upper limbs, chest wall, cervical and axillary lymph nodes	Tuberculosis, lymphoma, malignant diseases of the head and neck, rubella
  Occipital	Head and neck skin	Local infections, rubella
  Behind-the-ear	External auditory canal, auricle, scalp	Local infections, rubella
  Anterior ear	Eyelids, conjunctiva, temporal region, auricle, external auditory canal	Local infections
  Right supraclavicular lymph node	Mediastinum, lungs, esophagus	Damage to the lungs, esophagus
  Left supraclavicular lymph node	Chest, abdominal cavity through the thoracic duct.	Lymphoma, a malignant lesion of the abdominal and retroperitoneal organs
  Axillary	Upper limb, chest wall, mammary gland	Infections, cat scratch disease, lymphoma, breast cancer, silicone implants, brucellosis, melanoma
  Cubital (ulnar) lymph node	The elbow of the forearm and hand	Infections, lymphoma, sarcoidosis, tularemia, secondary syphilis
  Inguinal	Penis, scrotum, vulva, vagina, perineum, gluteal region, lower abdominal wall, anal canal, lower limb	Lower extremity infections, sexually transmitted infections (e.g. herpes, gonorrhea, syphilis, chancroid, inguinal granuloma, lymphogranuloma venereum), lymphoma, pelvic malignancy, bubonic plague

  Supraclavicular lymphadenopathy is most commonly associated with malignant disease. Holding the supraclavicular lymph nodes during palpation increases the likelihood of finding an enlarged lymph node. Lymphadenopathy in the right supraclavicular region is often associated with the presence of a malignant tumor in the mediastinum, lungs, and esophagus.

  The left supraclavicular lymph nodes (Virchow's lymph node) receive lymph through the thoracic duct from the thoracic and abdominal cavity, retroperitoneal space, and their increase can be a signal of damage to the testes, ovaries, kidneys, pancreas, prostate, stomach or gallbladder.

  An increase in paraumbilical lymph nodes can be a sign of a malignant process in the pelvis or abdominal cavity. In patients with generalized lymphadenopathy, clinical examination should focus on looking for signs of systemic disease. The most valuable data are the detection of rash, mucosal lesions, hepatomegaly, splenomegaly, joint damage. Splenomegaly and lymphadenopathy occur in many conditions, including mononucleosis-like syndrome, lymphocytic leukemia, lymphoma, and sarcoidosis.

  Disease	Diagnostic findings	Research
  Mononucleosis-like syndrome	Weakness, fatigue, fever, leukocytosis, lymphocytosis, monocytosis, atypical mononuclear cells	Serological tests: Paul-Bunnel test, CD / PBD test, Hoff and Bauer test
  Infectious mononucleosis (Epstein-Barr virus)	Splenomegaly in 50%, rash of maculo-papular, small-spotted, roseolous, papular character, which lasts 1-3 days, disappears without a trace	Serological reactions: Paul-Bunnel reaction, CD / PBD reaction, Goff and Bauer reaction, study of IgM fraction, antibodies to viral capsid
  Toxoplasmosis	Subfebrile condition, 65% enlarged liver, choreoretinitis, CNS lesions	Antibodies of the IgM family to toxoplasma antigens
  Cytomegalovirus	Subtle symptoms	Antibodies to cytomegalovirus, virological research
  Initial stages of HIV infection	ARI-like syndrome, rash	Antibodies in HIV
  Cat scratch disease	Fever in 30% of patients, cervical, axillary lymphadenopathy	Clinically, biopsy
  Pharyngitis (staphylococcal, streptococcal)	Fever, pharyngeal involvement, cervical lymphadenopathy	Bacteriological examination of lavage from the pharynx
  Tuberculous lymphadenitis	Painless lymph node conglomerates	Tuberculin diagnosis, biopsy
  Secondary syphilis	Rash	Microprecipitation reaction, treponema pallidum immobilization reaction, RW
  Hepatitis B	Fever, nausea, vomiting, jaundice	Liver test, HBs antigen
  Lymphogranuloma venereum	Pain, conglomerate of inguinal lymph nodes	Serological tests
  Shankroid	Painless ulcer, painful inguinal lymph nodes	Clinic, bacteriological method
  lupus erythematosus	Arthritis, butterfly rash, serositis, renal, liver, CNS dysfunction	Clinic, antinuclear antibodies, complement level
  Rheumatoid arthritis	Arthritis	Clinic, rheumatic factor
  Lymphoma	Fever, night sweats, weight loss	Biopsy
  Lymphogranulomatosis		Study of peripheral blood, bone marrow, Berezovsky-Reed-Sternberg cells
  Serum sickness	Fever, weakness, arthralgia, urticaria, use of foreign serum in treatment	Anamnesis, clinic, study of the complement system, histology - accumulations of "foamy" macrophages around arterioles (granulomatous lesions)
  Sarcoidosis	The defeat of the lymph nodes of the root of the lung, skin damage	Biopsy
  Kawasaki disease	Fever, conjunctivitis, rash, mucosal lesions	Clinic
  Lyme disease	Erythema migrans (target), arthritis	Anamnesis (tick bite), n-RIF, ELISA test, PCR
  Measles	Fever, rash, conjunctivitis, cough	Clinic, spots of Belsky-Filatov-Koplik on the mucous membrane of the cheeks, serological tests (RSK, RTGA, RIF), diagnostic increase in titer by 4 times.
  Rubella	Rash	Clinic, serological tests
  Tularemia	Fever, ulcer at the injection site
  Brucellosis	Fever, sweating, weakness	Blood culture, serological research
  Plague	Fever, painful lymph nodes, acute onset	Blood culture, serological research
  Still's disease	Fever, rash, arthritis	Clinic, rheumatic factor, antinuclear antibodies
  Dermatomyositis	Weakness in the limbs, specific skin lesions	Muscle enzyme testing, electromyography, muscle biopsy
  Amyloidosis	Weakness, weight loss	Biopsy

  Separate nosological forms manifested by a symptom of lymphadenopathy[ | ]

  The appearance of lymphadenopathy is characteristic, in particular, for the following diseases:

  Lymphadenitis [ | ]

  Axillary and groin nodes are most commonly affected. The disease begins with painful enlargement and hardening of the corresponding nodes. They are mobile, not soldered to each other and the covering skin. With the progression of inflammation, a dense, monolithic, very painful infiltrate forms. The skin above it becomes motionless, red, hot, later becomes thinner, acquires a cherry color. Fluctuation appears, and pus breaks out. Then the abscess is cleared, all symptoms regress and recovery occurs. Depending on the spread of lymphadenitis, fever, chills, headache, sweating, general malaise, high leukocytosis and an increase in ESR are observed.

  A low-virulent infection can cause chronic hypoplastic lymphadenitis: slightly painful enlarged lymph nodes scar over time and turn into hard nodules. Lymphadenitis can be complicated by an abscess, phlegmon, phlebothrombosis, sepsis, lymphostasis and elephantiasis.

  Diagnostics. Acute superficial lymphadenitis is not difficult to diagnose, especially if a focus of infection and lymphangitis are detected. Lymphadenitis should be differentiated from abscess, phlegmon, osteomyelitis, hydradenitis, pyoderma. Puncture, X-ray examination of the affected area help diagnostics. Subacute and chronic lymphadenitis must be distinguished from tuberculosis, mycobacteriosis, syphilis, lymphogranulomatosis, tumor metastases, and blood diseases.

  Lymph node tuberculosis[ | ]

  It is more often diagnosed in children and adolescents, less often in adults and the elderly. More often cervical and submandibular lymph nodes are affected, less often - axillary, extremely rarely - inguinal and elbow. Affected lymph nodes are enlarged up to 1.5 cm in diameter and more, soft or dense in consistency.

  The disease can begin acutely, with high fever and severe intoxication, and the inflammatory process can spread from the lymph nodes to the subcutaneous tissue and skin. When the surrounding tissues are involved in the process, dense, large, inactive bundles of nodes are formed. Lack of treatment leads to suppuration: over the lymph nodes, the skin becomes hyperemic, fluctuation appears, pus breaks out and fistulas do not heal for a long time. The chronic course of tuberculosis of the external lymph nodes is manifested by dense formations of nodes), sometimes a chain of small nodules.

  There are three forms of tuberculous lymphadenitis:

  • infiltrative
  • caseous
  • inductive.

  Infiltrative form characterized by a slight increase in lymph nodes and their dense texture. More often one group of lymph nodes is affected. It proceeds favorably, only hyperplasia of the lymphoid tissue remains. When caseous form several groups of lymph nodes are affected. Lymph nodes undergo cheesy necrosis, with suppuration, fistula and ulceration. The current is heavy.

  Inductive (fibrous) formsbut it runs for a long time, with it, dense lymph nodes with petrification, scars on the skin after healed fistulas are determined. This form is more often the outcome of the caseous form, less often infiltrative. From the side of the blood in the acute course and during the period of exacerbation of lymphadenitis, there is an increased ESR, moderate leukocytosis with stab shift and monocytosis.

  Diagnosis of tuberculosis of peripheral nodes consists of anamnesis (contact with patients with tuberculosis, tuberculosis of the lungs and other organs, scars on the neck, eye disease), objective data, tuberculin diagnostics (the test is sharply positive), detection of mycobacterium tuberculosis in pus, in the puncture examination of lymph nodes, cytological punctates and histological analysis of biopsy material.

  The outcome of the disease depends on the timeliness of diagnosis, the form of lymphadenitis and the effectiveness of treatment. With a favorable course, the lymph nodes decrease and thicken (sometimes with subsequent formation in them), the fistulas are closed. Fistulous forms end in disfiguring sclerosed or keloid scars.

  Examination of a patient with suspected tuberculosis should be based on a mandatory diagnostic minimum, which must be performed at the initial visit. An additional diagnostic minimum and an optional diagnostic minimum are performed in a specialized medical institution.

  Infectious mononucleosis[ | ]

  Infectious mononucleosis is a viral disease caused by the Epstein-Barr virus. The incubation period ranges from 4 to 15 days (usually about a week). The disease usually begins acutely. By the 2-4th day of illness, fever and symptoms of general intoxication reach the greatest severity. From the first days, weakness, headache, myalgia and arthralgia appear, a little later - sore throat when swallowing. Body temperature 38 - 40 ° C. The duration of the fever is 1 to 3 weeks, rarely longer. Tonsillitis appears from the first days of the disease or develops later against the background of fever and other manifestations of the disease (from the 5th to 7th day). It can be catarrhal, lacunar or ulcerative-necrotic with the formation of fibrinous films (sometimes resembling diphtheria). Necrotic changes in the pharynx are especially pronounced in patients with significant agranulocytosis.

  Lymphadenopathy is observed in almost all patients. Submandibular and posterior cervical lymph nodes are more often affected, less often - axillary, inguinal, cubital. Not only peripheral lymph nodes are affected. Some patients may have a rather pronounced picture of acute mesenteric adenitis. Exanthema is noted in 25% of patients. The timing and nature of the rash vary widely. More often it appears on the 3rd - 5th day of illness, it can have a maculo-papular (measles-like) character, small-spotted, roseolous, papular. Elements of the rash last 1 - 3 days and disappear without a trace. From the 3rd - 5th day of illness in almost all patients, the liver and spleen increase, the increase persists up to 3 - 4 weeks. Changes in the liver are especially pronounced with icteric forms of infectious mononucleosis. The content of serum bilirubin increases, the activity of aminotransferases, especially ASAT, increases, the activity of alkaline phosphatase increases. For adults with infectious mononucleosis, an HIV antibody test must be performed.

  Rubella infection[ | ]

  For a long time, the characteristics of rubella included the description of only cases of the disease diagnosed by clinical data. With the development of methods for specific diagnostics, it became possible to supplement the existing ideas about the clinical picture of rubella with a precisely established diagnosis. Typical forms of rubella in most cases are characterized by a certain cyclical course of the disease with a change in the periods of incubation, prodromal, rash and convalescence.

  The incubation period is 18 ± 3 days on average. The prodromal period is not constantly observed, it lasts from several hours to 1-2 days. Patients in this period may have mild symptoms of intoxication in the form of an increase in temperature to subfebrile numbers, malaise, fatigue, sometimes drowsiness, headache. Along with this, often, mild catarrhal phenomena can also occur: runny nose or nasal congestion, sore throat, dry cough, spotted enanthema on the soft palate, hyperemia of the arches and posterior pharyngeal wall, Changes from the posterior cervical and occipital lymph nodes with their moderate increase and soreness.

  The prodromal period can be most clearly established in adults and older children, since they are better able to remember and analyze their sensations, and rubella is often more difficult for them. In children, the prodromal period occurs only in 5% with a duration from several hours to 1-2 days, while in adults - in 40% and in most cases it lasted 2-3 days or more.

  The rash period is constant in typical forms of rubella and is most pronounced. It most often lasts 2-3 days and is characterized by the presence of exanthema, sometimes mild symptoms of intoxication and mild catarrhal phenomena. Quite often, damage to the occipital and posterior cervical lymph nodes is observed.

  Depending on the presence of the main clinical symptoms in this period, three variants of the disease can be distinguished. The first - with the presence of only a rash, the second - with a rash and fever, the third - with a rash, temperature reaction and catarrhal phenomena.

  The rash in the overwhelming majority of patients with rubella is pale pink, small-spotted, rather abundant, its elements are of almost the same size with even outlines on an unchanged background. It appears at the same time and already during the first day covers the face, chest, abdomen and limbs. Sometimes the rash on the second day of the disease spreads to the limbs, especially the lower ones. The predominant localization of the rash is the extensor surfaces, although it can be quite abundant in the flexor area. Places of natural folds are slightly affected or even remain free of rashes. In some cases, the rash can be quite bright, large, maculopapular, with a tendency to merge, its peculiar variability is possible. On the first day, it is bright, large, especially on the face, in places - maculopapular and resembles a measles. On the second day, the size of the elements of the rash can change - to small-spotted, similar to a rash with scarlet fever, and are located both on the extensor and flexion surfaces. On the third day, the rash turns pale, becomes less abundant, localized mainly on the extensor surfaces of the shoulders, forearms, in the buttocks and on the outer thighs. The rash, as a rule, never occurs on the palms and feet. The disappearance of the rash occurs without a trace, as a rule, by the fourth day from the rash. Only in some patients can remain pale, short-term (within 2-3 days) pigmentation, sometimes indistinct marbling of the skin.

  Lymphadenitis is a fairly consistent sign of rubella. Characterized by the defeat of the posterior cervical, occipital, sometimes parotid, anterior cervical, popliteal, axillary lymph nodes, the increase in which, as a rule, is moderate, can be multiple or isolated in the form of an asymmetric lesion of one of them, sometimes accompanied by slight pain.

  Catarrhal inflammation of the mucous membranes of the upper respiratory tract and conjunctiva is observed in rubella inconsistently and is weakly expressed. It usually presents with a rare dry cough, nasal congestion, or small mucous secretions. Conjunctivitis rarely develops, but in some cases, there is a slight swelling of the eyelids, lacrimation, photophobia. There may be changes in the mucous membranes of the mouth in the form of mild hyperemia or the appearance of individual small spots on the mucous membrane of the cheeks, and only in exceptional cases the hyperemia of the mucous membranes of the cheeks is more pronounced, with the presence of a spotted enanthem on the soft palate. Quite common symptoms are mild hyperemia in the pharynx and pain when swallowing. Symptoms of intoxication also occur intermittently and are most often mild. The temperature can be normal or subfebrile, but sometimes there is a rather pronounced fever (38-39 ° C). The duration of the temperature reaction is usually 1-3 days. Even at a significant temperature, other symptoms of intoxication are rare and last for a short time. Symptoms such as headache, vomiting, and decreased appetite are only seen in older children and adults.

  The defeat of internal organs in rubella, as a rule, does not occur. Sometimes, against the background of a temperature reaction during auscultation, there may be a slight tachycardia, muffling of 1 tone at the apex of the heart. In older children and adults, synovitis may develop, more often in the form of damage to the small joints of the hand, sometimes the ankle and wrist joints. Synovitis occurs from the second to the seventh day of the disease, is benign and ends within three to four days. In the blood tests in the first week of the disease, leukopenia or a tendency to leukopenia is detected. In the leukocyte blood count, most patients have lymphocytosis and neutropenia, the appearance of plasma cells is quite characteristic, but it is not constant. In the second week of the disease, the number of leukocytes increases, but in a significant part of patients, tendencies to leukopenia and lymphocytosis may remain for a long time.

  The period of convalescence in rubella proceeds, as a rule, smoothly, without any pathological manifestations.

  Hodgkin's lymphoma, or lymphogranulomatosis (according to order No. 80 of the Ministry of Health of the Republic of Belarus)[ | ]

  The clinical examination of patients is similar to that of Hodgkin's lymphoma. With a symptom complex of CNS lesions, a lumbar puncture is performed (with lymphoblastic lymphomas or with suspicion of CNS damage) to examine the cerebrospinal fluid.

  Still's disease [ | ]

  Still's disease in adults is one of the variants of systemic connective tissue diseases, manifested by antibiotic-resistant fever, enlargement of LN and spleen, skin papular and hemorrhagic rashes, articular syndrome (arthralgia, less often arthritis). Peripheral blood is characterized by neutrophilic leukocytosis, increased ESR. The disease most often has to be differentiated with systemic lupus erythematosus, rheumatoid arthritis, viral hepatitis with systemic manifestations, septic process. There are no specific diagnostic methods. LN histological examination provides little information. A clinical effect in the form of relief of fever and other symptoms can be observed with the appointment of glucocorticoids.

  Viral hepatitis[ | ]

  Chronic viral hepatitis (more often viral hepatitis C) can manifest itself with various extrahepatic symptoms (fever, lymphadenopathy, hemorrhagic vasculitis, lung damage, polyserositis, Sjogren's syndrome). In some cases, extrahepatic symptomatology comes to the fore in the clinical picture and is the debut of hepatic disease. If chronic viral hepatitis is suspected, a laboratory test is required for the presence of all markers of hepatitis. For final verification, a histological examination of liver biopsies is advisable.

  Gaucher and Niemann-Pick diseases[ | ]

  Gaucher disease, Niemann-Pick disease belong to the so-called storage diseases, which are based on a hereditary defect in the metabolism of phospholipids and cerebrosides. Phagocytic mononuclear cells of the spleen and LU intensively proliferate and phagocytose unmetabolized lipids. Intensive proliferation of macrophage cells leads to an increase in LN and mainly in the spleen. Severe splenomegaly with cytopenic syndrome is a clinical marker of the disease. Therefore, the identification of a significant increase in the spleen in patients with lymphadenopathy in the absence of other reasons requires the exclusion of storage diseases, in particular Gaucher disease. The diagnostic sign is the presence of so-called Gaucher cells in punctate LN, bone marrow, spleen. The cells have a dense eccentrically located nucleus and a light gray cytoplasm with concentric striation. It is possible to verify the deficiency of the enzyme glucocerebrosidase, which ensures the utilization of lipids in peripheral blood leukocytes.

  Waldenstrom's macroglobulinemia[ | ]

  Waldenstrom's macroglobulinemia refers to chronic leukemia, the main substrate of which is mature and maturing lymphoid cells. A feature of the disease is the production of monoclonal macroglobulin IgM by tumor lymphoid cells, as a result of which vascular lesions (vasculitis) may develop. The main clinical manifestations of the disease, along with lymphadopathy, are enlargement of the spleen, hemorrhagic skin rashes, and the presence of urinary syndrome. The blood reveals absolute lymphocytosis, anemia (often due to autoimmune hemolysis), a significant increase in ESR. In the bone marrow, lymphoid infiltration. The diagnosis is confirmed by the presence of IgM macroglobulin in a patient with enlarged LN and spleen.

  Medicinal lymphadenopathies[ | ]

  Medicinal lymphadenopathies can occur as a result of the reaction of the lymphohistiocytic system to certain drugs (phenytoin, gold preparations, etc.).

  Sarcoidosis [ | ]

  Sarcoidosis is a granulomatous inflammation, clinically manifested by an increase in LN (more often bronchopulmonary, less often peripheral), damage to the lungs and other organs. A feature of patients with sarcoidosis is the suppression of cellular immunity, which is manifested by a negative reaction to the intradermal administration of tuberculin. The morphological substrate of sarcoidosis is sarcoid granuloma, consisting of lymphoid, epithelioid cells, giant Langhans cells in the absence (in contrast to tuberculous granulomas) of caseous necrosis.

  Tularemia [ | ]

  The introduction of the pathogen more often occurs through microtrauma on the skin, the use of food and water contaminated with pathogens. The pathogen of tularemia (Francisella tularensis) can be carried by ticks, mosquitoes, horseflies. The incubation period often lasts from 3 to 7 days (can vary from 1 to 14 days). The disease begins acutely or even suddenly. The body temperature rises to 38 - 40 º C. Patients complain of headache, weakness, muscle pain, lack of appetite, and vomiting. In severe forms, there may be delirium, patients are more often excited, lethargy is rarely observed. Depending on the clinical form, there may be various complaints at the site of future inflammatory changes in the area of \u200b\u200bthe gate of the infection: pain in the eye, pain when swallowing, pain in the chest, in the abdomen, in the area of \u200b\u200bthe developing bubo. In the initial period, the main symptoms of general intoxication are, later on, local changes associated with the gate of infection come to the fore. The temperature curve is often remitting or abnormally intermittent. Without antibiotic therapy, fever can last up to 2 weeks, and in the period of convalescence there can be a prolonged subfebrile condition. The total duration of the disease in protracted and chronic forms can last up to several months. By the end of the first week of the disease, the liver and spleen are enlarged. The main clinical forms of the disease are: skin-bubonic, ocular-bubonic, anginal-bubonic, abdominal, pulmonary and generalized.

  Lyme disease [ | ]

  Lyme Borelliosis

  Clinical classification of ixodic tick-borne borreliosis (Yu. V. Lobzin, V. S. Antonov, S. S. Kozlov, 1996) Forms of the disease: latent, manifest.

  1. Downstream: acute (up to 3 months), subacute (from 3 to 6 months), chronic (more than 6 months).

  2. On clinical grounds:

  • acute and subacute course: erythemal and non-erythemal forms with predominant damage to the nervous system, heart, joints;
  • chronic course: continuous and recurrent (course) with predominant damage to the nervous system, heart, joints, skin.

  3. By severity: heavy, moderate, light. The incubation period ranges from 1 to 20 days (usually 7 to 10). Its reliability depends on the accuracy of establishing the fact of tick sucking. Up to 30% of patients do not remember or deny a history of the bite of this vector. The disease usually begins subacutely with the appearance of soreness, itching, swelling and redness at the site of tick suction. Patients complain of moderate headache, general weakness, malaise, nausea, constriction and impaired sensitivity in the tick bite. At the same time, characteristic skin erythema appears (up to 70% of patients). The body temperature rises more often to 38 ° C, sometimes accompanied by chills. The febrile period lasts 2-7 days, after a decrease in body temperature, sometimes a subfebrile temperature is noted for several days. Erythema migrans - the main clinical marker of the disease - appears after 3-32 days (average 7) in the form of a red macula or papule at the site of a tick bite. The area of \u200b\u200bredness around the bite site expands, delimiting the unaffected skin with a bright red border, in the center of the lesion the intensity of changes is less pronounced. The size of erythema can be from a few centimeters to tens (3-70 cm), however, the severity of the disease is not related to the size of the erythema. At the site of the initial lesion, intense erythema is sometimes observed, vesicles and necrosis (primary affect) appear. The intensity of the color of the spreading skin lesion is uniform throughout, several red rings may appear within the outer border, the central part fades over time. In place of the former erythema, increased pigmentation and peeling of the skin often remain. In some patients, the manifestations of the disease are limited to skin lesions at the site of the tick bite and mild general symptoms, in some patients, apparently, hematogenous and lymphogenous borrelia can spread to other areas of the skin, secondary erythema occurs, but unlike the main one, there is no primary affect. Other skin symptoms may be observed: a rash on the face, urticaria, transient punctate and small ring-shaped rashes, conjunctivitis. In some patients, the developed erythema is similar to erysipelas, and the presence of primary affect and regional lymphadenitis is similar to the manifestations of tick-borne typhus and tularemia. Skin symptoms are often accompanied by headache, neck stiffness, fever, chills, migratory muscle and bone pain, arthralgia, and severe weakness and fatigue. Less common is generalized lymphadenopathy, sore throat, dry cough, conjunctivitis, testicular edema. The first symptoms of the disease usually subside and completely disappear within a few days (weeks) even without treatment.

  Streptococcal skin infections[ | ]

  They are manifested by the presence of skin lesions in the form of a non-follicular pustule (flikten) with a flaccid cover, spreading along the periphery, painful, filled with yellowish serous contents. Subsequently, erosion is formed. Superficial lesions - impetigo, deep lesions - ecthyma. Impetigo is more common on the face, ecthyma - on the limbs. Along with the primary lesion, localized lymphadenopathy can be detected.

  Cat scratch disease (benign lymphoreticulosis)[ | ]

  An acute infectious disease that occurs upon contact with infected cats - with a bite, scratches, salivation. It is characterized by fever, regional lymphadenitis, enlarged liver and spleen, sometimes primary affect and exanthema. The causative agent belongs to Bartonella. In terms of antigenic properties, it is close to the causative agents of psittacosis. Infected cats stay healthy. The incubation period lasts from 3 to 60 days (usually 2-3 weeks). The disease can begin with the appearance of a small sore or pustule at the site of the scratch (bite), the state of health remains good. 15-30 days after infection, regional lymphadenitis appears - the most characteristic symptom of the disease. More often, axillary, elbow, cervical, and less often other lymph nodes are enlarged. They reach 3-5 cm in diameter, are painful on palpation, and are not adhered to the surrounding tissues. In 50% of cases, they fester with the formation of thick yellowish-green pus (it is not possible to sow bacteria). At the same time, symptoms of general intoxication, fever, enlargement of the liver and spleen appear (in atypical cases or in people with immunosuppression). Lymphadenitis can persist for up to several months. Confirmation of the diagnosis can be a positive result of CSC (complement fixation reaction) with ornithosis antigen, although in many patients this reaction remains negative.

  HIV infection [ | ]

  HIV infection is an infectious process in the human body caused by the human immunodeficiency virus (HIV), characterized by a slow course, damage to the immune and nervous systems, the subsequent development against this background of opportunistic infections, neoplasms that lead to death by HIV infected.

  CLINICAL CLASSIFICATION OF HIV INFECTION

  During HIV infection, you can see several stages, gradually passing one into the other. The primary reaction of the body to the introduction of HIV is the production of antibodies. However, it usually takes an average of 3 weeks to 3 months from infection to antibody development. There are frequent cases of seroconversion after 6 months, cases are described even after 1-3 years. This period is called the "seroconversion window". In 15-25% of those infected, the appearance of antibodies to HIV in the body is manifested by the primary manifestation.

  1. Acute infection Most often appears between 6-12 weeks after infection, but may appear after 1 week and after 8-12 months or more. The clinical picture is most often manifested by a mononucleosis-like syndrome with or without aseptic meningitis, or this stage proceeds in a subclinical form.

  2. Asymptomatic infection (carrier of viruses) (AI) Characterized by the absence of any clinical manifestations and symptoms of HIV infection. The assignment of persons to this group is carried out on the basis of data from the epidemiological history and laboratory studies. The latter include the search for antibodies to HIV in the serum, analysis of blood cells to detect lymphopenia and thrombocytopenia, immunological methods to determine the number and ratio of T-helpers and T-suppressors, analysis of the functions of immunoglobulins.

  3. Persistent generalized lymphadenopathy (PGL) It is characterized by the presence of severe lymphadenopathy for three or more months in persons with epidemiological data on the possibility of HIV infection in the absence of any other infections and apparent causes.

  4. AIDS is an associated symptom complex (pre-AIDS, SAH) At this stage of the disease, there are no signs of opportunistic infections or tumor lesions inherent in the expanded picture of AIDS. It is characterized by the presence of:

  • "Constitutional" state:
    • body weight loss of 10% or more;
    • unexplained sub- and febrile fever for 3 months or more;
    • unmotivated diarrhea lasting more than 1 month;
    • chronic fatigue syndrome;
  • secondary diseases:
    • fungal, viral, bacterial lesions of the skin and mucous membranes;
    • repeated or disseminated shingles, localized Kaposi's sarcoma;
    • hairy leukoplakia;
    • repeated pharyngitis and sinusitis;
    • pulmonary tuberculosis;
    • repeated or persistent viral, bacterial, fungal, protozoal lesions of internal organs.

  AIDS is characterized by the development of opportunistic infections and tumors as a result of deep cellular immunodeficiency. All of these stages may appear inconsistently and do not have to be present in all those infected. The period of acute infection in 15-25% of infected people coincides with the period of seroconversion, therefore, when the first clinical symptoms appear in the patient's blood serum, antibodies to HIV proteins and glycoproteins may not be detected. In the stage of acute infection, there is often a transient decrease in the level of CD4T lymphocytes, which is sometimes accompanied by the development of clinical manifestations of secondary diseases (candidiasis, herpesvirus infection). These manifestations are usually mild, short-lived and respond well to therapy. Acute infection occurs in 50-90% of infected individuals in the first 3-6 months after infection. The duration of the clinical manifestations of an acute infection varies from several days to several months. However, the duration of the acute infection stage is usually 2–3 weeks, after which the disease progresses to one of two other stages — asymptomatic infection or persistent generalized lymphadenopathy (PGL). Relapses of clinical manifestations of acute infection are possible. In isolated cases, acute infection can, bypassing the stages of AI and PGL, go into the SAH stage (pre-AIDS).

  In the stage of asymptomatic infection, there may be a moderate increase in lymph nodes. In patients with asymptomatic stage (AI), antibodies to HIV antigens are determined. A characteristic feature of stage III is persistent generalized lymphadenopathy (an increase in at least 2 lymph nodes in two different groups, excluding inguinal lymph nodes in adults, up to a size of more than 1 cm, in children - more than 0.5 cm in diameter, persisting for at least 3 months) ... PGL can be observed in the late stages of HIV infection, however, at this stage it is the only clinical manifestation. Asymptomatic infection and persistent generalized lymphadenopathy develop after the acute infection stage or immediately after the seroconversion window stage. Enlarged lymph nodes may shrink and re-increase in size, so stages II and III can alternate. In general, the first three stages are characterized by a relative balance between the body's immune response and the action of the virus. The duration of this period can vary from 2-3 to 10-15 years. During this period, there is a gradual decrease in the level of CD-4 T-lymphocytes, on average at a rate of 50-70 cells per mm³ per year. As the disease progresses, patients begin to show clinical symptoms, indicating a deepening of the damage to the immune system, which characterizes the transition of HIV infection to the SAH stage (pre-AIDS). This stage usually begins to develop 3-5 years after infection. It is characterized by bacterial, fungal and viral lesions of the mucous membranes and skin, inflammatory diseases of the upper respiratory tract, which over time (5-7 years from the moment of infection) acquire a protracted course. Lesions of internal organs develop. In addition, localized Kaposi's sarcoma, moderately pronounced constitutional symptoms, and lesions of the peripheral nervous system may be noted.

  The stage of AIDS (after 7-10 years) is characterized by the development of severe, life-threatening secondary diseases, their generalized nature, and damage to the central nervous system. The lesions of organs and systems present in patients are irreversible: one disease replaces another. Even an adequately conducted therapy of secondary diseases is ineffective and the patient dies within a few months. The given terms of development of the stages of the disease are of an average nature. In some cases, the disease develops more rapidly and after 2-3 years passes into the terminal stage. In the Republic of Belarus, all cases of HIV infection are subject to registration, while in other countries only AIDS cases are registered. AIDS diagnosis can only be made according to the criteria adopted by the WHO.

  1. The diagnosis of AIDS can be made if there is laboratory confirmation of HIV infection and the following diseases are present:

  • Opportunistic infections;
    • bacterial infections, multiple or recurrent in a child under the age of 13;
    • coccidosis of the bronchus, trachea or lungs;
    • esophageal candidiasis;
    • coccidioidomycosis, widespread or extrapulmonary;
    • cryptococcosis, extrapulmonary;
    • intestinal cryptosporidiosis with diarrhea (duration more than 1 month);
    • cytomegalovirus (non-hepatic, spleen, or nodular) in a patient over 1 month of age;
    • cytomegalovirus, retinitis (with loss of vision);
    • herpes simplex: chronic ulcer (lasting more than 1 month) or bronchitis, pneumonia or esophagitis in patients older than 1 month;
    • histoplasmosis, widespread and extrapulmonary;
    • isosporosis, intestinal with diarrhea (duration more than 1 month);
    • mycobacterium avium or mycobacterium kansashi, diffuse or extrapulmonary;
    • mycobacterium tuberculosis, pulmonary in adults or adolescents (over 13 years old);
    • mycobacterium tuberculosis, extrapulmonary;
    • mycobacterium or other bacteria (or unidentified bacteria), diffuse or extrapulmonary;
    • pneumocystis pneumonia;
    • pneumonia, recurrent;
    • progressive multifocal leukodystrophy;
    • salmonella sencytimia (atypical), recurrent;
    • toxoplasmosis of the brain in a patient older than 1 month.
  • Other diseases:
    • invasive cervical cancer;
    • encephalopathy related to HIV;
    • Kaposi's sarcoma;
    • lymphoid interstitial pneumonia in children over 13 years old;
    • burkitt's lymphoma;
    • lymphoma immunoblastic;
    • brain lymphoma, primary;
    • hIV-related weight loss syndrome.

  2. The diagnosis of AIDS can be made without laboratory confirmation of HIV infection if reliably diagnosed diseases listed in paragraph 1 were observed. According to the WHO criteria, the diagnosis of AIDS is allowed and with negative laboratory tests, if the patient has all other causes of immunodeficiency excluded, and pneumocystis pneumonia occurs , reliably confirmed, or any of the above indicator diseases, diagnosed definitely, and the number of T-helpers is less than 400 mm³.

  3. It is impossible to diagnose AIDS without laboratory confirmation of HIV infection, if there were:

  • conducted with high doses and long-term systematic corticosteroid, as well as any other immunosuppressive therapy, carried out for 3 months before the onset of indicator disease;
  • any of the following diagnosed within 3 months before or after the detection of an indicator disease, lymphogranulomatosis diseases, other lymphomas (other than primary brain lymphoma), lymphoid leukemia, multifocal myeloma or other malignant disease from lymphoreticular or histiocytic tissue, angioimmunoblastic lymphadenopathy;
  • congenital (genetic) immunodeficiency syndrome or acquired immune deficiency, atypical for HIV infection.

  Features of the course of HIV infection in children

  Infection of children with HIV can occur from an infected mother during pregnancy, during childbirth and breastfeeding, as well as parenteral during medical and paramedical interventions. The risk of HIV transmission to children born to seropositive mothers, according to various sources, ranges from 25% to 50%, depends on the stage of HIV infection in the mother and increases with breastfeeding. The clinic of HIV infection in children has a number of features:

  • more often than in adults, there are recurrent bacterial infections, as well as interstitial lymphoid pneumonitis and hyperplasia of the pulmonary lymph nodes (up to 40% of cases);
  • very rare Kaposi's sarcoma;
  • the most common clinical signs are encephalopathy and delayed psychomotor and physical development;
  • thrombocytopenia is common, clinically manifested by hemorrhagic syndrome, which can be the cause of death in children;
  • HIV infection in children is characterized by a more rapid progressive course than in adults.

  Diagnosis of HIV infection in children born to seropositive mothers is difficult. On the one hand, during the first year of life, maternal antibodies circulate in the child's blood serum and, therefore, the detection of antibodies to HIV in children of the first year of life is not a sufficient basis for making a diagnosis of HIV infection. On the other hand, since HIV infection in the neonatal period can induce hypo-agammaglobulinemia, the disappearance of antibodies cannot be considered a sufficient basis for withdrawing the diagnosis of HIV infection, and therefore, children born to HIV-positive mothers should be followed up for at least 18 months from birth. After that, the question of whether they have HIV infection is decided on the basis of an analysis of a complex of clinical, immunological and serological data.

  Rationale for the clinical diagnosis

  The clinical diagnosis of a patient with HIV infection is established by a commission on the basis of epidemiological, clinical and available laboratory data.

  Basic guidelines for the management of patients with lymphadenopathy[ | ]

  • Thoroughly collect anamnesis, specifying the fact of injuries, inflammatory diseases of organs, migration and travel history.
  • Conduct a thorough examination of all lymphatic organs to exclude generalized lymphadenopathy or a specific disease:
    • examination of the tonsils,
    • palpation of all groups of lymph nodes: (occipital, parotid, cervical, supraclavicular, subclavian, axillary, inguinal, cubital),
    • palpation of the liver and spleen,
    • percussion of the liver and spleen,
    • if an increase is suspected - ultrasound
  • When describing the characteristics of the lymph nodes, note:
    • localization,
    • shape
    • soreness
    • consistency,
    • the condition of the skin over the affected group of lymph nodes,
    • adhesion of lymph nodes to the skin and to each other
  • Examine the organs drained into this group of lymph nodes.
  • Perform a diagnostic minimum: complete blood count (CBC), general urine analysis (OAM), biochemical blood test (BAC) with the determination of glucose, urea, bilirubin, o.protein, ALT, AST, protein fractions. If necessary, expansion with the determination of other liver enzymes, thymol test, etc.
  • Based on the analysis of the data obtained from the primary examination, correction of diagnostic procedures, prescription of a blood test for RW, rheumatic factor, circulating immune complexes, etc.
  • In the absence of a long history of enlarged lymph nodes, observation of patients for 2-4 weeks.
  • In the presence of a bacterial infection in the drainage area of \u200b\u200bthe lymph nodes, the appointment of antibiotic therapy, taking into account the expected flora and data on antibiotic sensitivity.
  • Puncture or excisional biopsy of the LN with cytological and histological examination. Indications: dense, painless lymph nodes larger than 2 cm2, supraclavicular localization, age over 40 years.
  • The appointment of hormonal drugs for lymphadenopathies of unknown origin is NOT PERMISSIBLE.
  • If the size of the LN does not exceed 1 cm², then the probability of reactive lymphadenopathy is high. In patients with enlarged LNs larger than 2 cm², a tumor or granulomatous process is more often suspected. In cases of LN increase not exceeding 1.5 cm², and in the absence of obvious signs of infection, further observation of patients is necessary.

  Links [ | ]

  • Order No. 76 A of February 12, 2004 On approval of protocols for the diagnosis and treatment of malignant neoplasms in the system of the Ministry of Health of the Republic of Belarus
  • Appendix to the Order of the Ministry of Health of the Republic of Belarus of 12.02.2004 No. 76A Protocols for diagnosis and treatment of malignant neoplasms
  • Order of the Ministry of Health of the Republic of Belarus, December 16, 1998, No. 351 on revising departmental regulations governing HIV / AIDS issues.
  • V. M. Semenov, A. A. Astapov, T. I. Dmitrachenko Rubella infection. - Minsk: OOO "Oracle", 1994. - 143p.
  • Guidelines for phthisiology / [M. N. Lomako, S. I. Sudnik, S. A. Sobol; ed. MN Lomako] .- Mn .: Vysh. School, 1978 .-- 336s.
  • Infectious Diseases: A Textbook for Honey. universities / Edited by Cor. RAMS, Prof. Yu.V. Lobzina.- SPb .: SpetsLit, 2001.- 543p.
  • Robert Ferrer Lymphadenopathy: Differential Diagnosis and Evaluation // American Family Physician. - Vol. 58. - No. 6 (October 15, 1998)
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