Reactive lymphadenitis with macrofocal hemorrhage. Causes, symptoms and treatment of lymphadenitis

Lymphocytes are a type of leukocytes - the so-called white blood cells that provide immunity ( protection of the body from various external and internal influences). Lymphocytes are produced in the red bone marrow, which is located inside the bones of the body ( in the bones of the pelvis, vertebrae, ribs, sternum and other). From the bone marrow, immature forms of lymphocytes are released into the bloodstream, which enter the spleen, where the processes of their differentiation end.

Lymph

A certain proportion of proteins and about 10% of the fluid from the intercellular space does not return to circulatory system and enters the lymphatic capillaries. In this way, lymph is formed, which, in addition to proteins and plasma, contains various trace elements, fats and carbohydrates, as well as cellular elements ( predominantly lymphocytes).

Lymphatic vessels

The efferent lymphatic vessels emerge from the lymph nodes, which also merge to form large lymphatic trunks and ducts. Through them, the lymphatic fluid is transferred to the large veins of the body, thus returning to the systemic circulation.

In the human body, there are several large lymphatic ducts:

• thoracic lymphatic duct collects lymph from the legs, pelvic organs, abdominal cavity and left half chest.
• Left subclavian trunk - collects lymph from the left arm.
• Left jugular trunk - collects lymph from the left half of the head and neck.
• Right lymphatic duct It is formed by the fusion of several lymphatic trunks and collects lymph from the right half of the head, neck, right half of the chest and right arm.

The lymph nodes

Lymphocytes are formed in the lymph nodes, starting from the period embryonic development. Their main function is to recognize foreign agents ( viruses, fragments of bacteria and their toxins, tumor cells, and so on) and activation of other defense systems of the body aimed at neutralizing them.

Lymph entering the lymph nodes slowly seeps through narrow slit-like spaces called sinuses. Thus, it is cleansed of various foreign bodies, and contact between foreign agents and lymphocytes is also ensured.

main function lymph nodes is to prevent the spread of pathological processes in the body. This is realized due to the presence of several groups of lymph nodes, in which lymph is filtered from various parts of the body. They are located in such a way as to become an obstacle to infectious processes and prevent foreign antigens from entering various organs and tissues.

The main groups of lymph nodes in the human body are:

• lymph nodes of the head and neck cervical, submandibular, occipital and others);
• lymph nodes of the chest cavity;
• lymph nodes of the abdomen and abdomen mesenteric, iliac, pelvic);
• lymph nodes of the lower extremities inguinal, popliteal);
• upper limb lymph nodes axillary, elbow).

The development of the inflammatory process in the lymph node

In the lymph nodes, foreign antigens interact with lymphocytes, as a result of which the latter are activated and begin to produce specific antibodies - an inflammatory process develops. A large number of other types of leukocytes enter the lymph node from the bloodstream, which contribute to the development of inflammation and the destruction of foreign substances.

Causes of lymphadenitis

Depending on the type of infection, lymphadenitis can be:

• non-specific;
• specific.

Nonspecific lymphadenitis

The causes of nonspecific lymphadenitis can be:

• Bacteria and their toxins. A bacterium is a living cell that can exist and multiply in various organs of the human body, affecting them. Inflammation of the lymph nodes may be due to the ingestion of staphylococcus, streptococcus, Escherichia coli and many other microorganisms. Some of them in the course of their life activity ( or after their death) release certain toxic substances that can also cause lymphadenitis.
• Viruses. Viruses are small fragments of nucleic acids - DNA ( deoxyribonucleic acid) or RNA ( ribonucleic acid), which can only reproduce inside living cells. In the cells of the human body, nucleic acids are contained in the nucleus and are responsible for the processes of cell growth, the performance of specific functions, as well as for the storage and transmission of genetic information. When infected with a virus, its DNA is introduced into the genetic apparatus of the host cell, as a result of which it begins to produce new viral particles. When an infected cell is destroyed, the newly formed viruses are released into the surrounding tissues and infect neighboring cells. Part of the viral fragments seeps into the lymphatic capillaries, lingering in the regional lymph nodes and causing the development of an inflammatory process in them.
• Mushrooms. Fungi are a special class of microorganisms similar to bacteria that can grow in the human body. Science knows many types of mushrooms ( yeast, mold and so on). Some of them are dangerous to humans and, if ingested, can cause the development of various diseases ( mycoses). Others are normal inhabitants of the skin and mucous membranes and acquire pathogenic properties only when the functions of the immune system are impaired - for example, with AIDS ( acquired immune deficiency syndrome).

Specific lymphadenitis

The cause of specific lymphadenitis can be:

• mycobacterium tuberculosis;
• pale treponema ( the causative agent of syphilis);
• plague wand ( plague agent);
• actinomycete ( pathogenic fungus, causative agent of actinomycosis);
• brucella ( brucellosis pathogens);
• tularemia bacteria ( causative agents of tularemia).

Types of lymphadenitis

Depending on the rate of development of the inflammatory process, there are:

• Acute lymphadenitis. It develops as a result of damage to the lymph nodes by a highly virulent infection. It is characterized by rapid and pronounced inflammation of the lymph nodes, often against the background of general manifestations of the infectious process ( fever, general weakness, headaches and muscle pain). Without appropriate treatment, acute lymphadenitis can turn into a purulent form, which will eventually lead to purulent melting of the lymph node and damage to surrounding tissues ( development of an abscess or adenophlegmon).
• Chronic lymphadenitis. It develops when infected with a weakly virulent infection or is the outcome of an untreated acute lymphadenitis, when the inflammatory process takes a protracted course. Also, quite often, specific lymphadenitis is characterized by a chronic course ( tuberculous, syphilitic).

Depending on the nature of the inflammatory process, there are:

• catarrhal ( simple) lymphadenitis. It is typical for the initial stage of the disease. Violation of the permeability of the capillaries in the inflamed lymph node leads to the fact that the liquid part of the blood leaves the vascular bed and impregnates the tissue of the lymph node. There is also a moderate migration of leukocytes to the focus of inflammation.
• Hyperplastic lymphadenitis. It is a later stage in the development of the disease and is characterized by growth ( hyperplasia) lymphocytes in the inflamed lymph node, as well as a pronounced infiltration of leukocytes ( neutrophils, eosinophils and other cells).
• Purulent lymphadenitis. It is the last stage in the development of bacterial lymphadenitis, when suppuration and purulent destruction of the lymph node occurs. The outcome of this form of the disease may be the formation of an abscess ( confined space filled with pus) or development of adenophlegmon ( diffuse purulent process that extends far beyond the primary focus of infection).

Causes of lymphadenitis in various areas

If regional lymph nodes do not cope with their barrier function ( with a severe infectious disease or as a result of a weakening of the body's defenses), infectious agents can enter the systemic circulation and spread to other organs and tissues, which can lead to the development of generalized lymphadenitis ( inflammation of various groups of lymph nodes throughout the body).

Causes of submandibular lymphadenitis

The organs from which lymph flows into the submandibular lymph nodes are:

• skin and soft tissues of the face lower eyelids, cheeks, nose, lips, chin);
• oral cavity ( mucous membrane of the palate, back of the tongue);
• gums and teeth;
• submandibular and sublingual salivary glands.

Causes of submandibular lymphadenitis

Causes of cervical lymphadenitis

There are several groups of lymph nodes in the neck area:

• Surface. They collect lymph from the skin and soft tissues of the neck and head ( except for muscles).
• Deep. They drain lymph from internal organs neck ( from the pharynx, larynx, trachea, upper esophagus, thyroid gland, and neck muscles), as well as from the nasal cavity, mouth, ear and other organs. In addition, the leading lymphatic vessels from the submandibular and other smaller lymph nodes of the head and neck flow into them. Therefore, all of the above infectious processes can cause cervical lymphadenitis ( in violation of the barrier function of the submandibular lymph nodes).

• Fungal diseases of the scalp- trichophytosis ( ringworm), microsporia, scab.
• Otitis - inflammation of the ear caused by pathogenic microorganisms ( pneumococci, staphylococci).
• Tonsillitis - inflammation of the lymphoid formations of the oral cavity ( tonsils) caused by the ingress of pathogenic bacteria or viruses into them.
• Pharyngitis - infectious inflammation of the mucous membrane of the pharynx.
• Rhinitis - inflammation of the nasal mucosa.
• Sinusitis - inflammation of one or more paranasal sinuses nose - maxillary ( sinusitis), frontal ( frontitis), wedge-shaped ( sphenoiditis) and lattice labyrinth ( ethmoiditis).
• Infectious thyroiditis - inflammation of the thyroid gland caused by viruses or bacteria.
• Infectious mononucleosis – a viral disease in which there is a primary lesion of the cervical, and subsequently other groups of lymph nodes.
• Rubella - a systemic viral disease that develops when the pathogen enters the body through the mucous membranes respiratory tract (by airborne droplets), which leads to inflammation of the cervical, and subsequently other groups of lymph nodes.
• Adenovirus infection - a group of colds of the upper respiratory tract caused by adenoviruses.
• Flu - acute respiratory viral infection ( SARS) caused by the influenza virus.
• Festering wounds of the head and neck.

Causes of axillary lymphadenitis

The cause of inflammation of the axillary lymph nodes can be:

• Purulent-inflammatory diseases of the skin of the upper limb - furuncle, carbuncle, hydradenitis of the axillary sweat glands, impetigo, erysipelas ( described earlier).
• Suppuration of cuts and abrasions in the arms, chest and upper abdomen.
• Fungal skin lesions- sporotrichosis, trichophytosis, microsporia.
• Osteomyelitis of the bones of the hand inflammatory process caused by pyogenic microorganisms and affecting bone tissue.
• Panaritium - purulent-inflammatory process of the soft tissues of the fingers, which can spread to tendons, bones and joints.
• Mastitis - an inflammatory disease of the breast in women, most often occurring during breastfeeding.

Causes of inguinal lymphadenitis

All infectious diseases of the skin, soft tissues and bones described earlier can cause inflammation of the inguinal lymph nodes if lymph flows from the area of ​​​​the body in which the focus of infection is located.

The cause of inflammation of the inguinal lymph nodes can also be:

• Gonorrhea - an infectious disease caused by gonococcus, which is sexually transmitted and is characterized by purulent inflammation of the mucous membranes of the external genital organs ( predominantly in men, very rarely in women).
• Balanoposthitis - inflammation of the skin of the glans penis and foreskin caused by various infectious agents ( usually in case of non-compliance with the rules of personal hygiene).
• Colpitis - infectious inflammation of the mucous membrane of the vagina.
• Vulvit - infectious inflammation of the external female genital organs.

Symptoms of lymphadenitis in various areas

Symptoms of submandibular lymphadenitis

Symptoms of submandibular lymphadenitis are:

• Enlarged submandibular lymph nodes. To the touch ( palpation) they are defined as dense, painful formations of a round or oval shape, located in the submandibular region on one or both sides, not soldered to the surrounding tissues ( move easily under the skin from side to side). The sizes of lymph nodes vary from a few millimeters in the initial stage to several centimeters in the hyperplastic stage of the disease. Quite often, inflamed lymphatic vessels are palpated in the submandibular region - dense, thin, thread-like structures extending from the inflamed lymph node.
• Pain. In the initial stage of the disease, there may be mild pain on palpation of the submandibular region. As the disease progresses, the pain intensifies and accompanies any movement of the jaw ( when talking, while eating) may also appear at rest.
• Change in the skin. IN initial stages the skin over the lymph nodes may not be changed. As the inflammatory process develops, redness and swelling of the skin over the focus of inflammation and in the surrounding area is noted ( which is due to the expansion and increase in the permeability of small vessels). There is a local increase in temperature ( 1-2 degrees compared to normal skin).
• Suppuration of the lymph nodes ( develops with a bacterial infection). In the purulent stage, the lymph nodes fuse with each other and with the surrounding tissues, turning into dense, almost immobile formations. The skin over the focus of inflammation is bright red, tense, swollen. There is a pronounced pain on palpation and at rest, which limits the movement of the lower jaw and neck.
• Systemic manifestations. When the infection spreads beyond the lymph nodes, there is a general increase in body temperature up to 38 - 40ºС, general weakness, drowsiness, muscle pain, headaches.

Symptoms of cervical lymphadenitis

Symptoms of cervical lymphadenitis are:

• Enlarged cervical lymph nodes. They can be determined on the front or side of the neck, above the collarbone. When palpated, they are characterized by the same signs as the inflamed submandibular nodes ( described above). With inflammation of the superficial lymph nodes, inflamed lymphatic vessels can be palpated.
• Pain. There is pain on palpation, while turning the head, when talking, while chewing and swallowing food.
• Change in the skin. With cervical lymphadenitis, swelling and swelling of the skin in the focus of inflammation, as well as beyond it, is noted. With the development of a purulent form, the skin becomes red in color, small breakthroughs of pus can be determined on its surface. In this case, the general symptoms are very pronounced - there is an increase in body temperature up to 40ºС, weakness, sleep disturbance, headaches.
• Restriction of movements. It is associated with a pain syndrome that develops in the later stages of the disease - with any turn or tilt of the head, the patient experiences severe acute pain in the area of ​​​​the inflammation. In addition, a pronounced increase in deep lymph nodes can lead to compression of various organs of the neck - the vocal cords, trachea, esophagus, large vessels, which will be manifested by the corresponding symptoms ( voice change, difficulty breathing, difficulty swallowing food).

Symptoms of axillary lymphadenitis

Symptoms of axillary lymphadenitis are:

• Enlarged lymph nodes in the armpit. More often one is determined, less often - several enlarged lymph nodes. Their palpation characteristics do not differ from lymphadenitis in other areas. Inflamed lymphatic vessels may be seen ( with inflammation of the superficial lymph nodes).
• Pain. There is severe pain in the axillary region, which can spread to the shoulder area and the lateral surface of the chest from the affected side. The patient often takes a forced position of the body with the hand laid aside, which reduces the pressure on the inflamed lymph nodes and somewhat reduces the pain syndrome.
• Changes in the skin in the armpit. With inflammation of the axillary nodes, the skin color over them may remain unchanged for a long time. Only with the development of a purulent process, the skin acquires a purple-red color, becomes edematous, tense.
• Impaired hand movements. The pain is aggravated by touching the area of ​​the inflamed lymph nodes and by moving the hand, which may limit the daily activity of the patient. Also, movements can be limited as a result of a pronounced increase in axillary lymph nodes, reaching several centimeters in diameter.
• Swelling of the hands on the affected side. May occur as a result of squeezing by enlarged lymph nodes of large veins of the shoulder and axillary region. In this case, the outflow of fluid from the upper limb is difficult, it leaves the vascular bed and impregnates the surrounding tissues, leading to the development of edema.
• Violation of sensitivity in the hand on the side of the lesion. This symptom may appear in case of a pronounced increase in axillary lymph nodes. This will lead to compression of the nerve trunks passing in the axillary and shoulder regions, which may manifest as paresthesia ( tingling sensation, crawling on the skin) in the area of ​​the hand on the side of the lesion, a violation of sensitivity, pain and various motor disorders.

Symptoms of inguinal lymphadenitis

Symptoms of inguinal lymphadenitis are:

• Enlarged lymph nodes in the groin. Enlarged lymph nodes are located in the region of the inguinal ligament and can reach several centimeters in diameter. Palpation characteristics do not differ from lymphadenitis in other areas.
• Pain. Inguinal lymphadenitis is characterized by severe pain both in the focus of inflammation itself and in the lower abdomen, in the upper part of the leg. Pain is aggravated by walking, which may limit the patient's normal movement.
• Skin changes. The skin over the focus of inflammation and around it is tense, swollen. If a purulent process has not developed, the color of the skin may be normal or pinkish.
• Swelling of the legs on the affected side. Cause given symptom is both a direct violation of the outflow of lymph through the inflamed lymph nodes, and a pronounced increase in their size, which can lead to squeezing of large vessels ( including the femoral vein, passing directly behind the inguinal lymph nodes).
• General condition of the body. Not changed if suppuration of the inflamed lymph node has not occurred. In this case, there is an increase in body temperature up to 38 - 40ºС, general weakness, pain in the muscles of the legs and abdomen, headaches, increased heart rate and other symptoms of intoxication of the body.

Diagnosis of lymphadenitis

In the diagnosis of lymphadenitis is used:

• ultrasound procedure;
• radiological research methods;
• lymph node biopsy.

General blood analysis ( UAC)

With the help of ultrasound it is possible to determine:

• Location, number, shape, size and structure of the lymph nodes.
• The relationship of the lymph node with the surrounding tissues ( soldered or not).
• The presence of inflammation in the lymphatic vessels of the study area.
• Availability purulent complications lymphadenitis ( abscess, phlegmon).
• The presence of a focus of infection in the internal organs.

X-ray methods of research

X-ray methods include:

• Plain radiograph of the chest and abdomen. Allows you to identify groups of enlarged lymph nodes ( bronchopulmonary, tracheal and other), to determine the damage to the bones of the extremities in osteomyelitis. With specific tuberculous lymphadenitis, it is possible to determine the foci of tuberculosis in the lung tissue.
• CT scan – modern method research that allows you to more accurately determine the size, location and shape of inflamed lymph nodes, the presence of abscesses or adenophlegmon, the degree of spread of the purulent process in the affected area.

Biopsy of a lymph node

Indications for performing a biopsy of the lymph node are:

• suspicion of the tumor nature of the enlargement of the lymph node;
• chronic lymphadenitis;
• suspicion of specific lymphadenitis;
• lack of effect from the prescribed treatment ( with acute or chronic lymphadenitis).

To take material from inflamed lymph nodes, the following is used:

• Needle biopsy. In this case, a special hollow needle is inserted into the affected lymph node, while part of its tissues passes into the lumen of the needle.
• Fine needle aspiration biopsy. A special thin needle is used, the inner diameter of which is less than 1 millimeter. The needle is connected to an empty syringe and inserted into the affected lymph node ( often under ultrasound guidance), followed by aspiration ( exhaustion) lymph node tissue into a syringe and its further study.

Research results
The resulting material is sent to the laboratory, where it is stained with special dyes and examined under a microscope. This allows you to identify tumor cells in the lymph node ( if available), as well as to determine the severity and nature of the inflammatory process - the predominance of lymphocytes will testify in favor of a viral lesion of the lymph node, the predominance of neutrophils - in favor of a bacterial infection.

Also, the resulting material is sown on special nutrient media intended for growing certain types of microorganisms. The nutrient medium with the test material is placed in a special thermostat, which creates optimal conditions for the growth and reproduction of bacteria. If an infectious agent is present in the punctate of the lymph node, then it will begin to actively multiply, and after a while whole colonies of these microorganisms will appear on the nutrient medium. This allows you to accurately determine the type of pathogen, as well as determine its sensitivity to various antibacterial drugs, which will allow you to prescribe the most effective treatment.

Treatment of lymphadenitis

Which doctor to contact?

Depending on the location and type of lymphadenitis, you may need to consult the following specialists:

• Otorhinolaryngologist ( Laura) and/or a dentist – with inflammation of the submandibular and cervical lymph nodes.
• Urologist - with inflammation of the inguinal lymph nodes.
• Therapist - with inflammation of the lymph nodes in the chest or abdominal cavity ( identified using various instrumental diagnostic methods).
• Dermatologist - in chronic infectious diseases of the skin.
• Phthisiatrician - with tuberculous lymphadenitis.
• Surgeon - in the presence of signs of a purulent process in the inflamed lymph nodes.

• drug treatment;
• physiotherapy;
• folk methods treatment;
• surgery.

Medical treatment

Medical treatment of lymphadenitis

Physiotherapy

Of the physiotherapeutic methods in the treatment of lymphadenitis are used:

• ultra high frequency ( UHF) therapy;
• laser therapy;
• galvanization.

UHF therapy is indicated in the presence of an acute inflammatory process in the lymph nodes. Absolute contraindications are the suspicion of a tumor process, as well as specific tuberculous lymphadenitis. It is not recommended to use this method if there are symptoms of a general infectious process in the body ( fever, chills, heart palpitations, muscle pain and so on).

Laser therapy
The essence of this method is the impact of light waves of a certain length on the tissues of the body. This leads to an improvement in microcirculation in the inflamed lymph node, has an anti-inflammatory and analgesic effect, and also stimulates reparative ( restorative) processes.

This method is prescribed for acute and chronic lymphadenitis. Contraindications are the same as for UHF therapy. In addition, laser exposure to areas of the skin in which there are benign neoplasms ( moles, age spots and others).

Galvanization
The essence of the method lies in the impact on the body of a constant electric current of low strength ( up to 50 milliamps) and low voltage ( 30 - 80 volts), which passes through the tissues of the body, causing a number of complex physiological processes. It has a local analgesic effect, improves microcirculation in the area of ​​current exposure, promotes the restoration of damaged tissues and nerve fibers.

This method is used at the recovery stage of treatment after eliminating the cause of lymphadenitis and reducing the activity of the inflammatory process in the lymph nodes, as well as in chronic forms of lymphadenitis.

Folk methods of treatment

The most common folk methods for treating lymphadenitis are:

• warming up the lymph nodes;
• herbal preparations;
• echinacea tincture.

Warming up the lymph nodes is absolutely contraindicated:

• in the presence of a tumor process in enlarged lymph nodes;
• with specific tuberculous lymphadenitis;
• with the development of adenophlegmon;
• if there are signs of intoxication of the body ( fever, muscle and headaches, heart palpitations).

With a progressive increase in lymph nodes after the start of treatment, an increase in body temperature or a deterioration in general well-being, warming up should be stopped immediately and a specialist should be consulted.

Herbal preparations
The anti-inflammatory and antimicrobial properties of various plants have been used in the treatment of lymphadenitis for many decades. They should be used in combination with other treatments.

• Infusion of dandelion roots. Pour 10 g of crushed raw materials with a glass of boiling water. Infuse for 4 hours, then strain and take 1 tablespoon 3-4 times a day.
• Infusion of nettle flowers. 5 tablespoons of dried nettle flowers should be poured with 1 liter of boiling water. Insist for 2 hours, then strain and take 100 ml 2 times a day. This infusion has a certain anti-inflammatory effect, and also helps to eliminate toxins from the body.
• Aloe juice. Aloe leaves must be washed, crushed and squeezed out of them juice. Add 200 g of honey to 100 g of juice and infuse for 1 day. Take 1 teaspoon 2 times a day. It has a certain anti-inflammatory and antimicrobial effect.

The beneficial effects of echinacea in lymphadenitis are due to:

• increased migration of lymphocytes to the focus of inflammation;
• increased phagocytic activity of leukocytes;
• facilitating the release of biologically active substances in the focus of inflammation.

Echinacea tincture can be used:

• Outwardly. A compress with echinacea tincture is usually used. To do this, dilute 10 - 20 ml of warm tincture ( not hot!) with water in a ratio of 1: 2, moisten a bandage or gauze in it and apply a compress to the site of inflammation overnight. It is not recommended to use this method for more than 5 - 7 days.
• inside. Adults take 20-40 drops of tincture dissolved in 100 ml of warm water, 1-2 times a day. Dose for children - 5 - 10 drops 1 - 2 times a day.

Surgical treatments

Inflammation of the lymph nodes - symptoms, causes, complications and what to do?

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 Hematology scientific center According to 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, consistency, pain, mobility of the lymph nodes);
• presence of other clinical signs(enlargement of the 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 a 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 during the initial examination of the patient, one should work out the skills and abilities to detect enlarged LUs. 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, hydradenitis, an increase in the parotid salivary glands, and more rarely found non-lymphoid nodular formations (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. For example, 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 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, mammary and thyroid gland). At the same time, an increase in supraclavicular and prescalene LNs is almost never reactive, but more often associated with lymphoproliferative tumors (lymphogranulomatosis), metastatic tumor process (tumors of the stomach, ovaries, lungs, and 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.).

Despite 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 lesions of the cervical and axillary, and with sexually transmitted infections, inguinal LUs. 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 with genital infections, an increase in submandibular lymph nodes with 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 when 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.) makes 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 a patient, manifested by an increase in LU, taking certain medications).

Clinical signs. A thorough clinical examination of a patient with LDP is necessary 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 the routine laboratory methods of differential diagnosis in patients with LDP, the study of peripheral blood parameters is mandatory. 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 a pathognomonic laboratory sign of 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).

As well as general analysis peripheral blood during the initial treatment of a patient with LDP mandatory studies are: x-ray examination of the chest, ultrasound of the abdominal organs, immuno-serological 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.

If a local inflammatory process is detected in patients with an increase in regional lymph nodes, the situation is regarded as reactive lymphadenitis. The 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, surgical treatment) or spontaneous regression. 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

Very often, the lymph nodes increase due to a nonspecific inflammatory process - reactive lymphadenitis (non-tumor nature) occurs, and ultrasound data of the lymph nodes are very important as a differential diagnosis in this case.

For the convenience of diagnosis, all nonspecific reactive lymphadenitis is divided as follows:

1. According to the course of the disease: 1) acute; 2) subacute; 3) chronic lymphadenitis.
2. By localization of the process: 1) isolated; 2) regional; 3) widespread; 4) generalized lymphadenitis.

Those reactive changes that occur in response to various pathological processes in the body (such as an inflammatory process or vaccination) contribute to the appearance of such ultrasound signs as: an increase in the size of the lymph node, tension in its capsule, increased vascular pattern of the lymph node, expansion its cortical and near-cortical zones, edema and rupture of the capsule, expansion of the sinuses is determined, as well as single anechoic structures of a "cystic" nature can be found in the lymph node, in the future their abscess formation may occur. It should also be taken into account that changes in the lymph nodes that are located next to the tumor, with ultrasound of the lymph nodes, can also manifest themselves as a non-specific inflammatory reaction.

Hyperplastic nodes according to ultrasound of the lymph nodes are more often oval in shape, their echostructure is hyperechoic, with a thin hypoechoic rim, which occupies about 1/3 of the node; if we talk about the size of the affected lymph nodes, then the size of the lymph nodes in the inguinal regions, as a rule, is not more than 3.5x1.5 cm, in other anatomical areas - 2.5x1 cm. The ratio of the thickness to the length of the lymph nodes with hyperplasia does not exceed 1: 2. The contours of such lymph nodes are clear, even. With the development of reactive lymphadenitis, the anatomical architecture of the node is preserved. If there are hypoechoic nodes of an oval or round shape, with even clear contours, small sizes, sometimes with a hyperechoic center that occupies less than 2/3 of the node, such lymph nodes can be both hyperplastic and metastatic.

The vessels in the inflamed lymph node are more dilated than those in the metastatic lymph node, which, on the contrary, are usually compressed by tumor cells.

In both normal and reactively altered lymph nodes during an inflamed process, visible vessels are more often located in the region of the gate of the lymph node or are not detected at all. In a hyperplastic lymph node big size the vascular pattern in its peripheral parts is always ordered, the blood vessels are determined along the capsule, and are also located radially from the gate to the periphery.

With node hyperplasia, if adequate treatment of lymph nodes with a positive effect was carried out, they become less contrasting, and there is also a decrease in their size. In chronic lymphadenitis, a thickening of the capsule of the lymph nodes is often noted, signs of soldering it with the tissues surrounding the node.

Lymphadenitis is called inflammation of the nodes lymphatic system caused by pathogenic microorganisms. Signs of the disease are enlargement and soreness of the lymph nodes. Lymphadenitis rarely acts as a primary disease, more often it appears as a result of any infectious disease in the body. The inflammatory process in the lymph node begins due to the ingress of harmful microbes from the primary inflammatory focus into it with the flow of lymph: suppuration, boils, etc.

Types and stages of development

Classifying inflammation of the lymph nodes, doctors take into account the causes, localization, as well as the duration and characteristics of the course of the disease.

On the basis of what infection became the cause, specific and non-specific are divided.

Nonspecific lymphadenitis is caused by:

• viruses;
• bacteria;
• fungal flora.

The specific form is a response to the penetration of special microorganisms into the lymph nodes, including:

• actiminocet or radiant fungus;
• pale treponema;
• brucella;
• tuberculosis bacillus;
• tularemia bacterium;
• plague stick.

The penetration of Koch's sticks into the lymph nodes causes tuberculous lymphadenitis. This form of the disease most often affects the cervical and submandibular lymph nodes, as pathogens enter the body through the oral cavity and nasopharynx. Tuberculous lymphadenitis is able to infect the symmetrical nodes of the lymphatic system.

The duration of the disease underlies the division into chronic and acute forms.

Acute lymphadenitis characterized by a rapid course of the disease. This form occurs when the body is affected common disease, or when the pathogen enters the lymph node directly. Provokes acute lymphadenitis infection with a high degree contagiousness.

Chronic lymphadenitis is the result of a long illness. Also, chronic lymphadenitis may be associated with the development of oncology or the presence of a chronic disease.

Based on the nature of the inflammation, serous lymphadenitis is distinguished (the primary stage, when the symptoms do not manifest themselves significantly) and purulent lymphadenitis (a dangerous form of the disease with vivid symptoms, requires mandatory professional treatment).

In accordance with where the inflammation of the lymph node occurred in the body, types are distinguished:

• parotid;
• mesenteric lymphadenitis.

The development of the disease goes through three stages:

1. Simple or catarrhal- initial.
2. hyperplastic- a later stage with an increase in the number of lymphocytes in the inflamed node.
3. Purulent - the last phase. Purulent lymphadenitis is characterized by the destruction of the lymph node.

Causes

The cause of lymphadenitis can be diseases of the internal organs. Cases when pathogenic microorganisms fall directly into the lymph nodes (in case of damage to the skin), occur less frequently. When local disturbances become the cause, it is called reactive lymphadenitis.

Both one lymph node and several adjacent ones can become inflamed. This form is called regional lymphadenitis.

Lymphadenitis in adults indicates a decrease in immunity. This disease affects the child's body mainly in preschool age, when the immune system not yet fully developed.

In addition to the above general causes, they can be characteristic only of the part of the body where lymphadenitis has occurred.

Cervical

Lymph nodes in the neck become inflamed under the influence of ENT diseases, allergies, metabolic disorders, connective tissue diseases, suppuration in the neck. Also provocateurs of inflammation are oncological diseases and HIV.

The danger of this form lies in its proximity to the throat and nose. With a serious course of the disease, problems with breathing and eating are not excluded, especially in children.

Submandibular

This is the most common form. Inflammation of the lymph nodes occurs against the background of diseases of the skin of the face, salivary glands, and oral cavity. May be due to acute tonsillitis.

Inguinal

Problems in the genital area can provoke an inguinal type: inflammation, tumors, STDs, as well as inflammatory processes in muscle tissues and on the skin, festering wounds in the crotch.

Axillary

Inflammation in the armpit, like other forms, occurs due to suppuration of the skin or damage by pathogenic microbes: HIV, various cocci, etc. Another reason for it is hypothermia, which is especially common in summer. In the heat, it is more difficult to protect sweaty armpits from drafts. In women, the axillary form can be triggered by mastitis, which often occurs during breastfeeding.

Rarer forms

One of the rare forms is parotid lymphadenitis. The cause of inflammation behind the ears can be contamination of the earlobe puncture, purulent diseases and skin injuries in this area. Lymphadenitis behind the ear is especially dangerous, as it can cause a disease such as inflammation of the brain. More information in the review

The cause of mesenteric (also sometimes called mesenteric) lymphadenitis are diseases of the upper respiratory tract and tonsils. Children are mostly susceptible to mesadenitis, in adults this form is less common.

The main symptoms of inflammation of the lymph nodes, taking into account localization

Common manifestations of the disease include fever, swelling of the lymph node and redness of the skin at the site of the lesion. The patient is feverish. The number of leukocytes in the blood increases.

Along with this, there are several local symptoms of lymphadenitis. So, the cervical type is characterized by pain when turning the head, eating, talking. The submandibular view is distinguished by pain when moving the jaw. With inflammation of the lymph node in the groin, the thigh swells on the affected side. Distinctive feature axillary form of the disease is swelling and difficulty in moving the arm.

Diagnostic Rules

The International Classification of Diseases of the Tenth Revision assigns the code L04 to acute lymphadenitis. According to this classification, nonspecific lymphadenitis has code I 88. Chronic (except mesenteric) lymphadenitis according to ICD-10 has code I88.1.

It is necessary to distinguish between lymphangitis and lymphadenitis. With lymphangitis, the lymphatic vessels become inflamed, not the nodes.

Diagnosis of inflammation of the lymph nodes should be carried out by the attending physician. It determines the symptoms and treatment. First of all, the doctor palpates the lymph nodes for inflammation, identifies the signs and prescribes how to treat lymphadenitis. To identify at what stage the disease is and what caused the disease, the following methods may be required:

• blood test (general, for HIV, STIs);
• x-ray/CT;
• biopsy of an inflamed lymph node.

More information about the biopsy procedure in the overview

Therapeutic methods

Treatment of lymphadenitis is always carried out in a complex. It should be aimed both at eliminating the inflammation itself and at the primary disease that caused it.

Medical therapy

To relieve inflammation of the lymph nodes and cure the root cause of the disease, the doctor prescribes antibiotics, anti-inflammatory and painkillers, as well as immunomodulators. Antifungal and anti-tuberculosis agents may also be prescribed.

Physiotherapy procedures

Physiotherapy helps to improve the patient's well-being, reduce the inflammatory process and restore the affected tissues. To treat this disease of the lymph nodes, the doctor prescribes the following physiotherapy: UHF, laser and galvanization.

Surgical treatment

Surgical treatment is required when inflammation increases. Purulent contents and dead tissue are surgically removed. The intervention is carried out local anesthesia. Drainage is installed for a week.

Treatment of lymph nodes at home

Home remedies can only be used in conjunction with therapy prescribed by a specialist. They are used to boost immunity, relieve swelling and inflammation, provided that this is allowed by the doctor.

Decoctions

Blueberries are good for immunity. Its berries are poured with water in a ratio of 1 to 4 and left for an hour. Drink 4 teaspoons twice a day.

Nettle flowers can help relieve inflammation. 5 tablespoons of dried flowers are poured with a liter of boiling water and infused for 2 hours. Strained infusion drink half a cup in the morning and evening.

Thanks to their healing properties dandelion is widely used in folk medicine. With inflammation of the lymph nodes, a decoction of its leaves is used. Take 1 part of dandelion leaves for 4 parts of water. Take 50 ml half an hour before meals three times a day.

Tinctures

Echinacea tincture is used to boost immunity. Half a glass of water is from 20 to 40 drops of tincture. Take orally 1-2 times a day.

Echinacea also has disinfecting properties, so its tincture is also useful for compresses. It is bred in a ratio of one to two. The compress is applied all night.

rinses

Useful properties of tea from chamomile, calendula and mint. It is taken both as a drink and as a gargle 3-4 times a day.

You can also gargle with a solution of soda and salt. Dissolve half a teaspoon of each remedy in a glass of hot water. Let cool and use several times a day.

Compresses

If there is no purulent inflammation, then compresses with dimexide can be used. It is diluted in half with water. The compress is used twice a day for 15 minutes.

Common compress from celandine. The leaves are poured over with boiling water and applied to the affected area. Hold for half an hour. Repeat 3 times a day.

Ointments

Due to its antiseptic properties, ichthyol ointment can be used in the treatment of inflammation of the lymph nodes. The ointment is applied to inflamed area several times a day.

Can it be cured forever?

Only a doctor should determine. A significant role is played by what caused this disease, and its type. It must be remembered that an acute form that has not been fully cured can transform into chronic lymphadenitis. Therefore, it is important to consult a doctor and follow the prescribed treatment in order to get rid of this disease forever.

In the chronic form of the disease, special attention should be paid to prevention: to maintain and restore immunity.

Diseases do not go alone. Sometimes one infectious disease provokes inflammatory processes in other departments and organs. While the disease itself develops and gives complications, inflammatory processes progress and give their side effects. If you remember, it is often respiratory diseases doctors palpate the lymph nodes. This is due to the fact that it does not go away separately from other diseases, but accompanies them.

Everything should be discussed about lymphadenitis on the site site.

What is it - lymphadenitis?

What is it - lymphadenitis? They call it an inflammatory process that occurs in the lymph nodes. Rarely, this disease occurs on its own. Usually it is a consequence of the occurrence of other infectious and inflammatory diseases. Often it accompanies diseases of the respiratory tract, heart, nose, throat, ear. The disease causes enlargement of the lymph nodes and their soreness. In 80%, the submandibular lymph nodes are affected. But there are other departments that can also be inflamed.

Lymphadenitis is a reaction of the body to a foreign organism that has penetrated into it. When a certain department or organ becomes ill by being affected by a bacterium or virus, then the infection can enter the lymph nodes through the lymph or blood. Leukocytes located in these areas are activated and cause an inflammatory process, which should destroy pathogenic agents.

It happens due to the fact that with a massive penetration of the infection into the lymph nodes, additional leukocytes begin to flow into these areas, which further provoke the process of inflammation. There is a proliferation and enlargement of the lymph nodes, as well as their soreness.

Thus, lymphadenitis is a beneficial inflammatory process, which means that the body is fighting infection.

Classification

1. According to the ways of penetration of infection into the lymph nodes:

• Hematogenous - through the blood;
• Contact - from nearby organs and tissues;
• Mechanical (exogenous) - from the environment when injured.

1. According to the causes of occurrence, types are distinguished:
   • Specific;
   • Non-specific.
2. By form:

• Acute - manifests itself with vivid symptoms and turns into a purulent form if not treated.
• With a purulent form, the lymph nodes melt and the disease affects neighboring tissues.
• Chronic - provoked by some specific microorganisms, as well as as a result of a long course of the inflammatory process, not treated acute form.
• Reactive - characterized by lightning-fast enlargement of the lymph nodes.

1. According to the nature of inflammation:

• Catarrhal (simple) - a violation of the permeability of the lymphatic capillaries and the release of blood from the vascular bed, impregnating the tissues. There is redness. There is a moderate migration of leukocytes.
• Hyperplastic - an inflammatory process in the later stages, when there is a massive intake and growth of leukocytes.
• Purulent - is the last stage in bacterial lymphadenitis, when suppuration and destruction of the lymph nodes are observed. Abscesses or adenophlegmons are formed.
• Serous (non-purulent) - a slight deterioration in health.
• Fibrinous - profuse exudation and loss of fibrin.
• Hemorrhagic - blood soaking with plague or anthrax
• Necrotic - rapid and extensive necrosis of tissues.

1. By pathogens is divided into types:

• Bacterial;
• Fungal;
• Viral.

1. By location:

• Submandibular;
• Cervical;
• Axillary;
• Parotid;
• Mesenteric (mesadenitis);
• Inguinal.

1. By prevalence:

• Single;
• Regional;
• Total.

Causes

The causes of inflammation of the lymph nodes are conditionally divided into specific and nonspecific. Nonspecific lymphadenitis is provoked by microorganisms of different infectivity and structure:

Specific lymphadenitis develops when the lymph nodes are affected by special microorganisms:

• Microbacterium tuberculosis;
• Pale treponema;
• Brucella;
• Plague wand;
• tularemia bacteria;
• Actinomycete.

These microorganisms cause their own unique set of symptoms that are unique to them.

Each section of the lymph nodes is provoked depending on what disease the person suffers from. Thus, the causes of inflammation of the submandibular lymph nodes are:

1. Skin infections: furuncle, impetigo, trauma, herpes, carbuncle, herpes zoster, hidradenitis, erysipelas.
2. Mouth infections: gingivitis, glossitis, caries, infectious stomatitis.
3. Salivary gland infections: bacterial and viral infections.

The causes of cervical lymphadenitis are:

1. Otitis.
2. Fungal diseases of the scalp.
3. Pharyngitis.
4. Sinusitis.
5. Rhinitis.
6. infectious thyroiditis.
7. Rubella.
8. Infectious mononucleosis.
9. adenovirus infection.
10. Flu.
11. Festering wounds on the head and neck.

The causes of the axillary appearance are:

1. Purulent diseases of the skin of the upper jaw.
2. Felon.
3. Suppuration of wounds in the region of the arms, torso.
4. Fungal lesions of the skin.
5. Mastitis.
6. Osteomyelitis of the bones of the hands.

Factors provoking inguinal lymphadenitis are:

1. the above inflammatory diseases.
2. Gonorrhea.
3. Colpitis.
4. Balanoposthitis.
5. Vulvit.

Symptoms and signs of lymphadenitis of the lymph nodes

Consider the symptoms of lymphadenitis of the lymph nodes by their location. The submandibular form is characterized by the following features:

• Enlarged lymph nodes. They become round or oval.
• Pain that gets progressively worse as the illness progresses. Accompanied by movement of the jaw.
• Discoloration of the skin in the region of the lymph nodes: it becomes red and swollen. Local body temperature may be observed.
• With a purulent form, suppuration, fusion of lymph nodes, their compaction occurs. The skin becomes red, swollen, tight. There is pain even at rest. Jaw movements are limited.
• Temperature increase up to 40ºС.
• Pain in the head.
• Weakness.
• Pain in the muscles.
• Drowsiness.

With the cervical form, symptoms appear:

• Enlargement of oval or round lymph nodes.
• Pain occurs when turning the head, talking, eating and swallowing, as in asthma.
• The skin becomes red, swollen, swollen, which appears not only in the region of the lymph nodes, but also beyond them.
• With a purulent form, the skin becomes red, pus breaks out, the temperature reaches 40 ° C, sleep is disturbed, weakness and pain in the head occur.
• Restriction in the movement of the neck. Any turns and movements cause severe pain.
• Squeezing of the cervical organs - vessels, trachea, vocal cords, esophagus - which causes the corresponding symptoms: voice change, as in laryngitis, difficulty breathing, as in tracheitis, swallowing disorder (dysphagia), as in esophagitis.

In the axillary form, the following symptoms are observed:

• Enlargement of lymph nodes and even blood vessels.
• Pain that radiates to the shoulder and side of the chest. The patient takes a forced position, lying on his side, moving his arm to the side, due to which the pressure in the region of the lymph nodes decreases, which reduces pain.
• Usually the skin does not change its color. But with a purulent form, it can become purple-red in color, acquire a swollen, tense appearance.
• Hand movements from the side of the affected area are limited.
• There are swelling of the hands in the affected areas.
• The sensitivity of the affected area of ​​the hand is impaired. There may be tingling, numbness, goosebumps, etc.

Symptoms of the inguinal form are:

• Enlargement of lymph nodes up to several centimeters.
• Pain that gets worse when walking, which makes the patient move less.
• Pain in the affected area, as well as in the lower abdomen and thigh.
• There is swelling and tension of the skin.
• The skin may be normal or pinkish, if purulent lymphadenitis has not developed.
• Swelling of the legs from the affected area.
• The general condition is satisfactory until a purulent form develops, in which the temperature rises, weakness, headaches, palpitations, pain in the muscles of the abdomen and legs occur.

Symptoms of acute lymphadenitis develop very brightly. The chronic form proceeds sluggishly. The lymph nodes increase, but practically do not hurt, swell, only slightly change the color of the skin.

Lymphadenitis in adults

Lymphadenitis in adults develops against the background of harmful work and with advanced forms of disease. Both men and women tend to neglect their own health when they are sick. Often attempts are made to self-medicate infectious diseases. This approach provokes suppuration of the lymphatic tissues, the transition of the disease to chronic form.

Lymphadenitis in children

Children are not spared by such a disease as lymphadenitis. It develops against the background of an infectious disease of another system, which in turn arose when infected through air or food.

Diagnostics

Diagnosis of inflammation of the lymph nodes begins with the collection of symptoms that bother, as well as a general examination (palpation, listening, identifying all signs of lymphadenitis). Additional studies help to establish the cause of the disease, as well as determine the severity:

1. Blood test.
2. Radiography.
3. Ultrasound of the affected area.
4. Biopsy of the lymph node.
5. Consultations with doctors who treat the disease that caused lymphadenitis: otorhinolaryngologist, urologist, therapist, dermatologist, phthisiatrician, surgeon.
6. Diagnosis of the underlying disease.

Treatment

1. Medicines;
2. Physiotherapy;
3. Folk methods;
4. Surgical intervention.

The main thing is the treatment of the underlying disease, against which inflammation of the lymph nodes has developed. Medicines that are used in the treatment of lymphadenitis are:

• Non-steroidal anti-inflammatory drugs: Ketorolac, Nimesulide;
• Antihistamines: Cetirizine;
• Antibiotics: Amoxiclav, Ceftriaxone, Clindamycin, Benzyllenicillin;
• Antiviral drugs: Acyclovir, Rimantadine;
• Anti-tuberculosis drugs: Ethambutol, Rifampicin, Capreomycin;
• Antifungals: Fluconazole, Amphotericin B.

What is treated in physiotherapy?

• Ultrahigh frequency therapy;
• laser therapy;
• Galvanization;
• Electrophoresis with iodine preparations.

Alternative methods that can be used at home and supplement (but not replace) medical and physiotherapy treatment are not excluded:

1. Heating with dry heat. Heat salt or sand in a pan, put in a cloth bag and apply to the affected area. If after the procedures the temperature rises and the condition worsens, then you should stop the procedures and seek medical help.
2. Herbal decoctions and infusions:
   • Pour boiling water over 10 g of crushed dandelion roots, leave for 4 hours and consume in a tablespoon.
   • Add honey (200 g) to aloe juice (100 g) and leave for an hour. Take a teaspoon.
3. Tinctures from echination, either bought at a pharmacy or prepared on their own: pour 100 g of crushed roots of raw materials with 60% alcohol (500 ml) and leave for 2 weeks. Strain. Use both internally and externally.
4. The diet consists in the use of vitamins and foods rich in fiber and protein.

Surgical intervention is resorted to only with a purulent form of lymphadenitis, when abscesses and adenophlegmons form. The purulent focus is opened, the contents and destroyed tissues are removed. Everything is washed with antiseptics and drained so that liquid and pus later come out through the tube.

life forecast

How long do they live with lymphadenitis? The disease is not considered fatal. Attention should be focused on eliminating the cause of the disease, while simultaneously treating lymphadenitis. The prognosis of life is favorable with timely treatment. Sometimes the disease goes away on its own, especially if the source of infection (that is, the underlying disease) is eliminated. However, one should not rely on this, so as not to develop a chronic form. Complications are possible if treatment is not carried out:

• thrombophlebitis,
• Fistula;
• tissue phlegmon;
• Sepsis.