- Denis Spelman, MBBS, FRACP, FRCPA, MPH
Denis Spelman, MBBS, FRACP, FRCPA, MPH
- Adjunct Professor, Monash University
- Alfred Hospital, Victoria, Australia
Lymphangitis is inflammation of lymphatic channels due to infectious or noninfectious causes. Potential pathogens include bacteria, mycobacteria, viruses, fungi, and parasites. Lymphangitis most commonly develops after cutaneous inoculation of microorganisms into the lymphatic vessels through a skin wound or as a complication of a distal infection.
The pathophysiology, clinical manifestations, microbiology, diagnosis, and treatment of lymphangitis will be reviewed here. Further information about the individual etiologies of lymphangitis is discussed in detail separately.
The major function of the lymphatic system is to resorb fluid and protein from tissues and extravascular spaces. The absence of a basement membrane beneath lymphatic endothelial cells affords the lymphatic channels a unique permeability, allowing resorption of proteins that are too large to be resorbed by venules.
Lymphatic channels are situated in the deep dermis and subdermal tissues parallel to the veins and have a series of valves to ensure one-way flow . Lymph drains via afferent lymphatics to regional lymph nodes and then by efferent lymphatics to the cisterna chyli and the thoracic duct into the subclavian vein and venous circulation.
Lymphangitis most commonly develops after cutaneous inoculation of microorganisms that invade the lymphatic vessels and spread toward the regional lymph nodes. Organisms may invade lymphatic vessels directly through a skin wound or an abrasion or as a complication of a distal infection.
- Suami H, Taylor GI, Pan WR. The lymphatic territories of the upper limb: anatomical study and clinical implications. Plast Reconstr Surg 2007; 119:1813.
- Simon MS, Cody RL. Cellulitis after axillary lymph node dissection for carcinoma of the breast. Am J Med 1992; 93:543.
- Wenner KA, Kenner JR. Anthrax. Dermatol Clin 2004; 22:247.
- Sands M, Brown R. Herpes simplex lymphangitis. Two cases and a review of the literature. Arch Intern Med 1988; 148:2066.
- Mabey D, Peeling RW. Lymphogranuloma venereum. Sex Transm Infect 2002; 78:90.
- Lázaro MJ, López PM, Vall-Mayans M, et al. A case of late-stage lymphogranuloma venereum in a woman in Europe. Sex Transm Dis 2013; 40:792.
- Fournier PE, Gouriet F, Brouqui P, et al. Lymphangitis-associated rickettsiosis, a new rickettsiosis caused by Rickettsia sibirica mongolotimonae: seven new cases and review of the literature. Clin Infect Dis 2005; 40:1435.
- de Sousa R, Duque L, Anes M, et al. Lymphangitis in a Portuguese patient infected with Rickettsia sibirica. Emerg Infect Dis 2008; 14:529.
- Roch N, Epaulard O, Pelloux I, et al. African tick bite fever in elderly patients: 8 cases in French tourists returning from South Africa. Clin Infect Dis 2008; 47:e28.
- Smego RA Jr, Castiglia M, Asperilla MO. Lymphocutaneous syndrome. A review of non-sporothrix causes. Medicine (Baltimore) 1999; 78:38.
- Kostman JR, DiNubile MJ. Nodular lymphangitis: a distinctive but often unrecognized syndrome. Ann Intern Med 1993; 118:883.
- Schubach A, Barros MB, Wanke B. Epidemic sporotrichosis. Curr Opin Infect Dis 2008; 21:129.
- Beaman BL, Beaman L. Nocardia species: host-parasite relationships. Clin Microbiol Rev 1994; 7:213.
- Capellan J, Fong IW. Tularemia from a cat bite: case report and review of feline-associated tularemia. Clin Infect Dis 1993; 16:472.
- Boyce Z, Collins N. Scedosporium apiospermum: An unreported cause of fungal sporotrichoid-like lymphocutaneous infection in Australia and review of the literature. Australas J Dermatol 2015; 56:e39.
- Taylor MJ, Cross HF, Ford L, et al. Wolbachia bacteria in filarial immunity and disease. Parasite Immunol 2001; 23:401.
- Pani SP, Yuvaraj J, Vanamail P, et al. Episodic adenolymphangitis and lymphoedema in patients with bancroftian filariasis. Trans R Soc Trop Med Hyg 1995; 89:72.
- Wu JW, Chiles C. Lymphangitic carcinomatosis from prostate carcinoma. J Comput Assist Tomogr 1999; 23:761.
- Kohmo S, Tachibana I, Osaki T, et al. Multiple organ mucosa-associated lymphoid tissue lymphoma presenting with lymphangitic pattern of spread in the lung. J Thorac Oncol 2007; 2:1057.
- Murphy MJ, Kogan B, Carlson JA. Granulomatous lymphangitis of the scrotum and penis. Report of a case and review of the literature of genital swelling with sarcoidal granulomatous inflammation. J Cutan Pathol 2001; 28:419.
- Van Kruiningen HJ, Colombel JF. The forgotten role of lymphangitis in Crohn's disease. Gut 2008; 57:1.
- Rosen T, Hwong H. Sclerosing lymphangitis of the penis. J Am Acad Dermatol 2003; 49:916.
- Morrison JB. Lymphangitis after tuberculin tests. Br Med J (Clin Res Ed) 1984; 289:413.
- Trichet E, Cohen-Bacrie S, Conrath J, et al. Nocardia transvalensis keratitis: an emerging pathology among travelers returning from Asia. BMC Infect Dis 2011; 11:296.
- Xiao M, Kong F, Sorrell TC, et al. Identification of pathogenic Nocardia species by reverse line blot hybridization targeting the 16S rRNA and 16S-23S rRNA gene spacer regions. J Clin Microbiol 2010; 48:503.
- Iannotti CA, Hall GS, Procop GW, et al. Solitary Nocardia farcinica brain abscess in an immunocompetent adult mimicking metastatic brain tumor: rapid diagnosis by pyrosequencing and successful treatment. Surg Neurol 2009; 72:74.
- Kheirandish F, Sharafi AC, Kazemi B, et al. First molecular identification of Leishmania species in a new endemic area of cutaneous leishmaniasis in Lorestan, Iran. Asian Pac J Trop Med 2013; 6:713.
- Alborzi A, Pouladfar GR, Ghadimi Moghadam A, et al. First molecular-based detection of mucocutaneous leishmaniasis caused by Leishmania major in Iran. J Infect Dev Ctries 2013; 7:413.
- Ulu-Kilic A, Gulen G, Sezen F, et al. Tularemia in central Anatolia. Infection 2013; 41:391.
- Lohrmann C, Foeldi E, Bartholomä JP, Langer M. Interstitial MR lymphangiography - a diagnostic imaging method for the evaluation of patients with clinically advanced stages of lymphedema. Acta Trop 2007; 104:8.
- Garfein ES, Borud LJ, Warren AG, Slavin SA. Learning from a lymphedema clinic: an algorithm for the management of localized swelling. Plast Reconstr Surg 2008; 121:521.