Chronic lymphadenitis

Chronic lymphadenitis is characterized by infectious inflammation over a long period of time, localized in the lymph nodes. The human immune system and the lymph nodes, as an integral part of it, prevent penetration into the body and eliminate all kinds of infections and inflammations with their functions. The main function of the lymph nodes is to filter all kinds of harmful microorganisms, viruses and bacteria, with their subsequent removal from the body.

The anatomical location of the lymph nodes is determined by their location in the neck, armpit and groin area. The peculiarity of lymphatic lymphadenitis is its isolated inflammatory processes. Thus, inflammation can affect one lymph node, several lymph nodes at once within one area, or multiple lymph nodes in several foci of inflammation.

Chronic lymphadenitis has two forms of chronic inflammation of the lymph nodes - specific and non-specific. Specific chronic lymphadenitis has a clear relationship between the chronic form and a specific infectious agent. At the same time, it does not matter at all what group of infectious agents it belongs to - bacterial, for example, syphilis, tuberculosis or fungal group.

There are known infectious agents of the bacterial group that belong to a specific form of chronic lymphadenitis and at the same time do not have chronic symptoms, because, as a rule, they lead to a fatal outcome of the disease due to untimely treatment. Such dangerous diseases include anthrax or plague. All other infectious inflammations belong to the non-specific chronic form of chronic lymphadenitis. Mixed infections and infections with opportunistic microflora can also be included here. Such infections provoke sluggish diseases of the teeth and tonsils, for example, periodontitis and tonsillitis. These diseases occur against the background of weakened immunity or vitamin deficiency, various microtraumas of the skin. Penetration of the infection occurs through damaged skin, thereby provoking the occurrence of an inflammatory process, which subsequently enters the lymph node through the lymph ducts. Any chronic inflammation sooner or later enters the human lymphatic system, thereby contributing to inflammatory processes and disorders of the lymph nodes.

Features of the diagnosis of the disease conventionally divide chronic lymphadenitis into specific and non-specific forms. The non-specific form of chronic lymphadenitis is characterized by general signs of the inflammatory process. For example, compaction of the lymph node, slight pain during palpation, absence of adhesions between surrounding tissues and individual nodes. If during palpation the lymph nodes move freely in different directions relative to their main location. With the non-specific form of chronic lymphadenitis, purulent processes are absent, and a significant decrease in the size of the lymph node is also noted. This process is explained by the compaction of the connective tissue and the lymph node.

A specific form of chronic lymphadenitis is accompanied by suppuration of the lymph nodes, painful sensations when palpating them, dense adhesions with the surrounding connective tissue. The general condition of the body also has characteristic changes. Increased sweating is observed, especially at night, elevated body temperature, and weight loss is possible.

Chronic lymphadenitis is caused by bacteria and viruses of a purulent nature. Penetrating through the lymphatic vessels with the flow of lymph or blood, from foci of purulent inflammation or by direct penetration through microtraumas of the skin. Chronic lymphadenitis can be purulent and non-purulent. The inflammatory process of purulent chronic lymphadenitis can affect both one lymph node and several nodes at once, forming an inflammatory focus of suppuration of soft tissues.

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Causes of chronic lymphadenitis

The causes of chronic lymphadenitis have some peculiarities, mainly due to the anatomical structure and functions of the lymph nodes of the human body. In general, there are several main causes of chronic lymphadenitis. A conditionally virulent infection can provoke the transformation of the acute form of the disease into a chronic one. It is possible that the process will turn into a chronic form due to dysfunction of nearby organs. The lymph nodes have the anatomical function of filtering all kinds of infections and viruses from the blood and lymph, therefore they take on all the danger of inflammatory processes. The result of this is their swelling and increase in size with the spread of all kinds of inflammatory processes.

The causes of chronic lymphadenitis are due to other purulent inflammatory processes, the bacteria of which, together with blood and lymph, enter the lymph nodes, settle in them and continue the inflammatory process directly in the lymph nodes. Penetration of infection can occur through direct contact, by penetration of streptococcal and staphylococcal bacteria and their toxins into the body. For example, the tuberculosis bacillus provokes tuberculous lymphadenitis. The enlargement of the lymph node occurs due to the accumulation of inflammatory reaction cells in the area of the detected bacteria. Both several lymph nodes and one lymph node are subject to damage. If the infectious inflammation spreads to regional lymphatic vessels, this provokes the development of regional lymphadenitis.

There are several types of chronic lymphadenitis, each of which has its own characteristics. Let's consider them in more detail. Various inflammatory processes in the oral cavity, such as caries, periodontal disease, tonsillitis, can provoke the development of submandibular lymphadenitis.

Infectious diseases such as purulent tonsillitis, pneumonia, and flu, under certain conditions, can cause the development of cervical lymphadenitis.

The occurrence of inguinal lymphadenitis occurs against the background of the development of the main venereal disease and is accompanied by infectious inflammation of the lymph nodes in the groin area. Primary inflammation of the lymph nodes in the groin area is extremely rare. In children, lymphadenitis of the inguinal area is almost never found, due to the infrequent occurrence of venereal diseases. If such inflammation does occur, then most likely it is associated with a violation of the outflow of lymph or problems with the child's immune system. Any infected injury in the groin area with weakened immunity can cause chronic lymphadenitis.

Infectious diseases of the oral cavity, such as inflammation of the tonsils and caries, can be the cause of the development of axillary lymphadenitis, because the axillary lymph nodes receive lymph from the face and neck.

Inflammation of the inner ear, auricle can provoke the development of parotid lymphadenitis. This type of lymphadenitis is quite dangerous and can infect the membranes of the brain, which will lead to meningitis. Inflammatory processes of the lymph nodes of the mesentery lead to the development of mesenteric lymphadenitis, which is a consequence of inflammation of the tonsils and diseases of the upper respiratory tract.

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Symptoms of chronic lymphadenitis

Symptoms of chronic lymphadenitis vary depending on the location of the lymph nodes and, accordingly, the inflammatory processes. As the disease develops, symptoms of chronic submandibular lymphadenitis appear. One of the first symptoms is the appearance of hard lymph nodes under the lower jaw, they are painful upon palpation. At the same time, ear pain appears, the temperature rises, and sleep is disturbed. Redness of the skin appears above the areas of inflammation. Symptoms of submandibular lymphadenitis appear gradually. The first stage is characterized by mobile, clearly outlined, slightly inflamed lymph nodes. Mild pain occurs upon palpation. After two or three days, a significant increase in the size of the lymph nodes and swelling of the submandibular surface in the lower direction are noted. The mucous membrane of the oral cavity is inflamed and reddened. The body temperature rises to 38 ° C. Diagnosis of lymphadenitis at this stage of the disease and the beginning of the treatment process has a very favorable prognosis and almost complete cure. In the absence of quality treatment, the patient's body temperature rises to 41 ° C, pain increases, and the lymph nodes become burgundy. There is a great risk of suppuration of the lymph nodes. Due to frequent inflammation of the upper respiratory tract, submandibular lymphadenitis most often occurs in children.

Symptoms of chronic cervical lymphadenitis at the first stage of the disease are characterized by swelling of the lymph nodes, headaches, general malaise, fever, loss of appetite. The nature of the disease determines the size of the suppuration, which ranges from one to several fused nodules. An acute lymph node is very similar in appearance to a furuncle.

Symptoms of chronic lymphadenitis in the groin area are accompanied by enlargement and compaction of the lymph nodes. There is a high temperature, pain when moving, arising in the lower abdomen and combined with general malaise. There are cases when the disease affects almost all lymph nodes and has symptoms of purulent lymphadenitis. In such cases, an abscess may develop, requiring immediate surgical intervention.

The symptoms of chronic axillary lymphadenitis are very similar to the general symptoms of the disease. The lymph nodes become inflamed, the patient's body temperature rises. In the purulent form of lymphadenitis, intoxication is observed, while the lymph nodes and the surrounding connective tissues merge into one conglomerate. Strong pain is felt upon palpation, and a significant increase in temperature is noted.

Chronic nonspecific lymphadenitis

In case of sluggish or recurrent inflammatory diseases, such as chronic tonsillitis, inflammatory diseases of the teeth, and also as a result of weakly virulent microflora, chronic nonspecific lymphadenitis is possible. Chronic nonspecific lymphadenitis can also be a consequence of acute lymphadenitis, when inflammation in the lymph nodes does not stop, but takes the form of a chronic disease. The transition of chronic inflammation of the lymph nodes to the purulent phase of the disease occurs quite rarely and such inflammations are productive. Latent infection during exacerbations provokes purulent melting of the lymph nodes. The manifestation of symptoms of chronic nonspecific lymphadenitis is characterized by an increase in the lymph nodes. When palpated, they are dense to the touch and slightly painful, there are no adhesions between them or surrounding tissues. As the connective tissues in the lymph nodes grow, their size decreases. There are cases when pronounced proliferation of connective tissues and shrinkage of lymph nodes provoke lymphostasis, edema, lymphatic disorders and even elephantiasis. It is necessary to differentiate chronic non-specific lymphadenitis and enlargement of lymph nodes in other diseases, such as syphilis, lymphogranulomatosis, diphtheria, influenza, tuberculosis, malignant tumors. It is advisable to diagnose chronic non-specific lymphadenitis based on an objective assessment of all clinical signs of the disease. In cases where doubts arise, it is possible to perform a puncture biopsy of the lymph nodes or a histological examination of a completely removed lymph node. This is very important in the differential diagnosis of chronic lymphadenitis and malignant tumors and their metastases.

In most cases, chronic nonspecific lymphadenitis has a favorable prognosis. As a rule, the outcome of the disease is manifested by scarring. Connective tissue replaces lymphoid tissue, the lymph node decreases in size, becomes dense to the touch.

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Chronic lymphadenitis of the neck

Chronic lymphadenitis of the neck is one of the most common diseases of this area of the human body. This circumstance is explained by the multitude of lymph nodes and the immediate proximity of the cervical region to the oral cavity and the beginning of the upper respiratory tract, which are the site of frequent penetration of exogenous infections. In general, the human body has about eight hundred lymph nodes, and more than three hundred of them are located in the neck. Therefore, chronic lymphadenitis of the neck is the most common disease, both among children and adults.

The inflammatory process penetrates into the lymph nodes of the upper cervical region. According to the nature of pathological changes in the lymph nodes, there are serous-productive, ichorous-purulent and productive lymphadenitis.

A secondary pathology, usually caused by pyogenic microflora, such as staphylococci, streptococci, is chronic lymphadenitis of the neck. With chronic lymphadenitis of the neck, both specific and non-specific, multiple lesions of the lymph nodes occur. In some cases, bilateral lesions of the lymph nodes are possible. Such lesions are complications of infectious diseases of the oral cavity or upper respiratory tract, nasopharynx.

A sluggish process, during which productive components predominate, leads to an increase in lymph nodes over a long period of time. In this case, the lymph nodes are enlarged in size and slightly painful upon palpation. Abundant development of fibrous tissue makes complete reduction of the lymph node impossible, the process of resorption of the lymph node is very slow.

Chronic lymphadenitis of the neck is usually treated conservatively. But first of all, it is necessary to sanitize the primary inflammatory focus. Then physiotherapeutic methods of treatment are used, antibiotics are prescribed. Large lymph nodes that do not respond to conservative treatment are subject to surgical removal. It should be noted that X-ray therapy for chronic lymphadenitis of the neck is strictly contraindicated, due to the risk of developing a thyroid tumor.

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Chronic submandibular lymphadenitis

One of the varieties and the most common form of inflammation of the lymph nodes is chronic submandibular lymphadenitis. The occurrence of chronic submandibular lymphadenitis is caused by all sorts of inflammatory processes in the oral cavity. This can be caries, chronic tonsillitis, and numerous diseases of the soft tissues of the gums. Chronic submandibular lymphadenitis can be a sign of problems with teeth or gums.

Symptoms of chronic submandibular lymphadenitis are determined by the presence of painful lymph nodes, tight to the touch, located under the lower part of the jaw. These pains are given to the auricle, the skin of the inflamed areas is red, the patient's body temperature increases. Sleep disturbances are noted. The disease has a gradual nature of its development, the main symptoms appear one after another. Initially, during inflammation, the lymph nodes are barely palpable, slight pain is felt during palpation. At this stage of the disease, the lymph nodes are quite mobile, have clear boundaries. Later, the lymph nodes increase in size, painful sensations arise, preventing the jaw from moving. After two or three days, the lymph nodes become very large, the skin around them becomes burgundy and looks as if stretched. The mucous membrane of the oral cavity is inflamed, attempts to move the jaw provoke increasing pain. An increase in body temperature can reach 38 ° C. There is a lack of appetite, an indifferent attitude to everything that happens around, a feeling of chronic fatigue, and sleep disturbances. At this stage of the disease, it is very important to determine the source of infection, this will allow the disease to be cured. But, unfortunately, very often patients practice self-medication, which does not give a positive result. They turn to specialists when the lymph nodes become bloody red, the pain is of a shooting nature, and the body temperature reaches 40 ° C. Such cases are very dangerous, due to the fact that pus accumulates in the lymph nodes. Self-medication in cases of chronic submandibular lymphadenitis is unacceptable!

There are some difficulties in diagnosing chronic submandibular lymphadenitis, due to its similarity to inflammation of the salivary glands, submandibular bed or paramandibular infiltrate. There are difficulties in determining the localization of the inflammatory process.

The course of treatment for chronic inflammation of the submandibular lymph nodes initially begins with the elimination of the primary infectious focus. In this case, strict adherence to strict hygiene measures is necessary.

Purulent form of inflammation of submandibular lymph nodes is treated with antibiotics. Significant purulent inflammation of lymph nodes is removed by surgical intervention.

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Chronic cervical lymphadenitis

Chronic cervical lymphadenitis or, in simple terms, cervical lymphadenitis is an inflammation of the lymph nodes in the neck area that lasts for a long time. This disease is typical for people with a weakened immune system. Chronic cervical lymphadenitis manifests itself in manifestations of colds and flu. Chronic cervical lymphadenitis usually develops in children and is not a dangerous disease. Inflammation of the lymph nodes in an adult occurs in a somewhat complicated form. The human lymphatic system immediately reacts to all sorts of viruses and infections that enter the body. An increase in the size of the lymph nodes and their compaction, first of all, is a signal indicating an inflammatory process in the body.

In exceptional cases, enlarged lymph nodes transform into malignant tumors.

The main causes of chronic cervical lymphadenitis are considered to be all sorts of diseases of the upper respiratory tract, such as tonsillitis, pneumonia, flu, acute respiratory diseases. In some cases, chronic cervical lymphadenitis can be provoked by diseases of the oral cavity - periodontosis, gingivitis, caries. Provided that they are latent.

The penetration of all kinds of infections into the body is the main cause of inflammatory processes in the lymph nodes. The causative agents of these infections are usually staphylococci, streptococci and other pyogenic bacteria.

Chronic cervical lymphadenitis regularly manifests itself even with minor symptoms of colds or flu. People with weakened immune systems have significant risks of developing chronic cervical lymphadenitis.

Characteristic symptoms of chronic cervical lymphadenitis are easy enough to detect on your own. First of all, the presence of small seals on the neck, which are painful to palpate. The general condition of the patient is characterized as tired, there is a feeling of malaise, the body temperature rises. In small children, intoxication of the body is observed. The size of the enlarged lymph nodes varies depending on the stage of the disease. In the absence of qualified treatment, the chronic form of lymphadenitis can become acute. If the patient's body temperature rises above 38 ° C, the lymph nodes become very painful, urgent hospitalization is necessary. Do not allow such situations, timely qualified treatment contributes to a speedy recovery.

The course of treatment for chronic cervical lymphadenitis begins with establishing the underlying cause of the inflammatory process. Warming up the lymph nodes is contraindicated in inflammatory processes! Prescription of anti-inflammatory drugs is practiced in cases where the body cannot cope with the infection on its own. After the course of treatment, the lymph nodes gradually restore their functions and original appearance.

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Diagnosis of chronic lymphadenitis

Diagnosis of chronic lymphadenitis is based on clinical data and anamnestic indications. Superficial lymphadenitis is not difficult to determine, unlike the diagnosis of lymphadenitis complicated by periadenitis or adenophlegmon. Diagnosis of chronic lymphadenitis is preceded by precise determination of the localization of the primary purulent-inflammatory focus.

When diagnosing chronic non-specific lymphadenitis, it is necessary to differentiate the enlargement of the lymph nodes in infectious diseases, such as influenza, syphilis, diphtheria, scarlet fever.

In general, the diagnosis of chronic lymphadenitis is based on all clinical indications of the disease. Doubtful cases of differential diagnosis suggest performing a puncture biopsy of the lymph nodes or removing the lymph nodes for histological examination. The results of a puncture of the affected lymph node, as a rule, allow making reasonable conclusions about the state of the lymphatic system as a whole. The formation of calcifications in the lymph nodes can be detected by fluoroscopy.

This is of great importance in diagnosing chronic lymphadenitis for the presence of malignant tumors.

A comprehensive examination of the patient allows establishing the correct diagnosis. First of all, specialists study the results of the body's reaction to tuberculin, possible damage to the lungs and other organs of the upper respiratory tract. A detailed study of the patient's medical history can contribute to the correct diagnosis of chronic lymphadenitis.

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Treatment of chronic lymphadenitis

Treatment of chronic lymphadenitis should be started with the elimination of the underlying cause of infectious inflammation of the lymph nodes. If chronic lymphadenitis has signs of stomatogenic or unilateral origin, the specialist performs an intervention aimed directly at eliminating the foci of infectious inflammation. At the same time, the inflammatory process in the lymph nodes is eliminated. Broad-spectrum antibiotics are usually used, as well as general tonics, antihistamines and desensitizing medications. In order to actively counteract inflammatory processes, it is necessary to take medications already at the first stages of the disease. The most effective drugs in such cases are flemoxin, ceftriaxone, amoxicillin, ceftazidime, ampicillin.

Flemoxin is taken internally regardless of food intake; for adults and children over 10 years of age, the dosage is 500 mg three times a day, for children from 3 to 10 years of age – 250 mg three times a day, for children under 3 years of age – 125 mg three times a day.

Ceftriaxone is administered intramuscularly and intravenously. The daily dosage of the drug for adults and children over 12 years of age is 1.0-2.0 grams per day or 0.5-1.0 grams every 12 hours. If necessary, in cases of infection with moderately sensitive pathogens, the daily dosage can be increased to 4.0 grams. The daily dose for newborns is 20-50 mg, while it is not recommended to exceed a dose of 50 mg, due to the underdeveloped enzyme system. For children under 12 years of age, the recommended dose is 20-75 mg per day.

Amoxicillin is taken internally, the dosage of the drug is individual depending on the severity of the infectious inflammation. The recommended daily dosage for adults and children over 10 years of age is 500 mg three times a day. In complicated cases, the maximum dosage can be increased to 3000 mg per day. For children under 2 years of age, the recommended dosage is 20 mg three times a day, from 2 to 5 years, the daily dosage is 125 mg three times a day, from 5 to 10 years, the daily dosage is recommended in the amount of 250 mg three times a day.

Ceftazidime is administered intramuscularly and intravenously. The dosage of ceftazidime for newborns and infants up to 2 months is 25-50 mg twice a day. For children from 2 months to 12 years old, the drug is recommended at a dosage of 50-100 mg three times a day. In case of weakened immunity or severe infectious inflammation, the dosage may be increased to 150 mg three times a day. For adults and children over 12 years old, the recommended dosage is 1.0 gram every 8 hours or 2.0 grams every 12 hours.

Ampicillin is taken orally approximately one hour before meals. The daily dosage of the drug is prescribed individually and depends on the degree of infectious inflammation. Adults and children over 10 years old - 250-500 mg every 6 hours. In this case, the daily dose can be increased to 6 mg. For children, the daily dosage is 100 mg in 6 doses. The duration of the course of treatment is from a week to two weeks and depends on the localization of the infection and the degree of its development.

Treatment of chronic lymphadenitis requires the mandatory inclusion of a course of physiotherapy procedures. Some cases of chronic lymphadenitis require surgical intervention, which involves abscessing of the inflamed lymph node. Treatment of early stages of chronic lymphadenitis is possible by physiotherapy procedures, such as electrophoresis, compresses with dimexide. One of the new methods of physiotherapy procedures is laser irradiation of neon gels. Treatment of chronic lymphadenitis should be combined with an increase in the immune response of the body as a whole. For this, drugs such as methyluracil, pentoxyl, pantocrine, eleutherococcus are used.

Methyluracil is taken internally after meals or during meals. The dosage for adults is 0.5 grams four times a day. In some cases, if necessary, the number of doses can be increased to six times. The dosage for children under 8 years old is 0.25 grams per day, for children over 8 years old - 0.25-0.5 grams per day. The course of treatment lasts about forty days.

Pentaxil and pantocrine are taken internally, exclusively after meals. The dosage for adults is 0.2-0.4 grams no more than four times a day, the dosage for children is 0.2 grams per day.

Eleutherococcus is a biologically active supplement, the dosage is one to two capsules twice a day - morning and evening.

The course of electrotherapeutic treatment of inflammation of the lymph nodes has shown its effectiveness in the treatment of chronic lymphadenitis. The use of phonophoresis, irradiation with infrared rays, paraffin therapy, electrophoresis definitely contribute to the effectiveness of the course of treatment.

Prevention of chronic lymphadenitis

Effective prevention of chronic lymphadenitis involves, first of all, preventing various types of trauma, wounds, microtraumas, various cuts, both domestic and industrial. If such a situation does occur, it is necessary to thoroughly treat such violations of the integrity of the skin with disinfectants. The modern range of disinfectants is quite wide. A very important preventive measure is the treatment of abrasions and other skin damage in order to prevent possible infection. Daily observance of basic personal hygiene rules is also an important element in the prevention of chronic lymphadenitis. Of particular importance for the prevention of chronic lymphadenitis is the timely treatment of inflammatory processes and purulent pathological formations in the human body. Timely and correct diagnosis of infectious diseases that provoke specific forms of chronic lymphadenitis is also one of the effective preventive measures for this disease.

Prognosis of chronic lymphadenitis

Timely and qualified treatment in most cases guarantees a favorable prognosis for chronic lymphadenitis, with the exception of particularly severe cases of the disease. The absence of the necessary therapy or untimely initiation of the course of treatment contributes to the spread and generalization of pathological and inflammatory processes in the body, disruption of lymphatic drainage and lymphedema. Subsequently, the lymph nodes become scarred due to the process of replacement of lymphoid tissue. In cases of development of destructive forms of chronic lymphadenitis, the death of lymph nodes and their subsequent replacement with scar tissue are noted.

Localization of chronic lymphadenitis on the extremities, in some cases, leads to disturbances in lymph drainage and the development of lymphostasis. All this can provoke the further development of elephantiasis. It is worth recalling the importance of timely seeking medical help from qualified specialists. Self-treatment of chronic lymphadenitis is strictly contraindicated and can lead to disastrous consequences.