Chronic lymphadenitis

Chronic lymphadenitis is characterized by infectious inflammation for a long time, localized in the lymph nodes. The immune system of a person and lymph nodes, as an integral part of it, by its functions prevent penetration into the body and eliminate all kinds of infections and inflammations. The main function of lymph nodes is the filtration of all kinds of harmful microorganisms, viruses and bacteria, with further elimination of them from the body.

The anatomical location of the lymph nodes is due to their location in the neck, in the armpit and groin. A feature of lymphatic lymphadenitis consists in its isolated inflammatory processes. So, the inflammation can affect one lymph node, several lymph nodes within one region, or numerous lymph nodes in several foci of inflammation.

Chronic lymphadenitis has two forms of chronic inflammation of the lymph nodes - specific and nonspecific. Specific chronic lymphadenitis has a clear relationship between the chronic form and the specific infectious agent. In this case, it does not matter to which group of infectious pathogens it belongs - bacterial, for example, syphilis, tuberculosis or fungal group.

Infectious pathogens of the bacterial group are known to belong to the specific form of chronic lymphadenitis and at the same time have no chronic signs, because, as a rule, they lead to the death of the disease due to untimely treatment. These dangerous diseases include anthrax or plague. All other infectious inflammations are related to the nonspecific chronic form of chronic lymphadenitis. This includes mixed infections and infections with opportunistic microflora. Such infections provoke sluggish diseases of teeth and palatine tonsils, for example, periodontitis and tonsillitis. These diseases occur against the background of the weakening of immunity or avitaminosis, various microtraumas of the skin. Penetration of the infection occurs through the damaged skin, provoking the occurrence of an inflammatory process, which then enters the lymph node through the lymphatic 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 diagnosis of the disease conditionally divide chronic lymphadenitis into specific and non-specific forms. The non-specific form of chronic lymphadenitis is characterized by common signs of the inflammatory process. For example, lymph node consolidation, minor pain in palpation, absence of adhesions between surrounding tissues and individual nodes. If the palpation lymph nodes freely move in different directions relative to their main location. With the nonspecific form of chronic lymphadenitis, purulent processes are absent, as well as a significant decrease in the size of the lymph node. This process is explained by the tightening of the connective tissue and lymph node.

The specific form of chronic lymphadenitis is accompanied by suppuration of the lymph nodes, painful sensations during their palpation, tight adhesions with the surrounding connective tissue. The general state of the body also has a characteristic change. There is increased sweating, especially at night, increased body temperature, possibly weight loss.

Chronic lymphadenitis is provoked by bacteria and viruses of a pyogenic nature. Adhering to lymphatic vessels with a current of lymph or blood, from the foci of suppurative inflammation or through direct penetration through microtraumas of the skin. Chronic lymphadenitis can be purulent and nasty. 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.

[1], [2]

Causes of Chronic Lymphadenitis

The causes of chronic lymphadenitis have some features, 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. Conditional-virulent infection can provoke the transformation of acute into a chronic form of the disease. Possible, the transition to the chronic form of the process in view of violations of functions, located a number of organs. Lymph nodes have an anatomical function of filtering all kinds of infections and viruses from the blood and lymph, so they take on the whole danger of inflammatory processes. The result of this is their swelling and increase in size when spreading all kinds of inflammatory processes.

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

There are several varieties of chronic lymphadenitis, each of which has its own characteristics. Let us consider them in more detail. Various inflammatory processes in the oral cavity, for example, caries, periodontal disease, tonsillitis, can provoke the development of submandibular lymphadenitis.

Infectious diseases such as purulent sore throat, pneumonia, influenza, under certain conditions, can cause the onset of cervical lymphadenitis.

The occurrence of inguinal lymphadenitis occurs against the background of the development of the main venereal disease and is accompanied by an infectious inflammation of the lymph nodes in the inguinal region. It is extremely rare to have primary inflammation of the lymph nodes in the groin area. In children, lymphadenitis of the inguinal region is practically not found, in view of infrequent disease of venereal diseases. If all the same there is such inflammation, then, most likely it is associated with a violation of outflow of lymph or problems of the immune system of the child. Any infected trauma 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 area of the face and neck.

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

[3], [4], [5]

Symptoms of chronic lymphadenitis

Symptoms of chronic lymphadenitis differ depending on the localization of lymph nodes and, accordingly, inflammatory processes. As the disease develops, symptoms of submaxillary chronic lymphadenitis appear. One of the first symptoms is the appearance under the lower jaw of solid lymph nodes, with palpation they are painful. Simultaneously, there is pain in the ears, the temperature rises, sleep is disturbed. Over the areas of inflammation there is reddening of the skin. Symptoms of submandibular lymphadenitis appear gradually. The first stage is characterized by moving, having clear outlines, slightly inflamed with lymph nodes. When palpation, light pain occurs. After two or three days, there was a significant increase in the size of the lymph nodes and a swelling of the submaxillary surface along the inferior direction. The mucous membrane of the oral cavity is inflamed and has redness. 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 ° С, painful sensations increase, lymph nodes become burgundy. There is a great danger of suppuration of the lymph nodes. In view of frequent inflammation of the upper respiratory tract, submandibular lymphadenitis often occurs in children.

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

Symptoms of chronic lymphadenitis in the inguinal region are accompanied by an increase and thickening of the lymph nodes. There is a high fever, pain when moving, appearing in the lower abdomen and combined with a general malaise. There are cases when the disease affects almost all the lymph nodes and has symptoms of purulent lymphadenitis. In such cases, it is possible to develop an abscess that requires immediate surgical intervention.

Symptoms of chronic lymphadenitis of the armpit are very similar with the common symptoms of the disease. Lymph nodes are inflamed, the temperature of the patient's body rises. With a purulent form of lymphadenitis, intoxication is observed, with the lymph nodes and surrounding connective tissues merging into one conglomerate. At a palpation strong painful sensations are felt, the significant temperature increase is marked.

Chronic nonspecific lymphadenitis

With slow or recurrent inflammatory diseases, for example, chronic tonsillitis, inflammatory diseases of the teeth, as well as a weakly virulent microflora, chronic non-specific lymphadenitis is possible. Similarly, chronic nonspecific lymphadenitis can 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 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 lymph nodes. When palpation they are dense to the touch and painless, no adhesions between them or surrounding tissues. As the proliferation of connective tissues in the lymph nodes, their size decreases. There are cases when a pronounced proliferation of connective tissue and wrinkling of the lymph nodes provokes lymphostasis, edema, lymph circulation disorder and even elephantiasis. It is necessary to differentiate chronic nonspecific lymphadenitis and enlargement of lymph nodes in other diseases such as syphilis, lymphogranulomatosis, diphtheria, influenza, tuberculosis, malignant formations. It is advisable to carry out diagnostics of chronic nonspecific lymphadenitis based on an objective evaluation of all clinical signs of the disease. In case of doubt, it is possible to conduct puncture biopsy of the lymph nodes or histological examination of the completely removed lymph node. This is very important in conducting 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. The connective tissue replaces the lymphoid tissue, the lymph node shrinks in size, becomes dense to the touch.

[6], [7], [8], [9]

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 a number 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 just on the neck. Therefore chronic neck lymphadenitis is the most frequent disease, both among children and adults.

Inflammatory process penetrates into the lymph nodes of the upper cervical region. By the nature of pathological changes in the lymph nodes there are serous-productive, ichorozno-purulent and productive lymphadenitis.

Secondary pathology, usually caused by pyogenic microflora, for example, staphylococci, streptococci - is chronic lymphadenitis of the neck. With chronic lymphadenitis of the neck, both specific and non-specific, multiple lymph node involvement occurs. In some cases, bilateral lymph node involvement is possible. Such lesions are complications of infectious diseases of the oral cavity or upper respiratory tract, nasopharynx.

Sluggish process, during which the predominant productive components lead to an increase in lymph nodes for a long time. At the same time, the lymph nodes are enlarged in size and not very painful for palpation. The abundant development of fibrous tissue makes it impossible to completely reduce the lymph node, the process of resorption of the lymph node passes very slowly.

Chronic lymphadenitis of the neck, as a rule, undergoes conservative treatment. But first of all, the sanation of the primary inflammatory focus is necessary. Then apply physiotherapeutic methods of treatment, the appointment of antibiotics. Large lymph nodes that are not amenable to conservative treatment, are subject to surgical removal. It should be noted that X-ray therapy for chronic lymphadenitis of the neck is categorically contraindicated, in view of the danger of a tumor of the thyroid gland.

[10], [11]

Chronic submandibular lymphadenitis

One of the varieties and the most common form of inflammation of the lymph nodes is chronic submandibular lymphadenitis. The emergence of chronic submandibular lymphadenitis is caused by all possible inflammatory processes in the oral cavity. It can be a defeat of caries, chronic tonsillitis, and numerous diseases of soft gum tissues. 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 that are tight to the touch, located under the lower part of the jaw. These pains are given to the area of the auricle, the skin of the inflamed areas has reddening, the temperature of the patient's body increases. There is a violation of sleep. The disease has a gradual nature of its development, the main signs are manifested in turn. Initially, with inflammation, the lymph nodes can hardly be palpated, with palpation, there is a slight pain. At this stage of the disease, the lymph nodes are sufficiently mobile, have clear boundaries. Later, the lymph nodes increase in size, painful sensations arise that do not allow the jaw to move. 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 aggravating pain. The rise in body temperature can reach 38 ° C. There is a lack of appetite, an indifferent attitude to everything that happens around, there is a feeling of chronic fatigue, sleep is broken. At this stage of the disease it is very important to determine the focus of the infection, this will help to cure the disease. But, unfortunately, very often patients practice self-treatment, which does not give a positive result. Refer to specialists already when the lymph nodes become blood red, the pain has a shooting character, the body temperature reaches 40 ° C. Such cases are very dangerous, since 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, in view of its similarity with inflammation of the salivary glands, submandibular bed, or near the jawed infiltrate. There are difficulties in determining the localization of the inflammatory process.

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

The purulent form of inflammation of the submaxillary lymph nodes is treated with the use of antibiotics. Significant purulent inflammation of the lymph nodes is removed by surgery.

[12], [13], [14],

Chronic cervical lymphadenitis

Chronic cervical lymphadenitis or, in simple terms, cervical lymphadenitis is an inflammation of the lymph nodes in the neck that continues for a long time. This disease is typical for people with a weakened immune system. Chronic cervical lymphadenitis is manifested in manifestations of colds and flu. Chronic cervical lymphadenitis develops, as a rule, in children and is not a dangerous disease. Inflammation of the adult's lymph nodes occurs in a somewhat complicated form. The human lymphatic system immediately reacts to all kinds of viruses and infections that enter the body. The increase in the size of lymph nodes and their densification, above all, is a signal that indicates an inflammatory process in the body.

In exceptional cases, enlarged lymph nodes are converted into malignant formations.

The main causes of chronic cervical lymphadenitis are all kinds of diseases of the upper respiratory tract, for example, angina, pneumonia, influenza, acute respiratory diseases. In some cases, chronic cervical lymphadenitis can provoke diseases of the oral cavity - periodontal disease, gingivitis, caries. Provided that they are latent.

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

Chronic cervical lymphadenitis appears regularly even with minor symptoms of colds or flu. People with a weakened immune system have significant risks of chronic cervical lymphadenitis.

Characteristic symptoms of chronic cervical lymphadenitis are fairly easy to detect independently. First of all, the presence of small seals on the neck, with palpation of which, there is pain. The general condition of the patient is characterized as tired, the malaise is felt, the body temperature rises. In young children there is an intoxication of the body. The size of enlarged lymph nodes varies depending on the stage of the disease. If there is no 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 needed. Do not allow such situations, timely qualified treatment contributes to a speedy recovery.

The course of treatment of chronic cervical lymphadenitis begins with the establishment of the main cause of the inflammatory process. Contraindicated heating lymph nodes in inflammatory processes! The administration of anti-inflammatory drugs is practiced in cases where the body does not cope with the infection on its own. After the course of treatment, the lymph nodes gradually restore their original appearance.

[15], [16]

Diagnosis of chronic lymphadenitis

Diagnosis of chronic lymphadenitis is based on the clinical picture and anamnestic indications. Superficial lymphadenitis is not difficult to determine, unlike the diagnosis of lymphadenitis complicated by periadenitis or adenophlegmone. Diagnosis of chronic lymphadenitis is preceded by an accurate definition of the localization of the primary purulent-inflammatory focus.

When diagnosing chronic nonspecific lymphadenitis, it is necessary to differentiate the enlargement of lymph nodes in infectious diseases, for example, influenza, syphilis, diphtheria, scarlet fever.

In general, the diagnosis of chronic lymphadenitis is based on data from all clinical indications of the disease. Doubtful cases of differential diagnosis suggest carrying out puncture biopsy of lymph nodes or removal of lymph nodes, for the purpose of carrying out a histological examination. The results of puncture of the affected lymph node, as a rule, allow us to make well-founded conclusions about the state of the lymphatic system as a whole. The formation of calcification in the lymph nodes can be detected by fluoroscopy.

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

Complex examination of the patient allows you to establish 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.

[17], [18]

Treatment of chronic lymphadenitis

Treatment of chronic lymphadenitis is advisable to begin with the elimination of the underlying cause of infectious inflammation of the lymph nodes. If chronic lymphadenitis has evidence of dental or monotonous occurrence, a specialist directs directly to eliminate foci of infectious inflammation. Simultaneously, the inflammatory process in the lymph nodes is eliminated. Usually the use of antibiotics of a wide range of effects is practiced, as well as the use of restorative, antihistamines and desensitizing medications. In order to actively combat inflammatory processes, it is necessary to take medications already at the first stages of the disease development. The most effective in such cases are drugs such as flemoxin, ceftriaxone, amoxicillin, ceftazidime, ampicillin.

The intake of flemoxin is carried out internally regardless of food intake, adults and children over 10 years of age the dosage is 500 mg three times a day, children from 3 to 10 years - 250 mg three times a day, children up to 3 years - 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 in 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, with a dose of 50 mg is not recommended to exceed, due to undeveloped enzyme system. Children under 12 years of age are recommended a dose of 20 to 75 mg per day.

Amoxicillin is administered internally, the dosage of the drug is individual for the severity of infectious inflammation. The recommended daily dosage for adults and children over 10 years is 500 mg three times a day. In complicated cases, the maximum dosage can be increased to 3000 mg per day. Children up to 2 years are recommended dosage - 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 an 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, the drug is recommended in a dosage of 50-100 mg three times a day. With weakened immunity or severe infectious inflammation, dosage can be increased to 150 mg three times a day. Adults and children over 12 years of age are recommended to take a dosage of 1.0 gram in 8 hours or 2.0 grams every 12 hours.

Ampicillin is taken internally about an hour before a meal. The daily dosage of the drug is administered individually and depends on the degree of infectious inflammation. Adults and children over 10 years of age - 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 one week to two weeks and depends on the location of the infection and the degree of its development.

Treatment of chronic lymphadenitis involves the mandatory inclusion of a course of physiotherapy procedures. Some cases of chronic lymphadenitis require surgical intervention, which involves abscessing the inflamed lymph node. Treatment of early stages of chronic lymphadenitis is possible by carrying out physiotherapeutic procedures, for example, electrophoresis, compresses with dimexide. One of the new methods of physiotherapeutic procedures is irradiation with a laser beam of gels of neon action. Treatment of chronic lymphadenitis should be combined with an increase in the immunological response of the body as a whole. To do this, use drugs like methyluracil, pentoxyl, pantocrine, eleutherococcus.

Methyluracil is taken internally after a meal or while eating. Dosage for adults is - 0.5 grams four times a day. In some cases, if necessary, you can increase the number of receptions up to six times. Dosage for children under 8 years is 0.25 grams per day, for children older than 8 years - 0.25-0.5 grams per day. The course of treatment lasts for about forty days.

Pentaxyl and pantocrine are taken internally, solely after meals. Dosage for adults is 0.2-0.4 grams no more than four times a day, the child's dosage is 0.2 grams per day.

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

The course of electrotherapeutic treatment of inflammation of the lymph nodes showed its effectiveness in the treatment of chronic lymphadenitis. Application of phonophoresis, irradiation with infrared rays, paraffinotherapy, electrophoresis uniquely contribute to the effectiveness of the course of treatment.

Prophylaxis of chronic lymphadenitis

Effective prevention of chronic lymphadenitis involves, first of all, the prevention of various types of injuries, injuries, microtraumas, various cuts in both domestic and industrial cuts. If such a situation does occur, it is necessary to carefully treat such violations of the integrity of the skin with disinfectants. A modern range of disinfectants - is presented quite widely. A very important preventive measure is the treatment of abrasions and other skin lesions, in order to prevent possible infection. Daily observance of elementary rules of personal hygiene 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. Conducting timely and correct diagnosis of infectious diseases that provoke specific forms of chronic lymphadenitis is also one of the effective preventive measures of this disease.

Prognosis of chronic lymphadenitis

Timely and qualified treatment in most cases guarantees a favorable prognosis of chronic lymphadenitis, with exception of especially severe cases of the disease. Lack of necessary therapy or untimely initiation of treatment, promotes the spread and generalization of pathological and inflammatory processes in the body, disorders of lymphatic drainage and lymphedema. In the future, lymph nodes are scarred, due to the replacement process of lymphoid tissue. In cases of the development of destructive forms of chronic lymphadenitis, dying of the lymph nodes and their further replacement with scar tissues are noted.

The localization of chronic lymphadenitis on the limbs, in some cases, leads to disorders of the lymph drainage and the appearance of lymphostasis. All this can provoke the further development of elephantiasis. It is not superfluous to recall the importance of timely seeking medical help from qualified specialists. Self-treatment of chronic lymphadenitis is categorically contraindicated and can lead to disastrous consequences.