Lymphadenitis

The inflammatory process in the lymph nodes, often purulent in nature, is called lymphadenitis. A common disease among children and adult patients, it is most often detected in the axillary, submandibular, inguinal area or in the neck area.

Based on the severity of the course, lymphadenitis is divided into the following subtypes:

• with the formation of pus and non-purulent;
• acute and chronic type;
• single and multiple foci (according to the number of affected lymph nodes);
• specific and non-specific form.

The non-specific form of the disease is caused by streptococci, staphylococci, and other pyogenic microflora. The clinical picture is aggravated by the release of toxins and decay products from the primary lesion. Pathogens may be microorganisms from furuncles, carbuncles, upper respiratory tract infections (tonsillitis, pharyngitis, bronchitis, etc.), bacteria in erysipelas or trophic ulcers.

Specific pathology is caused by "cat scratch disease", tuberculosis, syphilis, etc. In this case, lymphadenitis is provoked by specific infectious agents: Candida fungi, Koch's bacillus, actinomycetes, etc.

Lymphadenitis: ICD-10 code

The International Classification of Diseases, Tenth Revision, includes Class XII – “Infections of the Skin and Subcutaneous Tissue” with a rubricator in which acute lymphadenitis corresponds to the code L04. If there is a need to indicate the causative agent of the infection, additional identification with the code B95-B97 is used.

In turn, acute lymphadenitis ICD is subdivided into:

• L04.0 – pathological foci are located in the area of the face, neck, head;
• L04.1 – the lymph nodes of the body are inflamed;
• L04.2 – the disease is detected on the upper limbs (shoulders, armpits);
• L04.3 – detection of affected nodes (the pathology is acute) on the lower limbs (pelvic area);
• L04.8 – localization in other zones;
• L04.9 – acute lymphadenitis, unspecified type.

Non-specific form of lymphadenitis I88 is included in the section "Diseases of veins, lymphatic vessels and nodes", class IX:

• I88.0 – mesenteric lymphadenitis of non-specific type (acute/chronic);
• I88.1 – chronic course of the disease, excluding mesenteric;
• I88.8 – other nonspecific lymphadenitis;
• I88.9 – non-specific process of unspecified nature.

Causes of lymphadenitis

Lymphadenitis is a consequence of infection of the lymph node by pathogenic microorganisms, as a primary and independent disease it develops extremely rarely. The bacteria that provoke the pathology are: streptococcus, staphylococcus, pseudomonas, E. coli, pneumococcus. The lymph node increases in size as a result of the accumulation of cells in the inflammation zone. Microorganisms can also enter the lymph node through the lymphatic flow from the original lesion. For example, as a result of caries, purulent rash on the skin, furuncle, etc.

Often, the causes of lymphadenitis are hidden in diseases of internal organs. The presence of inflammatory processes in the intestines, infection in the ovaries, various liver diseases are dangerous due to the hematogenous spread of pathogenic particles (through the bloodstream), settling in the lymphatic system and causing inflammation of the lymph node.

The contact method of infection is the rarest, when microbes enter the lymph node directly, which is possible when the integrity of the skin is lost (for example, when the lymph node is injured).

Non-specific infection is the most common cause of compaction, growth and inflammatory reaction of the lymph nodes. Caused by opportunistic microorganisms, lymphadenitis is typical for: submandibular, cervical, elbow, inguinal, axillary, femoral, popliteal zones. Favorable conditions for the reproduction of pathogenic microorganisms will be injury, hypothermia, stress or disease, etc.

Lymph nodes are protective filters that prevent the penetration and proliferation of pathogenic microflora in the human body. When the level of infectious particles (elements of dead cells, microorganisms, tumor components, etc.) is excessively high, the lymphatic system may not cope and an inflammatory process develops. Lymphadenitis indicates a weakening of the immune system due to various factors - an elderly or, conversely, a young, weak organism, mental or physical fatigue, previous illnesses, etc.

One should not confuse the enlargement of lymph nodes and the inflammatory process in their tissues. The growth of the lymph node is due to the production of a larger number of lymphocytes, which produce antibodies to combat a potential threat, which in itself indicates the performance of the lymphatic system's protective function and does not relate to pathology.

[ 1 ], [ 2 ], [ 3 ]

How long does lymphadenitis last?

Having recalled the types and features of the course of lymphadenitis, we can answer the question: "How long does lymphadenitis last?" The acute process is characterized by a sudden onset with pronounced symptoms and a duration of up to two weeks. Chronic inflammation of the lymph nodes is a sluggish, latent pathology without obvious manifestations, which develops over a month.

It should be noted that non-purulent and purulent lymphadenitis can occur in both acute and chronic forms. Although the formation of suppuration is often due to a sharp deterioration in the general condition, characteristic of the acute course of the disease. The purulent process requires sanitation and cleaning of the affected tissues. When the lymph node melts after opening the abscess, the cavity is drained. The rate of healing of the wound surface also affects the duration of recovery.

As for specific lymphadenitis, the therapeutic effect is achieved in at least eight months. Depending on the severity of the primary inflammatory process, treatment can last up to one and a half years.

Symptoms of lymphadenitis

The symptoms of the disease largely depend on the type of lymphadenitis and help the specialist make the correct diagnosis, as well as choose the right treatment tactics. Common signs are: swelling, local reddening of the skin, fever, limited mobility of the limb, chills, and an increase in the number of leukocytes in the blood.

The following symptoms of lymphadenitis are distinguished:

• non-specific chronic inflammation is a sluggish, latent process that does not manifest itself for a long time. It is characterized by slight swelling of the skin adjacent to the affected lymph node and subfebrile temperature (37 ^o C);
• acute lymphadenitis - has pronounced symptoms, namely: sharp pain and enlargement of nodes, limiting motor ability. Often the condition is aggravated by aching or dull headache, general weakness, fever;
• the state of the purulent process is determined by a twitching, sharp pain syndrome. The patient feels pain during palpation. The skin is red. As the disease progresses, the affected lymph nodes grow together with each other and with adjacent tissues, forming immobile seals;
• serous pathology - dull pain syndrome is localized in the area of regional lymph nodes, which are enlarged and dense. The initial stage is characterized by the absence of signs of inflammation on the skin, only after destructive processes in the lymph node tissue and the accumulation of purulent contents, necrotic areas appear;
• adenophlegmon is a stage that purulent inflammation progresses to without proper therapy. The skin shows signs of hyperemia, swelling has blurred boundaries with foci of softening. Among the obvious signs of pathology are high temperature, rapid heartbeat, chills, severe weakness, headache.

It is important to remember that lymphadenitis is a secondary disease that can mask serious problems (plague, tumors, tuberculosis, etc.). Only a competent specialist can differentiate the pathological condition, so it is important to seek advice in a timely manner.

Cervical lymphadenitis

Enlargement of the cervical lymph nodes occurs as a result of infectious and inflammatory processes of the upper respiratory tract (tonsillitis, pharyngitis, purulent otitis, etc.). Cervical lymphadenitis occurs mainly in children, as a consequence of influenza, acute respiratory viral infections, pneumonia. In adulthood, it may indicate such serious diseases as tuberculosis or syphilis.

[ 4 ], [ 5 ]

Submandibular lymphadenitis

In clinical practice, the most common cases are inflammation of the submandibular lymph nodes. This pathology develops due to chronic tonsillitis, gum inflammation or advanced caries. Submandibular lymphadenitis is characterized by a gradual increase in symptoms. If the source of infection can be determined at the first signs of pathology, recovery occurs quickly.

Inguinal lymphadenitis

Inguinal lymphadenitis is an example of a secondary inflammatory process, when pathogenic microflora penetrates the lymph node with the blood or lymph flow. The inguinal nodes are divided into three groups. The first, the largest, receives lymph from the gluteal region and the lower part of the peritoneum. Lymph in the second or medial group comes from the external genitalia, the excretory opening and the perineum. The last group contains lymph from the lower extremities. The reaction of the nodes of the second group will indicate the presence of a genital tract infection.

Inguinal lymphadenitis in women

The growth of lymph nodes in the size of the inguinal zone is observed when microorganisms penetrate the lymphatic system. Common causative bacteria are: streptococci, diplococci and staphylococci, pseudomonas aeruginosa and Escherichia coli.

Inguinal lymphadenitis in women is formed as a result of cystic formations, infectious inflammations of the external/internal organs of the genital area, but can also indicate more serious diseases - syphilis, gonorrhea, etc. Inguinal lymphadenitis is detected as a primary focus much less often, which is possible when a lymph node is infected by injury.

In addition to enlargement and compaction of the inguinal nodes, the symptoms of lymphadenitis include:

• swelling, reddening of the skin over the inflamed lymph nodes;
• pain in the lower abdomen and groin area, which is observed during movement or physical effort;
• deterioration of general well-being;
• There may be an elevated temperature.

Pathology of the inguinal nodes can be acute and chronic. The acute process is divided into serous (without pus, conservative treatment is possible) and purulent forms. The appearance of purulent contents is easily suspected by a twitching, sharp pain. To avoid sepsis due to the spread of pus, they often resort to surgical intervention with excision of the lymph node.

Axillary lymphadenitis

The supraclavicular and subclavian lymph nodes collect lymph from the shoulders, neck, face, upper abdominal organs, and the anterior chest. Pain of varying intensity and enlarged lymph nodes under the arms indicate axillary lymphadenitis, the symptoms of which are more pronounced the more severe the disease. Pathogens of the pathology are: strepto-, staphylo-, enterococci and their toxins, E. coli, Proteus. Inflammation can occur due to injury to the skin and direct penetration of pathogenic microorganisms into the lymph node.

[ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ]

Acute lymphadenitis

The presence of an infection in the body, such as a boil, a purulent wound or a scratch, contributes to the entry of bacteria into the lymphatic system. The lymph brings pathogenic flora to the lymph nodes, which become inflamed. This is how acute lymphadenitis occurs, which manifests itself as sharp, increasing pain, increased temperature and deterioration of the general condition.

[ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ]

Subacute lymphadenitis

A very rare disease, subacute lymphadenitis, is clinically very similar to an acute inflammatory process in the lymph nodes. This pathology is differentiated by the primary immune response. The subacute variety is characterized by a more intense red coloration of the skin in the area of the infected lymph node, which has a dense consistency than in acute lymphadenitis. Visual examination is not enough to confirm the diagnosis, so cytological and histological examinations are used.

Cytology reveals macrophages with a large number of cellular particles and leukocytes, as well as follicular hyperplasia at the cellular level. The analysis reveals single mastocytes, basophilic cells and a huge number of lymphoblasts. Histology allows us to determine the sharp outline of lymphatic follicles, an increase in blood vessels filled with blood.

In the subacute form, a significant increase in body temperature is possible if pus is formed. In other cases, the temperature is close to subfebrile.

Chronic lymphadenitis

Chronic lymphadenitis is a consequence of an acute process or occurs as an independent disease, bypassing the acute stage. This difference is associated with the microorganisms that cause the disease.

Chronic lymphadenitis is accompanied by an increase in nodes (often painless) and preservation of their shape. The lymph node is not connected to nearby tissues, has a round or oval shape. There are cases when the affected tissues of the lymph node are replaced by granulation cells, which often grow beyond the node and thin the surrounding tissues. Over time, the skin breaks through, forming a fistula. Chronic inflammation can occur with the release of a small amount of pus, oozing out and drying in the form of a crust.

[ 18 ], [ 19 ], [ 20 ]

Generalized lymphadenitis

Simultaneous inflammation of several lymph nodes or their sequential damage is generalized lymphadenitis. A rather rare disease is a consequence of a primary infectious process, for example, generalized tuberculosis. Often the disease manifests itself and proceeds brightly with pronounced intoxication, and also progresses rapidly. In this case, all groups of lymph nodes are significantly enlarged, the inflammation rapidly covers nearby tissues, spreading to internal organs. The generalized form can acquire a chronic course, gradually depleting the body's defenses.

Generalized inflammation of the lymph nodes is possible with the following diseases:

• bacterial infections – tuberculosis, syphilis, sepsis, etc.;
• malignant/benign tumors – leukemia, lung cancer, sarcoidosis, etc.;
• autoimmune problems – dermatomyositis, rheumatoid arthritis, lupus, etc.;
• storage diseases - Niemann-Pick and Gaucher diseases;
• reactions to medications and chemical compounds – hay fever, allergic reactions to medications.

Hemorrhagic lymphadenitis

Hemorrhagic lymphadenitis is a special form of inflammation of the lymph nodes, in which dysfunction of capillary permeability leads to saturation of the lymph node with blood. This is observed in cases of anthrax or plague.

Anthrax inflammation is characterized by lymphangitis and regional lymphadenitis, but the enlargement of the lymph nodes is painless. The inflammatory process has a long course. Initially, the nodes located in close proximity to the carbuncle are affected, and then the distant ones. However, suppuration of the lymph nodes is extremely rare.

Granulomatous lymphadenitis

Granulomatous lymphadenitis is characterized by the presence of granulomas or the formation of groups of histiocytes. According to the course of the disease, it is divided into granulomas with epithelioid histiocytes and a purulent process.

Granulomatous inflammation develops as a result of the presence in the patient's body of mycobacteria (tuberculosis), spirochetes (syphilis), chlamydia (felinosis, Nicolas-Favre disease), pasteurella (adenitis, tularemia), micrococcus (brucellosis). Purulent granulomatous inflammations provoke chlamydia, cat scratch disease, diseases under the influence of microparasites (leishmania, turulla, toxoplasma, etc.).

The diagnosis is confirmed by bacteriological, immunohistochemical or serological methods, as well as specific skin tests and molecular methods (PCR).

The lesion most often affects regional lymph nodes, where pathogenic flora is collected from the entry gate of infection, but disseminated infection can develop. The degree of node enlargement, the intensity of pain depend on the course of the inflammatory disease, its characteristics and the clinical picture of the primary focus.

Specific lymphadenitis

Such serious diseases as tuberculosis, syphilis, HIV, plague and others cause infection of the lymphatic system, which is manifested by an increase in lymph nodes. Moreover, the underlying disease may still be at the stage of development, and the lymph nodes promptly "signal" about a hidden problem.

Specific lymphadenitis is classified into:

• viral;
• tuberculous;
• actinomycotic;
• fungal;
• syphilitic;
• vaccination, etc.

A specific form of inflammation of the lymph nodes is characterized by a wide range of clinical manifestations. The defeat of the cervical nodes often indicates tuberculous lymphadenitis, an increase in nodes in the inguinal zone indicates specific peritonitis. Supraclavicular nodes react if the primary infection is localized at the pulmonary apex. Pathology of regional lymph nodes is observed after vaccinations. The tumor is detected on one or both sides. "Children's pruritus" or scrofula also causes generalized growth of nodes.

Specific lymphadenitis is often chronic with characteristic periods of exacerbation. Symptoms of the disease vary depending on the type of infection. The pathogen is identified based on a blood test.

Tuberculous lymphadenitis

The penetration of the tuberculosis bacillus into the lymphatic system causes an increase in the nodes of the neck and submandibular area. Over time, the lymph nodes soften, the pathological process covers nearby cells, and when the lymph node capsule is opened, a gray purulent mass of crumbly consistency is found. Often, tuberculous lymphadenitis, developing against the background of primary or secondary tuberculosis, is the cause of symmetrical inflammation of the lymph nodes. The tuberculous form of inflammation rarely spreads to the inguinal lymph nodes.

When differentiating the disease, it is necessary to exclude fistulas on the neck, non-specific lymphadenitis, metastasis of malignant tumors, lymphosarcoma. Microscopic analysis of intracapsular pus helps to establish an accurate diagnosis.

Symptoms of lymph node inflammation largely depend on the progression of tuberculosis and the degree of tissue damage to the node. Palpation at the initial stage of the lesion does not reveal the pain that is characteristic of the caseous period of decomposition and fistula formation.

Caseous lymphadenitis

Caseous lymphadenitis is a form of tuberculous lymphadenitis characterized by caseous decay of lymph node tissue. In order to understand the aspects of the formation of this process, one should turn to the concept of primary tuberculosis, which develops when mycobacteria enter the lungs. Infection is possible both by airborne and alimentary means. Primary tuberculosis is most often detected in childhood and is divided into stages:

• the occurrence of a primary lesion in the lung;
• lymphangitis – the spread of infection to the efferent lymphatic vessels;
• lymphadenitis – damage to regional nodes.

In the inflammation zone, tissue necrosis is observed, serous edema gradually develops, leading to caseous pneumonia. The size of the primary tuberculous area depends on the affected area (alveolitis, lobe, acinus or segment). Specific inflammation quite quickly covers the lymphatic vessels adjacent to the primary focus. Lymphostasis forming at the root of the lung and characteristic edema with tubercles in the peribronchial and perivascular tissue make the root nodes accessible to infection. This is how the second stage begins - lymphangitis, which spreads to the regional lymph nodes, where caseous necrosis soon appears. The growth of the lymph nodes in size determines the total lesion and the onset of caseous lymphadenitis.

[ 21 ], [ 22 ]

Non-specific lymphadenitis

Staphylococcal and streptococcal infections are the cause of non-specific lymphadenitis. The primary source of inflammation is a festering scratch or wound, erysipelas, furuncles, skin ulcers, etc. Pathogenic microorganisms affect the lymph nodes, spreading with the flow of lymph, blood, or directly when the node is injured.

Non-specific lymphadenitis is classified according to the type of course into:

• acute - more often as a serous form. It is possible that one or a group of lymph nodes will enlarge, which are painful and elastic in consistency;
• chronic – appears as a primary disease (the result of chronic inflammatory processes: tonsillitis, dental problems, etc.) or is a consequence of acute inflammation of the lymph nodes.

Acute course is characterized by the absence of symptoms or minor changes in the general condition of the patient. The severity of inflammatory signs of the lymph nodes largely depends on the primary focus. The development of the disease from the serous form to the purulent stage causes an increase in temperature, weakness, and malaise. The next signs of inflammation progression will be pain syndrome and immobility of the lymph node.

The chronic type of non-specific process is not characterized by the formation of pus. The lymph nodes remain enlarged for a long time, practically painless and not fused with the surrounding tissues. Sometimes the spread of connective tissue in the lymph node is fraught with problems of lymph circulation, edema, lymphostasis, elephantiasis.

Reactive lymphadenitis

Reactive lymphadenitis is a stage of inflammation of the lymph nodes, the cause of which is local disorders in the body. The reactive form is characterized by the development of a pathological focus in the absence of predisposing factors. For example, in tuberculous lymphadenitis, the pathogenic bacillus did not give any symptoms (latent process), only the diagnosis of enlarged lymph nodes revealed the pathogen.

It can be said that the reactive phase often accompanies the acute course of inflammation. However, it also occurs in chronic diseases of the exacerbation period, characterized by an active reaction from the body.

Reactive lymphadenitis occurs as a result of the failure of the immune forces of children or because of a prepared organism, which already knows the microorganism and has antibodies to suppress it. Let's remember the Mantoux test, which shows the body's response to the tuberculosis bacillus. The presence of a skin ball indicates recognition of the infection. A similar mechanism of immune response is displayed by the lymph nodes.

The reactive course of inflammation is always a rapid process, meaning the fight against the source of infection, when the other links of the body's defense system have not yet had time to "join the confrontation". The reactive phase changes quite quickly. Recovery can occur if the infectious agent was suppressed in time by the body's immune forces.

Lymphadenitis behind the ear

Quite often, inflammation of the lymph nodes behind the ears is observed. The reason for the increase in the size of the node is the complication of purulent and inflammatory processes in the body with the proliferation of purulent agents. Predisposing factors are colds (tonsillitis, pharyngitis, runny nose, etc.), pathologies of the eyes, ears (fungal infections, herpes, etc.) or allergic reactions.

Lymphadenitis behind the ear can be purulent/non-purulent, acute/chronic, affect one or a group of nodes. The clinical picture of the disease manifests itself with the formation of a painful lump behind the ear, and the pain spreads inside the ear, which often confuses the patient. The general condition worsens: headache appears, fever is observed with a purulent course of the disease, the pain syndrome becomes "shooting" in nature, and in some cases redness of the skin in the area of the inflamed lymph node is possible.

The growth of the parotid nodes in size is sometimes caused by lymphoma, various cancers of the lymph nodes. Active hair loss on the head, annoying itching and the presence of peeling of the skin often indicate a fungal infection. In any case, you should not independently establish a diagnosis and prescribe treatment for yourself. Timely contact with a specialist will save you from mistakes that provoke irreparable complications.

Postauricular lymphadenitis

The growth of lymph nodes behind the ears signals the need to undergo an examination. Inflammation of the nodes may indicate both the reaction of the body's defenses and the presence of an infectious agent. Diseases of the throat, ears, eyes, some allergic manifestations cause the spread of pathogenic flora with the flow of lymph. A large volume of pathogenic microorganisms settling in the lymph nodes often provokes parotid lymphadenitis. The inflammatory process can be a harbinger of serious diseases, such as cancerous tumors.

Lymphadenitis is directly related to the primary lesion of viral, fungal or viral origin. Thus, peeling of the scalp, severe hair loss and incessant itching are symptoms of a fungal disease. Frequent colds, various diseases of the upper respiratory tract make it possible for microorganisms to enter the lymphatic system. Problems with the oral cavity, untreated or neglected caries, diseases of the organs of vision are also the cause of inflammatory enlargement of the lymph nodes.

The presence of a primary and secondary lesion in close proximity to the brain poses a danger to the patient in the form of complications, severe course of the disease and long recovery. Only timely seeking medical help will allow you to avoid all negative consequences and restore health in a short time.

[ 23 ], [ 24 ], [ 25 ]

Lymphadenitis of the face and neck

The face is the location of the cheek, mandibular, chin, parotid, and the smallest lymph nodes located near the nasolabial fold and in the inner corners of the eyes. The neck contains chains of superficial and deep (retropharyngeal) lymph nodes. The retropharyngeal nodes receive lymph from the posterior parts of the nasal cavity, partly from the palate. The lymph nodes of the cheeks, mandibular, submandibular, and chin receive lymph from the oral cavity, paranasal sinuses, teeth, mucous membranes, jaws, and salivary glands. Diseases of these organs contribute to the spread of infection through the lymphatic system and cause lymphadenitis of the face and neck.

Inflammation of the nodes of the submandibular, chin and cervical zones can be of odontogenic or non-odontogenic nature. Odontogenic processes are characterized by a pathological relationship with the dental system, often develop against the background of periostitis in the period of exacerbation, chronic periodontitis, acute pericoronitis. Inflammation of the lymph nodes of non-odontogenic type includes otogenic, rhinogenic and stomatogenic (formed as a result of stomatitis, otitis, glossitis, gingivitis, etc.).

Lymphadenitis of the throat

Viruses that provoke various diseases of the upper respiratory tract (tonsillitis, pharyngitis, laryngitis, etc.) or the oral cavity (stomatitis, diphtheria, etc.) can cause inflammation of the lymph nodes in the neck, as well as in the submandibular zone. Being a secondary pathological process, lymphadenitis of the throat often disappears with the treatment of the underlying cause. For example, the cervical lymph nodes return to normal with appropriate therapy for tonsillitis.

Symptoms of inflammation of the lymph nodes in the throat area:

• the size of the node increases – the size varies from a small pea to a chicken egg;
• the presence of pain syndrome - discomfort is felt during swallowing or palpation;
• general malaise – weakness, fever, headache, etc.

The defeat of the lymph nodes of the throat area is possible even without a concomitant disease, against the background of a significant weakening of the body's immune forces. In this case, the clinical picture is weakly expressed: a slight increase in lymph nodes is observed, during examination and when swallowing, slight pain may be present. The patient's body, as a rule, is weakened by frequent colds.

Occipital lymphadenitis

Identifying the reasons for which occipital lymphadenitis develops helps to eliminate the primary disease and cope with inflammation of the lymph nodes in the shortest possible time. For example, infections of the scalp, occurring against the background of dermatophytosis or pediculosis, create conditions for damage to the occipital lymph nodes.

Generalized viruses are an important diagnostic factor in occipital lymphadenitis accompanying measles rubella. In this pathology, inflammation of the posterior cervical nodes is also possible, sometimes a generalized type of lymphadenopathy is formed. Symptoms of the secondary pathological process appear earlier than skin rashes are differentiated. In the case of occipital lymphadenitis, the nodes are slightly enlarged, have a soft-elastic consistency, are easily displaced when palpated, without pain.

Chickenpox is a disease that causes occipital lymph nodes to grow. Typical symptoms of the disease include fever, skin rash, and upper respiratory tract problems. Specific infections of syphilis and tuberculosis very rarely affect the cervical and occipital lymph nodes.

Posterior cervical lymphadenitis

Lymphadenitis of the neck area is dangerous due to its close proximity to the brain, so it is important to diagnose the disease at an early stage and undergo appropriate treatment.

Posterior cervical lymphadenitis is a common occurrence in rubella. In addition to enlarged lymph nodes, patients complain of limited neck movement due to severe pain. Inflammation of the nodes near the ears and the occipital region is also observed. It is interesting that the pathological growth of the lymph nodes occurs before the characteristic red rash appears.

Identifying the causes of the inflammatory process and the growth of the lymph nodes located on the back of the neck is difficult in most cases. This is due to the fact that the inflammation can be provoked not only by an infectious disease, but also by more serious illnesses, such as tuberculosis. In the process of differential diagnosis, it is necessary to provide for the ability to form lymphoma, the development of lymph node metastases due to malignant neoplasms of the neck and head.

Mesenteric lymphadenitis

Disease of the mesenteric lymph nodes develops more often in children, occurs with signs of intoxication and characteristic pain in the abdominal area. There can be many reasons for the occurrence of pathology:

• viruses of acute respiratory processes (adeno-/enteroviruses);
• cytomegalovirus;
• tuberculosis pathogen;
• intestinal infections (campylobacter, salmonella, etc.);
• staphylococci and streptococci;
• Epstein-Barr virus.

It should be noted that there are a large number of lymph nodes in the abdominal cavity, so mesenteric lymphadenitis can occur when any pathogenic microorganisms of viral or bacterial nature enter them from the primary site of inflammation.

The disease begins with acute pain to the right of the navel, but the patient's general condition remains stable. As the inflammation progresses, nausea and vomiting are observed, which do not bring relief, and the patient has a fever. The clinical picture is complemented by stool disorders. Such symptoms last for several days and require immediate referral to a specialist, since the lack of proper treatment threatens serious complications.

Intestinal lymphadenitis

Mesadenitis is the name given to intestinal lymphadenitis, which is classified into the following forms:

Non-specific inflammation:

• simple/purulent;
• pseudo-tuberculous/tuberculous.

By type of flow:

• chronic/acute.

Inflammation of the lymph nodes of the peritoneum occurs hematogenously (through the bloodstream), directly through the intestines (saliva, sputum). Pathogens of the pathology are upper respiratory tract infections, inflammatory processes of the appendix and other parts of the digestive tract. When making a diagnosis using differential diagnostics, the following should be excluded: •

• attack of acute appendicitis;
• helminth infection;
• abdominal vasculitis of hemorrhagic type;
• lymphogranulomatosis.

Intestinal lymphadenitis is manifested by pain in the lower abdomen near the navel. The disease is accompanied by fever, nausea, a slight increase in temperature, and a violation of the excretory function (constipation or diarrhea). If the main focus is in the upper respiratory tract, then the pathological condition is aggravated by signs of a cold (runny nose, cough, etc.).

Complications of the disease include suppuration of the mesenteric nodes, which leads to abscess, sepsis, and intestinal obstruction due to adhesions.

Lymphangitis and lymphadenitis

The secondary inflammatory process in the capillaries and trunks of the lymphatic bed is called lymphangitis. Pathology is observed in purulent-inflammatory diseases as a result of superficial (scratch, wound) or deep damage (carbuncle, furuncle). Infectious agents in most cases are streptococci, staphylococci, but in clinical practice there are such pathogens as: Proteus, intestinal and tuberculosis bacilli and other microorganisms.

Quite often, lymphangitis and regional lymphadenitis are detected simultaneously, accompanied by swelling, hyperemia along the lymphatic vessels, pain syndrome, fever, chills and general weakness. Manifestations of superficial lymphangitis outwardly resemble erysipelas, and cord-like or rosary-like seals are palpated along the vascular bed. Damage to deep vessels of the lymphatic system is not accompanied by pronounced hyperemia, but swelling is clearly visible and pain persists.

Computer thermoscanning, ultrasound angioscanning, determination of the source of infection and isolation of the pathogen are used for diagnostic purposes. In the therapy of lymphangitis, an important place is occupied by the elimination of the primary focus of suppuration and the use of antibiotics. Compresses and ointment bandages are applied locally, mud therapy and X-ray treatment are used.

Odontogenic lymphadenitis

Acute serous inflammatory process in the submandibular lymph nodes without necessary treatment transforms into a new stage called odontogenic lymphadenitis. The lymph node is enlarged, the pain syndrome is of a shooting nature. Often the body temperature rises, the appetite and general condition of the patient worsen. In case of formation of pus, the face can acquire asymmetry due to the accumulated infiltrate. The skin becomes swollen with a red tint. Palpation causes discomfort. The acute purulent process covers nearby tissues, symptoms of intoxication appear.

The cause of the pathology is dental diseases. Oral infection penetrates not only the paramaxillary nodes, but also the parotid, buccal, submental, superficial and deep cervical lymph nodes. The pain in the area of the affected nodes increases with head movement. Difficulty opening the mouth is observed only if the purulent process spreads to the masticatory muscles.

Complications of odontogenic lymphadenitis include abscess or adenophlegmon.

Lymphadenitis of the cervical lymph nodes

The specific nature of cervical lymphadenitis of tuberculous origin has a number of distinctive features:

• the affected lymph nodes are fused together, but do not involve nearby tissues in the pathological process;
• more often it occurs without pain syndrome, which is confirmed by palpation;
• Inflammation is in most cases asymmetrical.

Tuberculous lymphadenitis of the cervical lymph nodes most often becomes chronic. Moreover, only in half of the cases the primary focus is found in the lungs. In clinical practice, there are atypical forms of mycobacteria that are difficult to treat with traditional therapy, so lymph nodes often have to be excised.

The presence of a primary syphiloma on the head (usually the tongue/lip area) causes cervical lymphadenitis, in which the nodes are dense and elastic, not fused with each other and the surrounding tissue, and are mobile. During examination of patients, the latter note the absence of pain, and the size of the inflamed lymph nodes varies in each specific case.

The cervical nodes of children under 5 years of age become inflamed with Kawasaki disease, accompanied by fever, skin rash, erythema on the soles and palms. A feature of the disease is that it is not treatable with antibiotics.

Lymphadenitis of the lower extremities

The lower limbs contain two groups of large nodes: popliteal and inguinal, which in turn are divided into superficial and deep. Lymph from the abdominal region, genital area and gluteal area enters the inguinal nodes, so the presence of infection in these organs provokes their inflammation. Viruses and bacteria that are the cause of the pathological focus in the legs (for example, a purulent wound) can also spread to the popliteal and inguinal nodes. Malignant tumors can metastasize to the nodes of the groin area, thereby causing their growth.

The onset of the disease is determined by an increase in lymph nodes, pain when pressing. Purulent lymphadenitis of the lower extremities causes an increase in temperature, swelling of the affected area. The spread of pus to nearby tissues is dangerous due to the formation of phlegmon.

Therapy includes the use of antibacterial complexes under the supervision of a specialist. The absence of treatment threatens the spread of infection to neighboring lymph nodes, as well as throughout the body.

Femoral lymphadenitis

The growth of femoral and inguinal lymph nodes is observed in the bubonic form of plague. The disease is accompanied by high fever, as well as signs of intoxication. After a week, suppuration of the node develops and a lymphatic fistula is formed.

Femoral lymphadenitis is sometimes diagnosed in cat scratch disease, although the axillary and elbow lymph nodes are more often inflamed. If the pathological process is neglected, fluctuation with purulent softening of the nodes is detected.

The popliteal lymph nodes receive lymph from the feet, so wounds, abrasions, and abscesses and other purulent formations should be treated promptly.

Inguinal lymph nodes become inflamed due to chlamydia, the pathology is caused by genital infections (venereal disease, syphilis, AIDS, Nicolas-Favre disease). Moreover, a group of nodes, fused together and with surrounding tissues, is often involved in the lesion.

The causes of femoral lymphadenitis are carbuncles, furuncles, thrombophlebitis of the lower extremities. Infections are not only bacterial in nature, but are also caused by viruses and protozoa. If it is impossible to determine the primary cause of inflammation, then inflammation continues in the lymph node, which can lead to suppuration and melting of the node.

[ 26 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ]

Lymphadenitis of the abdominal cavity

Infectious practice indicates the widespread prevalence of non-specific mesenteric lymphadenitis, which is most often encountered in childhood, but is also detected in adult patients.

Mesadenitis or lymphadenitis of the abdominal cavity is formed during acute respiratory processes, under the influence of pathogens of intestinal diseases, and also as a result of the presence of bacteria that provoke mononucleosis and tuberculosis. The peritoneum zone is a favorite breeding ground for pathogenic microorganisms. If the immune system cannot cope with the number of viruses, then the main blow falls on the lymph nodes of the mesentery.

The first signs of pathology can easily be confused with ordinary indigestion or symptoms of intoxication. The pain is localized near the navel on the right, more towards the lower abdomen. The pain syndrome intensifies as the inflammation develops, acquiring a nagging, cramping character of varying intensity. The condition is supplemented by fever, nausea, vomiting, and impaired excretory function. The formation of pus in the capsule of the affected lymph node is expressed by chills, fever, tachycardia, and a sharp deterioration in health.

Lymphadenitis of the abdominal cavity requires qualified treatment, otherwise complications are possible - peritonitis, adhesions of the organs of the peritoneum, abscess and sepsis.

Pulmonary lymphadenitis

Inflammation of the intrathoracic lymph nodes is a form of primary tuberculosis that develops immediately after infection. This disease has become widespread, especially among children, in adolescence, which is associated with vaccination and insufficiently strengthened immunity of patients in this age group.

Pulmonary lymphadenitis manifests itself in different ways, depending on the location of the inflammation, the extent of the pathological focus and the enlargement of the lymph nodes. Symptoms of the disease:

• cough, like whooping cough, which especially torments the patient at night;
• the development of a dry, unproductive cough into a wet cough with the production of sputum;
• noisy breathing;
• irritability;
• night chills;
• feverish state;
• chest pain;
• signs of intoxication;
• weakness.

Clinical practice knows cases of asymptomatic progression of the disease, when pulmonary lymphadenitis is diagnosed only during a routine examination. An increase in superficial nodes helps in differentiating the pathology.

Inflammation of the lung tissue is often combined with lymphadenitis and lymphangitis. Lymph node damage is detected by X-ray methods.

Lymphadenitis of the mammary gland

The mammary gland is conventionally divided into four parts:

• two quadrants outside;
• two quadrants inside.

The lymphatic drainage from the outer quadrants enters the axillary lymph nodes. The inner quadrants of the breast communicate with the parasternal lymph nodes. It should be noted that the mammary gland undergoes changes at various stages of the menstrual cycle, during pregnancy and breastfeeding.

Regional inflammation is understood as local damage to the lymph nodes. Symptoms of the disease begin with a pathological process in the nodes of the armpit, the area of the mammary glands, sub- and supraclavicular lymph nodes. Lymphadenitis of the mammary gland is most often provoked by streptococci and staphylococci, less often by gono- and pneumococci. The infection comes from primary foci of inflammation located directly on the chest (purulent wounds, skin diseases), or by the lymphogenous/hematogenous route from other affected organs and systems.

The clinical picture includes: enlarged and painful lymph nodes, the skin over the affected node is hyperemic and tense. The patient's condition worsens with the formation of purulent discharge in the inflammation site.

Left-sided lymphadenitis

Lymphadenitis is a disease that causes inflammation of a single lymph node (local lesion) or a group of nodes (regional lesion). The pathology can be detected on one or both sides at the same time, most often in the armpits and groin. Active growth of lymph nodes in size and sharp pain indicate the development of a pathological focus.

A complication after BCG vaccination is considered to be tuberculosis inflammation of the lymphatic system, which children are susceptible to. The causes of the disease are:

• a decrease in the body's resistance as a result of frequent colds, severe diathesis, rickets, etc.;
• vaccination of premature babies;
• over-administration of a vaccine.

The consequence of vaccination will be left-sided axillary lymphadenitis with its characteristic pain syndrome, often accompanied by lymphangitis.

Atypical mycobacteria of the face and oral cavity provoke unilateral inflammation of the lymph nodes of the lower jaw. Damage to the cervical nodes on the left or right is observed due to an infectious and inflammatory process in the body (tonsillitis, flu, tonsillitis, pneumonia, etc.).

Right-sided lymphadenitis

Right-sided lymphadenitis occurs in various pathologies. For example, the culprits of inflammation of the lymph nodes to the right below the navel are viral infections such as gastroenteritis, ENT diseases. Attacks occur in an acute form, resembling inflammation of the appendix with pronounced symptoms of intoxication.

Enlargement of the submandibular lymph nodes on the right side is caused by pathologies of the oral cavity of the same part of the face (untreated caries, gum disease, various chronic diseases).

The only sign of infectious mononucleosis is inflammation of the cervical lymph nodes on one side or symmetrically. With odontogenic lymphadenitis, the patient's face becomes distorted to the side where the pathological process of the lymph node has formed. If there is an infected tooth on the right side of the jaw, then right-sided lymphadenitis develops. Inflammation begins with nearby nodes (the area of the main collector), later signs of the disease are detected along the lymph flow or spread through the bloodstream.

Bilateral lymphadenitis

Severe bilateral lymphadenitis is formed as a result of:

• infectious mononucleosis;
• secondary syphilis;
• infiltrative lesion;
• detection of toxoplasma;
• phenytoin therapy and other diseases.

When infected with primary syphilis, a symmetrical inflammatory process of the inguinal and submandibular nodes is widespread, up to the size of a large bean or nut. In parallel, pathology is detected in the lymphatic vessel leading to the affected lymph node.

A disease such as rubella provokes an increase in the parotid, posterior cervical and occipital nodes, usually on both sides. The growth of lymph nodes is noted in the absence of a characteristic red rash. Patients' complaints are reduced to pain when turning the neck.

The odontogenic source of infection in acute or chronic leukemia is usually localized in the lymph nodes of the neck, submandibular area and on the face. In this case, the inflammation is often unilateral, but bilateral lesions also occur due to a decrease in the body's defenses.

[ 31 ], [ 32 ], [ 33 ], [ 34 ]

Supraclavicular lymphadenitis

When supraclavicular lymph nodes become inflamed, lymphoma, infectious and tumor processes of the chest organs, infections and tumor neoplasms of the peritoneum organs should be excluded. Tumors of the gastrointestinal tract often cause an increase in lymph nodes above the collarbone, mainly on the left. Neoplasms of the genital area, mammary glands, and lungs can also metastasize to the area of the supraclavicular lymph nodes.

An important differential sign is supraclavicular lymphadenitis. For example, the growth of a node in the right supraclavicular fossa is detected in malignant lower lobe lung lesions.

Examination and diagnosis of inflammation of the supraclavicular nodes is performed as follows:

• the patient is in a sitting position with his arms down, looking forward;
• the doctor stands behind the patient;
• the chance of detecting enlarged nodes in the supraclavicular fossa increases in the supine position;
• The Valsalva maneuver is performed, which helps to move the angle closer to the surface of the skin (sometimes even a light cough helps).

Lymphadenitis in adults

The body of an adult is able to resist various viruses and bacteria. This is possible thanks to the lymphatic system, which provides protective and drainage functions. Enlarged lymph nodes indicate the presence of an infection in the body and that the immune system has responded by producing antibodies to pathogens.

Lymphadenitis in adults often occurs asymptomatically or against the background of a slight deterioration in health. First of all, the cervical, submandibular, axillary and inguinal nodes become inflamed. The cause of the pathology is purulent processes of various organs (furuncle, erysipelas, etc.), severe diseases (tuberculosis, plague, etc.). The factors that provoke lymphadenitis in adult patients are: stress, hypothermia, decreased defenses. As a primary disease, inflammation of the lymph nodes is extremely rare with direct infection of the node during damage (trauma).

The lymph nodes of the groin area become inflamed more often in adulthood and indicate problems with the genital organs, and may foretell the presence of a venereal disease. Lymph node adenitis of the cervical nodes is considered a rather serious pathology in adults and requires immediate consultation with a dentist and otolaryngologist.

Lymphadenitis in children

Inflammation of the lymph nodes in childhood manifests itself much more vividly and proceeds more intensively than in adult patients. Lymphadenitis in children is provoked by various infections, most often of the upper respiratory tract. Such diseases as: angina, acute respiratory viral infections, tonsillitis, caries, etc. contribute to the enlargement of the submandibular lymph nodes. In clinical practice, cases of damage to the cervical, popliteal, axillary nodes are much less common. Inguinal lymphadenitis in children is an even rarer phenomenon, differentiated as a result of strangulation of the inguinal hernia.

Lymphadenitis in pregnant women

Inflammation of the lymph nodes during pregnancy occurs due to infectious and inflammatory processes and decreased immunity. Lymphadenitis in pregnant women mainly occurs in catarrhal and purulent forms.

Purulent inflammation is dangerous because of its consequences:

• lymphangitis - the disease spreads to the walls of the lymphatic vessels;
• thrombophlebitis – damage to the circulatory system;
• disruption in the functioning of the organs or systems of the body of the expectant mother.

Chronic processes often manifest themselves precisely during pregnancy, for this reason women are recommended to undergo examination before conception. A visit to a dentist and otolaryngologist is considered mandatory.

Detection of lymphadenitis after pregnancy requires immediate referral to a specialist. Therapy is carried out using antibiotics, most often cephalosporins or macrolides. Purulent formations in the lymph nodes are subject to surgical treatment.

The lack of proper and timely treatment threatens irreparable consequences for the fetus (delayed development, infections, etc.). The presence of chronic inflammation can affect subsequent pregnancies.

Why is lymphadenitis dangerous?

Progression of the inflammatory focus in the lymph nodes often entails hemorrhagic, fibrinous, serous purulent changes. Lymphadenitis at an advanced stage without proper treatment provokes irreversible processes: tissue necrosis, abscess formation, ichorous destruction of the lymph nodes, sepsis (blood poisoning).

Simple inflammation does not spread beyond the lymphatic capsule. Pathology with destructive manifestations covers nearby tissues, increasing the affected area several times. The non-specific form of the disease tends to develop into thrombophlebitis with the formation of metastatic foci of infection (septicopyemia, lymphatic fistula).

The chronic inflammatory process is dangerous because in most cases it proceeds covertly, without pronounced symptoms, indicating a decrease in the body's defenses and threatening degeneration of the lymph nodes. Characteristic complications of chronic non-specific lymphadenitis are: swelling, elephantiasis (proliferation of connective tissue), lymphostasis, dysfunction of lymph circulation.

Consequences of lymphadenitis

Lymphadenitis is dangerous because of the possibility of infection and cancer cells spreading throughout the body through the bloodstream or lymphatic system. The absence of an effective and correct treatment regimen can lead to death.

The consequences of lymphadenitis include disruption of lymph circulation, penetration of pus into adjacent tissues, development of elephantiasis, and formation of torticollis in children.

[ 35 ], [ 36 ], [ 37 ], [ 38 ], [ 39 ]

Complications of lymphadenitis

Without the necessary treatment, lymphadenitis threatens disability and even death of the patient. Complications of lymphadenitis:

• osteomyelitis;
• abscess;
• encephalitis;
• meningitis;
• septic arthritis;
• sepsis.

[ 40 ], [ 41 ], [ 42 ], [ 43 ]

Diagnosis of lymphadenitis

Lymph nodes of a healthy person can be palpated with difficulty. This is possible with a thin physique in childhood and adolescence. The growth of nodes in size serves as an important criterion for differentiating diseases in the early form, and signals the presence of viruses and bacteria in sluggish, hidden processes.

Initial diagnosis of lymphadenitis includes palpation of the inflamed nodes, after which instrumental and laboratory methods are prescribed:

• study of blood composition;
• histological analysis (taking a tissue sample from the affected node);
• in case of lymphadenitis of a specific type, attention is focused on the possibility of contact with a tuberculosis carrier and skin tests with laboratory testing (blood, sputum), as well as X-rays are performed;
• purulent inflammation requires surgical opening of the lymph node capsule and, if necessary, drainage of the wound;
• enlargement of the inguinal nodes is a signal to exclude a hernia in the groin;
• examination of children begins with suspicions of Quincke's edema, tumor formations in the cervical area and exclusion of congenital cysts;
• Often used are: ultrasound, consultation with an ENT specialist, computed tomography, HIV testing.

[ 44 ], [ 45 ], [ 46 ], [ 47 ], [ 48 ], [ 49 ], [ 50 ]

Blood test for lymphadenitis

The quantitative and qualitative characteristics of the composition can be identified by a blood test for lymphadenitis. In addition to the general analysis, the leukocyte formula and the level of LDH (lactate dehydrogenase), characteristic of leukemia and lymphoma, are calculated. An excess of ESR indicates inflammatory and tumor processes. A mandatory study of a peripheral blood smear is required to determine infectious mononucleosis.

Uric acid and transaminases (indicative of hepatitis) in a blood biochemistry test are basic criteria for systemic pathologies (autoimmune diseases, malignant neoplasms).

[ 51 ], [ 52 ], [ 53 ], [ 54 ], [ 55 ]

Lymphadenitis on ultrasound

Ultrasound examination helps to track the effectiveness of antibacterial therapy. For this purpose, the size of the affected node is recorded before and after the end of treatment.

Lymph nodes are normally oval or bean-shaped and are located in groups. The characteristics of the nodes (shape, size, structure, number, location) vary depending on the age and individual characteristics of the patient's body.

Lymphadenitis on ultrasound is characterized by a number of features:

• the nodes are enlarged in size;
• the lymph node capsule is tense;
• the vascular pattern is enhanced;
• the cortical and pericortical zones are significantly expanded;
• swelling is determined;
• anechoic areas may be present;
• hyperplastic and fused nodes are observed;
• Sometimes metastatic changes are detected.

Ultrasound can reveal the relative position of the lymph node and adjacent tissues - the presence of a connection, the presence of connective tissue, the integrity of the node capsule, the spread of the tumor process, and the adjacency to nearby organs (for example, a vessel).

Treatment of lymphadenitis

Therapy for lymphadenitis depends primarily on the form of the inflammatory process (acute/chronic course, specific/non-specific nature of the lesion). At the initial stage, treatment for lymphadenitis combines conservative methods with physiotherapy and a gentle regimen. An important place is occupied by the elimination of the primary source of infection: cleaning the purulent wound, installing a drainage system, etc. If a pathogen is detected, antibacterial therapy is prescribed. In the case of purulent inflammation of the lymph node, its capsule is opened and cleaned. For chronic inflammation of the lymph nodes, the main task will be to get rid of the source of infection.

What doctor treats lymphadenitis?

Inflammation of the lymph nodes is a reason to contact a therapist, who refers you for consultation with an endocrinologist, surgeon or oncologist. The choice of specialist largely depends on the nature of the course of lymphadenitis and the severity of the initial lesion. Often, an examination by an infectious disease specialist, hematologist or rheumatologist is required.

The duration of treatment for a specific type of lymphadenitis depends on the severity of the underlying disease and the correctness of the therapeutic regimen.

Prevention of lymphadenitis

Prevention of acute and chronic inflammation of the lymph nodes consists of timely therapy of primary diseases: angina, tonsillitis, purulent skin lesions, osteomyelitis, rhinitis, gingivitis, furuncles, carbuncles and various infectious diseases (flu, acute respiratory viral infections, etc.). Prevention of lymphadenitis also includes anti-caries measures: systematic visits to the dentist to treat caries, stomatitis and other pathological foci of the oral cavity.

Nursing mothers are advised to carefully monitor the hygiene of the mammary glands, not allowing the development of lactostasis. In cases of infectious diseases, it is important to follow all the instructions of the attending physician regarding antibacterial therapy. You should not independently reduce the period of taking antibiotics or replace the prescribed drug with another drug.

Preventive measures to prevent inflammation of the lymph nodes include timely removal of splinters, treatment of abrasions, microcracks and cuts with the application of antiseptic dressings.

Immunocorrective programs help to increase the body's defenses and fight pathogenic microflora more effectively.

Lymphadenitis prognosis

Non-specific acute lymphadenitis at the beginning of development with quality treatment most often has a favorable prognosis. The destructive course of the inflammatory process ends with the destruction of the lymph node with subsequent scarring. The progression of acute forms of lymphadenitis of the extremities provokes a violation of the lymph outflow, the formation of lymphostasis, and subsequently - to elephantiasis.

The purulent type of inflammation threatens periadenitis (the pathology spreads to the surrounding tissues), an abscess or phlegmon/adenophlegmon is formed around the melted node, requiring long-term treatment. The outcome of the disease is often thrombophlebitis, lymphatic fistulas.

The prognosis for chronic lymphadenitis is favorable when the underlying cause of the inflammation is established and timely therapy is administered. Negative consequences may include scarring and swelling of the tissue above the affected node. As a result of the shrinkage and compaction of the lymph node, there is a spread of connective cells and impaired lymph circulation.

Lymphadenitis can go away on its own if the underlying purulent-inflammatory disease is treated in a timely and effective manner. Therefore, at the first symptoms of inflammation of the lymph nodes, it is necessary to visit a doctor and strictly follow his instructions.