Causes of enlarged lymph nodes

An increase in the lymph nodes of one group is called local (regional) lymphadenopathy, an increase in lymph nodes of two or more groups - polyadenopathy or generalized lymphadenopathy.

There are acute (up to 3 months), prolonged (up to 6 months) and chronic (persistent) lymphadenopathy (over 6 months).

In infectious diseases, lymphadenitis, an inflammation of lymph nodes, usually closest to the site of penetration of the pathogen, develops more often; while the nature of the inflammatory process in the lymph nodes may be different (serous, serous-hemorrhagic, purulent inflammation). Lymphadenitis can be combined with primary affect or polyadenopathy (with tularemia, plague, listeriosis, syphilis, benign lymphoreticulosis, measles, rubella, toxoplasmosis).

Lymphadenitis is characteristic of tularemia, plague, yersiniosis, anthrax, scarlet fever, erysipelas, angina, listeriosis, staphylococcal and streptococcal purulent infection, diphtheria, tick-borne borreliosis, soda, tick-borne North Asian typhus, herpetic infection, foot and mouth disease, cowpox.

Acute and (more rarely) chronic lymphadenitis can be accompanied by suppuration and necrosis of the affected lymph nodes (purulent streptococcal and staphylococcal infection, scarlet fever, tonsillitis, benign lymphoreticulosis, plague, tularemia). The outcome can be a complete resorption of lymph nodes or sclerosing.

Often the inflammatory process in the lymph nodes is specific. In this case, a histological study of the biopsy or a postmortal examination can detect specific granulomas (brucellosis, benign lymphoreticulosis, pseudotuberculosis, listeriosis, tularemia, tuberculosis, syphilis, etc.).

Tularemia (its bubonic forms, including ulcerous-bubonic, ocular-bubonic, anginal-bubonic) is one of the most demonstrative representatives of a group of diseases with local lymphadenopathy. Bubon, more often inguinal, axillary, cervical, is usually formed in the lymph nodes closest to the site of penetration of the pathogen, and is combined with the general infectious syndrome - fever, moderate intoxication, and with local changes (primary affect) - a small painless sore on the skin at the site of the bite an insect, or one-sided conjunctivitis, or tonsillitis (unilateral, ulcerative-necrotic or membranous). The size of the tularemia bubo is 3-5 cm in diameter, but may be larger (up to 10 cm); it is characterized by clear contours, the absence of periadenitis, mobility, and insignificant soreness in palpation. The skin above the bubo is not changed at first, but in the absence of adequate antibiotic therapy, after 3-4 weeks, a bubble may be suppurated (then the skin turns red, the lymph node becomes soldered, becomes painful, there is a fluctuation), its spontaneous dissection with the formation of a fistula. When sclerosing bubo, lymph node enlargement persists for a long time after recovery. One of the options for the evolution of bubo is resorption, which occurs slowly, for several months.

Benign lymphoreticulosis (cat scratch disease, felinosis) can cause lymphadenitis, especially in children and adolescents. The diagnosis is based on the epidemiological history (contact with cats, their scratches and bites), the on-site detection of a scratch of the primary affect in the form of papule-vesicles-pustules, an increase in the diameter of the regional lymph node to 2.5-4.0 cm or more, body. Lymph nodes of a densely elastic consistency, sedentary due to periadenitis, moderately painful in palpation, the skin over it is hyperemic, the surrounding tissues are edematous. It is possible to develop lymphadenitis not only of the regional (eg, elbow) lymph node, but also of lymph following it (eg axillary); sometimes not one, but several lymph nodes of one or neighboring groups increases. After 2-4 weeks, the lymph nodes can become inflamed, fistulas are formed and pus is secreted. The process is prone to prolonged recurrent course, fever, intoxication, lymphadenitis may persist for several months.

Disease from bite of rats (soda). At the site of the bite, swelling, hyperemia of the skin, soreness and an increase in the regional or group of lymph nodes, which are dense to the touch, are welded to each other and to surrounding tissues. From the area of the bite, where ulcers and foci of necrosis can form, up to the enlarged lymph nodes there is a papular red lymphangitis band. In the biopsy specimen of the enlarged lymph node, hyperplasia of the lymphoid tissue is detected, small cell infiltration. The causative agent can be isolated by sowing punctate lymph nodes.

In practice, there is often a need for differential diagnosis between purulent "banal" lymphadenitis and specific lymphadenitis in tularemia, as well as in the plague. It should be borne in mind that nonspecific purulent lymphadenitis is more often secondary, and the primary purulent focus can be furuncles, infected wound, abscess, panaritium, mastitis, etc. It is often found lymphangitis from the primary focus to the regional lymph node, which is usually significantly enlarged, painful, the skin above it is hyperemic. Fever, intoxication occur simultaneously with lymphadenitis or later, rather than precede it. In the hemogram, neutrophilic leukocytosis is determined, an increase in ESR. When sowing pus obtained during puncture of the lymph node, streptococcus or staphylococcus is isolated.

Comparative characteristics of purulent lymphadenitis and bubo in plague, tularemia

Symptom	Plague	Tularemia	Purulent lymphadenitis
Soreness	Sharp	Minor	Expressive
Periadenitis	There is	No	Available
Contours	Fuzzy	Clear	With periadenitis fuzzy
Skin over bubo	Crimson red	Not changed, with suppuration of cyanosis	Red
Suppuration and autopsy	As a rule, on the 8-10th day of the disease	Inconsistently, after 3-4 weeks	Maybe in the early days
Primary affect	Rarely with cutaneous form	Often	Purulent foci (furuncle, panaritium, etc.)
Intoxication	Sharply expressed	Moderate	Weak
Fever	Precedes the bubo	Precedes the bubo	Appears simultaneously or later local changes

With infectious mononucleosis caused by EBV, a symmetrical increase occurs primarily in the posteroderma and submandibular lymph nodes, to a lesser extent and less often - axillary and inguinal. Usually, lymph nodes are enlarged in groups, less often - one at a time, their size can vary from 0.5 to 5 cm. When palpation lymph nodes are dense, not soldered to each other and to surrounding fiber, painless or slightly painful, the color of the skin over them is not changed. Sometimes around the enlarged lymph nodes on the neck is visible pastose subcutaneous tissue. Infectious mononucleosis is characterized by a discrepancy between the degree of enlargement of the lymph nodes and the severity of changes in the oropharynx: tonsils can be significantly enlarged, edematous, covered with a continuous dense coating that goes beyond their boundaries. The size of the lymph nodes is slightly higher than usual. Conversely, tonsillitis can be catarrhal, and cervical lymph nodes reach large sizes, sometimes form a solid conglomerate. As a rule, the cervical lymph nodes in infectious mononucleosis are clearly contoured and clearly visible when turning the head. In some patients, lymphadenopathy reaches such a degree that the configuration of the neck changes - the so-called bull's neck. Suppuration of lymph nodes with infectious mononucleosis does not happen.

Lymphadenopathy is one of the clinical manifestations of HIV infection. In the stage of acute HIV infection, the occipital and posterior lymph nodes usually increase, later - submandibular, axillary and inguinal. Lymph nodes are painless, soft-elastic consistency, 1-3 cm in diameter, are not welded to each other and to surrounding tissues, the skin over them is not changed. Along with lymphadenopathy, fever is observed, often pharyngitis and / or tonsillitis, enlargement of the liver, and sometimes spleen. The described symptom complex is extremely similar to infectious mononucleosis and therefore is called "mononucleosis-like syndrome". Duration of polyadenopathy. Which occurred in the stage of acute HIV infection, is usually 2-4 weeks. With the progression of the disease, lymphadenopathy persists or appears for the first time, and then, for several months / year, generalized lymphadenopathy may be the only clinical marker of HIV infection or be combined with other manifestations of it.

Accession of opportunistic infections is accompanied by compaction of lymph nodes, their consistency becomes dense, elastic, localization and sizes of lymph nodes depend on specific secondary diseases. In the terminal stage of HIV infection, the size of the lymph nodes decreases markedly, some previously enlarged cease to palpate. Thus, both the size and consistency of lymph nodes, as well as the duration and localization of lymphadenopathy, can be very diverse in HIV infection, which necessitates a laboratory examination for HIV infection of all patients with lymphadenopathy of unknown etiology.

Rubella is one of the most significant infections characterized by peripheral lymphadenopathy. Already in the prodromal period, even before the appearance of any other clinical symptoms, occipital, behind and cervical lymph nodes increase, and they become dense and painful on palpation. Enlargement of the lymph nodes is a pathognomonic rubella symptom, it can be so pronounced that it can be determined visually.

With measles, the same groups of lymph nodes increase as with rubella, but they are painless on palpation. Lymphadenopathy - not a leading symptom of measles, is combined with more vivid manifestations of this disease, including a marked catarrhal syndrome, Belsky-Filatov-Koplik spots on the oral mucosa, abundant patchy-papular exanthema, appearing and disappearing in stages, leaving behind pigmentation .

[1], [2], [3], [4], [5], [6]