Acute Lymphadenitis Acute lymphadenitis is an acute inflammation of the lymph nodes caused by bacterial infection, most commonly by Streptococcus pyogenes and Staphylococcus aureus. It often occurs as a result of infections in other parts of the body, and its main clinical manifestations include lymph node enlargement and pain. Bacteria invade the lymphatic system from damaged skin, mucous membranes, or other infectious foci, leading to acute inflammation of the lymph nodes.

Acute lymphadenitis is an acute inflammation of the lymph nodes caused by bacterial infection, with streptococcus and Staphylococcus aureus being the most common pathogens. It often follows infections in other parts of the body and is characterized by enlarged and painful lymph nodes. Pathogens enter the lymphatic system from skin or mucosal lesions or other infected sites, leading to acute inflammation of the lymph nodes.

It can be classified into several types based on the common sites of infection.

Cervical lymphadenitis

Common in children, often caused by upper respiratory tract infections, tonsillitis, dental caries, pharyngitis, oral cavity inflammation, or external auditory canal inflammation, leading to lymph node infection through lymphatic drainage pathways in the neck.

Mesenteric lymphadenitis

Mesenteric lymphadenitis is most common in children under 7 years of age and is often associated with viral infections. It typically occurs in the winter and spring seasons and frequently occurs as a complication or sequel to intestinal inflammation during an acute upper respiratory tract infection. Typical symptoms include fever, abdominal pain, vomiting, and sometimes accompanied by diarrhea or constipation.

Axillary lymphadenitis

Infections of the upper limbs, mammary glands, chest wall, back, and the upper abdomen above the navel can spread to the axillary lymph nodes.

Inguinal lymphadenitis

Infections of the lower limbs, lower abdominal wall below the navel, perineum, and buttocks can spread to the inguinal lymph nodes.

In mild cases of acute lymphadenitis, there is local lymph node enlargement and pain, with normal overlying skin. Enlarged and tender lymph nodes can be palpated clearly, and most cases can resolve and reduce swelling on their own.

As inflammation worsens, the enlarged lymph nodes can conglomerate into a mass, the overlying skin may become red, hot, and the pain intensifies.

In severe cases, lymphadenitis can lead to the formation of a local abscess due to necrosis, with fluctuance, or it may rupture and discharge pus, accompanied by fever, elevated white blood cell count, and other systemic inflammatory responses.

Differential diagnosis and treatment

Invasion of wind-heat to the surface

Clinical manifestations: Enlarged and painful lymph nodes behind the ears or on the side of the neck, with unchanged or slightly red skin, palpable and movable, obvious tenderness, accompanied by chills, fever, headache, and limb soreness. The tongue is pale, with a thin white or thin yellow coating, and the pulse is floating and rapid.

Differential diagnosis: The area of the head and neck is susceptible to invasion by wind pathogens. Wind warmth and wind-heat are the cause, but the condition is not severe, hence the skin color at the affected area remains unchanged or slightly red, and there are signs of exterior pathogenic factors throughout the body.

Treatment: Wind warmth and wind-heat pathogens are aggressive, and treatment should focus on gently clearing these pathogens, with less emphasis on detoxification.

Excessive heat and toxin

Clinical manifestations: Local redness, swelling, intense pain, firm and fixed mass, non-movable upon palpation, or a fluctuant response to pressure, accompanied by high fever, flushed face, thirst, stuffiness in the epigastrium, poor appetite, red tongue, yellow or greasy coating, and a rapid or slippery pulse.

Differential diagnosis: The external pathogenic factors have not been expelled, and the heat has penetrated internally, or toxic heat has generated internally, leading to pronounced redness, intense swelling, and a more severe mass. The heat is so intense that it causes the tissues to necrotize and form pus, resulting in intense pain and a soft, fluctuant response to pressure.

Treatment: Treatment should focus on clearing heat and detoxification, with adjunct measures to promote suppuration. External treatment involves incision and drainage to expel toxins.

Lingering pathogenic factors

Clinical manifestations: The local redness and pain have subsided, but the mass remains rigid and does not resolve, with slight pain upon palpation, and few systemic symptoms. The tongue is red, with a thin coating, and the pulse is weak and rapid.

Differential diagnosis: The heat and toxins have receded, but the stagnation of qi and blood remains unresolved, causing the redness and swelling to persist without significant improvement.

Treatment: Treatment should focus on promoting blood circulation, resolving swelling, and dispersing stagnation, to facilitate the unimpeded flow of meridians and collaterals, and the circulation of qi and blood, allowing the rigid swelling to resolve naturally.

For limb infections, the patient should rest in bed, elevate the affected limb, and engage in gentle joint movement. Encourage the patient to change positions frequently to prevent thrombophlebitis.

Maintain personal hygiene and skin cleanliness.

Actively prevent and address primary infectious foci, such as tonsillitis, dental caries, ringworm, tinea pedis, skin injuries, and various cutaneous and subcutaneous purulent infections.

During high fever, drink plenty of water, rest, and take antipyretic measures.

Consume a light and easily digestible diet, with a focus on consuming foods with heat-clearing and detoxifying properties, such as mung bean soup, Portulaca oleracea porridge, watermelon rind porridge, loofah, celery, and drink heat-clearing teas like chrysanthemum tea, honeysuckle tea, and loquat syrup. Avoid spicy and hot foods such as leeks, peppers, onions, and ginger, as well as seafood and mutton, which can exacerbate symptoms.

Avoid smoking and alcohol consumption.

Do not apply topical medications or hot compresses to hardened and swollen lymph nodes to prevent suppuration and rupture.

Penicillin-class drugs commonly used in clinical practice include penicillin G, benzylpenicillin, amoxicillin, ampicillin, piperacillin, and sulbenicillin. If a patient is allergic to one of these drugs, they may also be allergic to others, but the degree of allergic reaction may vary.

Due to the structural similarity between cephalosporins and penicillins, some patients may exhibit cross-allergic reactions. If a patient has had a previous allergic reaction to penicillin, it is not advisable to use cephalosporin antibiotics without consulting a healthcare professional for a detailed evaluation, and all emergency measures should be prepared when using them.

Promptly treat injuries and primary infectious foci such as tonsillitis, dental caries, finger infections, and tinea pedis infections.

Enhance nutrition and boost the body's resistance.