0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15
930 Lyme Disease Lymphadenitis and Lymphangitiscomplications and prognosis
■Prognosis excellent with complete response in 4–6 weeks; residual
synovitis, facial nerve palsy and need for permanent pacemaker all
rare occurrences; early treatment almost always prevents later stages
of disease
■Prevention includes avoiding tick-infested areas, covering exposed
skin, using insect repellants and inspecting and removal of ticks after
exposures
■Previous vaccine taken off the market in 2002 due to reports of toxi-
city. No vaccine currently available.LYMPHADENITIS AND LYMPHANGITIS
RICHARD A. JACOBS, MD, PhDhistory & physical
History
■Lymphadenitis is inflammation of lymph nodes – can be acute, devel-
oping over several days, or chronic, developing over weeks
■Lymphangitis is inflammation of lymphatic vessels – can be acute or
chronic
■Acute lymphadenitis most commonly due to Staphylococcus aureus
or Streptococcus pyogenes (group A streptococcus); anatomic sites
most commonly affected include cervical (due to infection of face or
scalp, tonsillitis or periodontal infection); axillary (due to infections
of hand or arm); epitrochlear (associated with infection of middle,
ring or little finger)
■Chronic lymphadenitis due to mycobacterium (atypical mycobac-
terium such as M. scrofulaceum more common in children and M.
tuberculosis more common in adults), fungi (Histoplasma capsu-
latum, Cryptococcus neoformans, Coccidiodes immitis), Bartonella
spp (cat-scratch disease)
■Oculoglandular syndrome (Parinaud’s syndrome) – granuloma-
tous conjunctivitis with preauricular adenopathy seen with cat-
scratch disease, tularemia (Francisella tularensis), lymphogranu-
loma venereum (Chlamydia trachomatis) and adenovirus (type 8
and 19)
■Inguinal adenopathy of venereal origin usually bilateral – primary
syphilis, lymphogranuloma venereum, chancroid (Haemophilus
ducreyi); nonvenereal causes include tularemia and plague (Yersinia