Related Subjects:
|Cellulitis
|Impetigo
|Pyoderma gangrenosum
|Pemphigus Vulgaris
|Toxic Epidermal Necrolysis
|Stevens-Johnson Syndrome
|Necrotising fasciitis
|Gas Gangrene (Clostridium perfringens)
|Anatomy of Skin
|Skin Pathology and lesions
|Skin and soft tissue and bone infections
|Lymphangitis
🚨 Acute lymphangitis is a rapidly spreading bacterial infection of the lymphatic vessels, usually arising from a distal skin breach.
⚡ It presents with painful erythematous streaks tracking proximally toward regional lymph nodes and may progress quickly to sepsis if untreated.
👉 Most commonly caused by Group A Streptococcus.
📖 Definition
- Infection of superficial lymphatic channels secondary to a cutaneous entry point.
- Often associated with cellulitis and regional lymphadenitis.
🦠 Aetiology
- Streptococcus pyogenes (Group A strep) – most common ⚠️
- Staphylococcus aureus – especially if abscess present
- Less common: Gram-negatives (immunocompromised), Pasteurella (animal bites)
⚠️ Risk Factors
- 🩹 Skin breaks – cuts, insect bites, ulcers
- 🦶 Tinea pedis (common entry site)
- 💉 IV drug use
- 🦠 Immunosuppression (diabetes, steroids)
- 🧬 Lymphoedema or previous lymph node dissection
🔍 Clinical Features
- 🔥 Linear erythematous streaks extending proximally from infection site
- 😖 Local pain and tenderness
- 🦠 Fever, malaise (systemic upset)
- 🧠 Regional lymphadenopathy
- ⚠️ May coexist with cellulitis
🚩 Red Flags
- Hypotension or tachycardia → possible sepsis
- Rapid progression → consider necrotising infection
- Severe pain out of proportion
🧪 Investigations
- 🩸 FBC, CRP – inflammatory markers
- 🧫 Blood cultures if febrile/systemically unwell
- 🧠 Diagnosis is primarily clinical
💊 Management (NICE-aligned principles)
- 🧴 First-line: Oral antibiotics (if mild/moderate)
- Flucloxacillin (covers staph + strep)
- Penicillin V if pure streptococcal suspected
- 💉 IV antibiotics if severe/systemic features
- 🦵 Elevate affected limb
- 💧 Analgesia + hydration
- 🔍 Treat source (e.g. fungal infection, wound care)
⚡ Complications
- 🦠 Sepsis
- 🧬 Recurrent episodes → chronic lymphoedema
- 🔥 Abscess formation
🧠 Exam Tips
- 📌 “Red streak up the limb” = lymphangitis until proven otherwise
- 📌 Usually Group A Strep → think penicillin-sensitive organism
- 📌 Differentiate from cellulitis (diffuse) vs lymphangitis (linear tracking)
- 📌 Always assess for sepsis
