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Source: Fish DN, Pendland SL, Danziger LH. Skin and Soft-Tissue Infections. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=8002378. Accessed July 21, 2012.

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  • Acute inflammation of subcutaneous lymph channels

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  • Most lesions caused by S. pyogenes.
  • Occurs secondary to puncture wounds, infected blisters, or other skin lesions.

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  • Skin lesions such as puncture wounds or infected blisters
  • History of a recent cut or abrasion

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  • Systemic manifestations often develop rapidly before sign of infection evident at initial site of inoculation.

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Signs and Symptoms

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  • Fever
  • Chills
  • Malaise
  • Headache
  • Enlarged and tender lymph nodes
  • Peripheral edema of involved extremity

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Means of Confirmation and Diagnosis

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  • Identification of peripheral lesion associated with proximal red linear streaks directed toward regional lymph nodes.

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Laboratory Tests

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  • Complete blood count (CBC): leukocytosis common.
  • Cultures often negative since offending organism is in lymphatic channels.
  • Gram stain of initial lesion helpful if done early.

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Differential Diagnosis

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  • Rapid eradication of infection
  • Prevention of further systemic complications

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  • Immobilization and elevation of affected extremity
  • Warm-water soaks every 2–4 hours

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  • Lymphangitis is a potentially serious and rapidly progressive infection.
  • Initiate treatment with IV penicillin for 2–3 days, then complete 10 days of therapy with oral penicillin VK (Table 1).

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Table Graphic Jump Location
Table 1. Recommended Drugs and Dosing Regimens for Treatment of Lymphangitis
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  • Signs and symptoms markedly decreased or absent within 24 hours of starting antibiotics.

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  • Expect cure with recommended antibiotics.

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