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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. Accessed July 21, 2012.

  • Acute inflammation of subcutaneous lymph channels

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

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

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

Signs and Symptoms

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

Means of Confirmation and Diagnosis

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

Laboratory Tests

  • 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.

Differential Diagnosis

  • Rapid eradication of infection
  • Prevention of further systemic complications

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

  • 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).

Table 1. Recommended Drugs and Dosing Regimens for Treatment of Lymphangitis

  • Signs and symptoms markedly decreased or absent within 24 hours of starting antibiotics.

  • Expect cure with recommended antibiotics.

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