Limfadenitis

LIMFADENITIS
FK-UISU
2013
Lymphadenitis is the inflammation

of a lymph node.
Lymph nodes
The glandlike masses of tissue in the
lymphatic system that contain
lymphocytes. The lymph nodes also
filter lymph, which is a clear yellowish
tissue fluid that carries lymphocytes
and fats throughout the body.
Lymphoid system of maxillofacial area:

1 glandula parotis; 2 nodi lymphatici occtpitales; 3 nodi lymphatici auriculares poster. 4
nodi lymphatici cervicales profundi superiores; 5 v. jugutaris dextra; 6 nodi lymphatici : cales
superficiales; 7 nodi lymphatici cervicales profundi inferiores; 8 nodi lymphatici auricu
anteriorea; 9 nodi lymphatici submaxillares; 10 nodulus lymphaticus submentalis; 11 a. ca
communis dextra; 12 truncus lymphaticus jugularis dexter.
THE MAINS WAYS OF FLOWING LYMPH FROM

LOWER AND APPER LIPS
Lymphadenitis :
Complication of bacterial infection, or
sometimes by virus and other
microbiological agents
May be generalized or limited to few
nodes
Is sometimes accompanied by
lymphangitis
Causes
Streptococcal
and staphylococcal
(most common)
Tuberculosis
Other
bacillus
: other bacterias, viruses,

protozoa, rickettsiae, fungi
CLINICAL CLASSIFICATION
OF LYMPHADENITIS
Non-spesific
: bacterias, viruses,
rickettsiae, protozoa, fungi
Spesific
: Mycobacterium tuberculosis
Other Classification :
Acute and Chronic
Non-spesific Lymphadenitis
Symptoms
Swollen
lymph nodes
Painful nodes, especially when
the doctor touches them
If the lymphadenitis is related to
an infected wound, the skin over
the nodes may be red and warm
to the touch
Fever
Diagnosis
Clinical
symptoms
Laboratory
:
Leucositosis, if caused by bacteria
Biopsy
Acute lymphadenitis
Chronic lymhadenitis
Removed lymph nodes
Treatment
The medications given for lymphadenitis

vary according to the bacterium or virus
that is causing it
Bacteria : Broad spectrum antibiotics, eg :

Cephalosporines, Quinolones
Supportive care : includes resting the

affected limb and treating the area with
hot moist compresses
Cellulitis associated with lymphadenitis

should be treated surgically because of
the risk of spreading the infection
Pus is drained only if there is an abscess

and usually after the patient has been
started on antibiotic treatment
In some cases, a biopsy of an inflamed

lymph node is necessary if no diagnosis
has been made and no response to
treatment has occurred.
Spesific Lymphadenitis
Introduction
Tuberculosis,
one of the oldest

diseases known to affect humans, is
a major cause of death worldwide.
This disease, which is caused by
bacteria of the Mycobacterium
tuberculosis complex affects the
lungs
Other organs are involved in up to
one-third of cases
Etiological Agent
M.
tuberculosis is a rod-shaped, nonspore-forming, thin aerobic

bacterium measuring 0.5 um by 3
um the bacilli cannot be decolorized
by acid alcohol; this characteristic
justifies their classification as acidfast bacilli.
History
Fever
Fatigue
Cough
and dyspnoea, especially if

lungs were affected
Weight loss
Painless swelling of the lymph nodes,
most commonly at posterior cervical
and supraclavicular sites.
Pathogenesis
Isolated
peripheral tuberculous
lymphadenopathy reactivation of
disease at a site seeded
hematogenously during primary TB
infection.
Clinical Presentation
The
most common presentation is

isolated chronic, nontender,
lymphadenopathy. The mass may be
present for up to 12 months before
diagnosis
firm discrete mass or matted

nodes fixed to surrounding
structures; the overlying skin may be
indurated. Uncommon findings
include fluctuance, draining sinus/
erythema nodosum
Cervical
lymphadenopathy is the
most common manifestation of TB
lymphadenitis.
A unilateral mass appears in the
anterior or posterior cervical
triangles; submandibular and
supraclavicular lymph node
involvement also occurs.
Bilateral disease is uncommon.
Multiple nodes may be involved at
that site.
The
axillary, inguinal, mesenteric,

mediastinal, and intramammary
lymph nodes.
Mediastinal lymphadenopathy
Dysphagia
Esophageal perforation
Vocal cord paralysis due to recurrent
laryngeal nerve involvement
Pulmonary artery occlusion
mimicking pulmonary embolism.
Tuberculous
peritoneal
lymphadenopathy i)periportal
region
ii)peripancreatic
iii)mesenteric lymph nodes.
iv)Hepatic lymph node
involvement can lead to jaundice,
portal vein thrombosis, and portal
hypertension
Extrinsic
compression of renal
arteries due to tuberculous
abdominal lymphadenopathy can
result in renovascular hypertension
Diagnosis
History
ESR
Sputum examination for AFB
TB Culture
Chest X-rays
BIOPSY
CT Scan & MRI (intraabdominal nodes)
The diagnosis is usually made by biopsy

(fine needle aspiration) of an affected lymph
node
Although AFB smears are positive in only

approximately 20% of cases,
granulomatous inflammation may be
obvious
Overall, biopsy has a sensitivity of 77% and

specificity of 93% for TB infection
Treatment
In
general, the same regimens are

used to treat pulmonary and
extrapulmonary tuberculosis, and
responses to antituberculous therapy
are similar in patients with HIV
infection and in those without.
Treatment
duration may need to be

extended, depending on drug
resistance, and in patients who have
a delayed or incomplete response.
six- to nine-month regimen (two

months of isoniazid, rifampin,
pyrazinamide, and ethambutol,
followed by four to seven months of
isoniazid and rifampin) is
recommended as initial therapy for
all forms of extrapulmonary
tuberculosis unless the organisms
are known or strongly suspected to
be resistant to the first-line drugs.
Regiments :
2 months of RHZE
4-7 months of RH
Evaluation :
Clinical symptoms
Lymph nodes characteristic
Biopsy, if needed
Physicians
should consider
noncompliance, malabsorption, and
drug resistance as possible reasons
for delayed or suboptimal response
to appropriate therapy
Directly
observed therapy (DOTS) is

strongly recommended to encourage
medication compliance
Special Cases
MDR TB
Multi-Drug Resistance TB
Resistance to at least 2 regiments of
antituberculosis (must include
Isoniazid)
Drug sensitivity test is needed
2nd line of antituberculosis
TERIMA KASIH

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LIMFADENITIS

Lymphadenitis is the inflammation

Lymphoid system of maxillofacial area:

THE MAINS WAYS OF FLOWING LYMPH FROM

: other bacterias, viruses,

Removed lymph nodes

The medications given for lymphadenitis

Bacteria : Broad spectrum antibiotics, eg :

Supportive care : includes resting the

Cellulitis associated with lymphadenitis

Pus is drained only if there is an abscess

In some cases, a biopsy of an inflamed

one of the oldest

tuberculosis is a rod-shaped, nonspore-forming, thin aerobic

and dyspnoea, especially if

most common presentation is

firm discrete mass or matted

axillary, inguinal, mesenteric,

The diagnosis is usually made by biopsy

Although AFB smears are positive in only

Overall, biopsy has a sensitivity of 77% and

general, the same regimens are

duration may need to be

six- to nine-month regimen (two

observed therapy (DOTS) is

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