Lymphadenitis

The inflammatory process in the lymph nodes is often of a purulent nature called lymphadenitis. A common disease among children and adult patients is more often detected in the armpit, submaxillary, inguinal zone or in the neck.

Based on the severity of the course, lymphadenitis is divided into the following subspecies:

• with the formation of pus and non-pus;
• acute and chronic type;
• single and multiple foci (by the number of affected lymph nodes);
• specific and nonspecific form.

A nonspecific form of the disease is caused by strepto-, staphylococci, and other pyogenic microflora. The clinical picture is exacerbated by the release of toxins and degradation products from the primary lesion. Microorganisms from furuncles, carbuncles, infections of the upper respiratory tract (angina, pharyngitis, bronchitis, etc.), bacteria in erysipelas or trophic ulcers can become pathogens.

Specific pathology is caused by "cat scratch disease", tuberculosis, syphilis, etc. In this case, the provocators of lymphadenitis are specific infectious agents: candida fungi, Koch's stick, actinomycetes and the like.

Lymphadenitis: ICD-10 code

The international classifier of diseases of the tenth revision includes the XII class - "Infections of the skin and subcutaneous tissue" with a rubricator in which the lymphadenitis of the acute form corresponds to the L04 encoding. If there is a need to specify an infectious agent, use an additional identification with code B95-B97.

In turn, acute lymphadenitis is divided:

• L04.0 - pathological foci located in the face, neck, head;
• L04.1 - lymph nodes of the trunk are inflamed;
• L04.2 - the disease is found on the upper limbs (shoulders, axillary hollows);
• L04.3 - detection of affected nodes (pathology is acute) on the lower extremities (pelvic region);
• L04.8 - localization in other areas;
• L04.9 - Acute lymphadenitis of unspecified type.

Nonspecific form of lymphadenitis I88 is included in the section "Diseases of veins, lymphatic vessels and nodes", class IX:

• I88.0 - mesenteric lymphadenitis of nonspecific type (acute / chronic);
• I88.1 - chronic course of the disease, excluding mesenteric;
• I88.8 - other nonspecific lymphadenitis;
• I88.9 - nonspecific process, unspecified.

Causes of lymphadenitis

Lymphadenitis is a consequence of infection of the lymph node with pathogenic microorganisms, as a primary and independent disease develops extremely rarely. Bacteria-provocateurs of pathology are: streptococcus, staphylococcus, Pseudomonas aeruginosa, Escherichia coli, pneumococcus. Lymph node increases as a result of accumulation of cells in the inflammation zone. The ingestion of microorganisms into the lymph node is also possible by means of the lymphatic flow from the original lesion focus. For example, as a consequence of caries, purulent rashes on the skin, furuncle, etc.

Often the causes of lymphadenitis are found in diseases of internal organs. The presence of inflammatory processes of the intestine, infection in the ovaries, various liver diseases is dangerous hematogenous spread of pathogens (through the blood flow), settling in the lymphatic system and causing inflammation of the lymph node.

The contact method of destruction is the rarest, when the microbes enter the lymph node directly, which is possible if the lymph node integrity of the skin (for example, the wound) is lost.

Nonspecific infection is the most common cause of compaction, growth and inflammatory response from the lymph nodes. Called conditionally by pathogenic microorganisms, lymphadenitis is characteristic for: submaxillary, cervical, ulnar, inguinal, axillary, femoral, popliteal zones. Favorable conditions for the propagation of pathogenic microorganisms will be trauma, hypothermia, stress or pain, and so on.

Lymph nodes are protective filters that prevent the penetration and reproduction of pathogenic microflora in the human body. When the level of infectious particles (elements of dead cells, microorganisms, tumor components and others) is excessively large, the lymphatic system can not cope and the inflammatory process develops. Lymphadenitis indicates the weakening of immunity in view of various factors - elderly or vice versa, a young, not strengthened organism, mental or physical exhaustion, previous illnesses, etc.

Do not confuse the increase in lymph nodes and the inflammatory process in their tissues. The growth of the lymph node is caused by the production of a larger number of lymphocytes, in which antibodies are produced to fight a potential threat, which in itself indicates the performance of the lymphatic system of the protective function and does not belong to pathology.

[1], [2], [3], [4], [5]

How long does lymphadenitis last?

Remembering the types and characteristics of lymphadenitis, you can answer the question: "How long does lymphadenitis last?" The acute process is characterized by a sudden appearance with severe symptoms and a duration of up to two weeks. Inflammation of lymph nodes of a chronic type is a slow, hidden pathology without bright manifestations, which has been developing for more than a month.

It should be noted that non-nasal and purulent lymphadenitis can occur, both in acute and chronic form. Although the formation of suppuration is more often due to a sharp deterioration in the general condition characteristic of the acute course of the disease. A purulent process requires sanation and cleaning of the affected tissues. When the lymph node melts after opening the abscess, the cavity is drained. The healing rate of the wound surface also affects the duration of recovery.

As for specific lymphadenitis, the therapeutic effect is achieved at least eight months. Depending on the severity of the primary inflammatory process, treatment can be up to a year and a half.

Symptoms of lymphadenitis

The symptomatology of the disease largely depends on the type of lymphadenitis and helps the specialist to make the right diagnosis, as well as to choose the right therapeutic tactics. Common signs are: edema, local redness of the skin, temperature, limb limb restriction, chills, the quantitative content of leukocytes in the blood increases.

The following symptoms of lymphadenitis are distinguished:

• nonspecific chronic inflammation is a sluggish, latent process that does not manifest itself for a long time. It is characterized by a slight swelling of the skin adjacent to the affected lymph node and a low-grade fever (37 ^° C);
• acute lymphadenitis - has a pronounced symptomatology, namely: sharp soreness and an increase in the nodes, limiting the motor ability. Often, the condition is aggravated by a aching or dull character with a headache, general weakness, and temperature;
• the state of the purulent process is determined by a tugging, sharp pain syndrome. When palpation, the patient feels pain. The skin is red. As the disease progresses, the affected lymph nodes grow together with adjacent tissues, forming immobile seals;
• pathology of serous type - dull pain syndrome is localized in the region of regional lymph nodes, which are enlarged and are dense. For the initial stage, there is no evidence of inflammation on the skin, only after destructive processes in the tissue of the lymph node and accumulation of purulent contents, necrotic areas appear;
• adenoflegona - the stage into which purulent inflammation passes without proper therapy. Skin with signs of hyperemia, edema has blurred borders with softening foci. Among the obvious signs of pathology - high temperature, frequent heartbeats, chills, severe weakness, headache.

It must be remembered that lymphadenitis is a secondary disease that can mask serious problems (plague, tumors, tuberculosis, etc.). Differentiate the pathological condition can only a competent specialist, so it is important to seek advice in a timely manner.

Cervical lymphadenitis

The increase in cervical lymph nodes occurs as a result of infectious inflammatory processes of the upper respiratory tract (angina, pharyngitis, purulent otitis, etc.). Cervical lymphadenitis occurs mainly in children, as a consequence of influenza, SARS, pneumonia. In adulthood, it can indicate serious diseases such as tuberculosis or syphilis.

[6], [7], [8]

Submandibular lymphadenitis

In clinical practice, the most common cases of inflammation of the submaxillary lymph nodes. This pathology develops due to chronic tonsillitis, inflammation of the gums or neglected caries. Submandibular lymphadenitis is characterized by a gradual increase in symptoms. If at the first signs of pathology it is possible to determine the source of infection, then recovery comes quickly.

Inguinal lymphadenitis

Inguinal lymphadenitis is an example of a secondary inflammatory process when a pathogenic microflora enters the lymph node with a blood or lymph flow. Inguinal nodes are divided into three groups. The first - the largest - receives lymph from the buttock zone and the lower part of the peritoneum. Lymph in the second or medial group comes from the external genitalia, excretory and perineum. The latter group contains lymph of the lower extremities. The reaction of the nodes of the second group will indicate the presence of genital tract infection.

Inguinal lymphadenitis in women

The growth of lymph nodes in the size of the inguinal zone is observed with the penetration of microorganisms into the lymphatic channel. Common bacterium-pathogens are: strepto-, diplo- and staphylococci, Pseudomonas aeruginosa and E. Coli.

Inguinal lymphadenitis in women is formed as a result of cystic formations, infectious inflammation of the external / internal organs of the genital area, but can also indicate more serious diseases - syphilis, gonorrhea and others. As the primary focus, inguinal lymphadenitis is detected much less often, which is possible if the lymph node is infected by injury.

In addition to enlarging and compacting the inguinal nodes, the symptoms of lymphadenitis include:

• swelling, the acquisition of skin over inflamed lymph nodes of a red shade;
• pain syndrome of the lower abdomen and inguinal zone, which is noted during movement or physical effort;
• deterioration of general well-being;
• there may be an increased temperature.

The pathology of the inguinal nodes can be acute and chronic. The acute process is divided into serous (without pus, perhaps conservative treatment) and purulent forms. The appearance of purulent contents is easily suspected of a jerking, sharp pain. To avoid sepsis due to poured pus often resort to surgical intervention with excision of the lymph node.

Axillary lymphadenitis

Supraclavicular and subclavian lymph nodes collect the lymph of the area of the shoulders, neck, face, upper abdominal organs, as well as the anterior chest zone. Soreness of different intensity and an increase in lymph nodes under the armpits indicate an axillary lymphadenitis, the symptomatology of which is all the more pronounced, the more serious the disease is. The causative agents of pathology are: strepto-, staphylococcus, enterococci and their toxins, Escherichia coli, Proteus. Inflammation can occur due to trauma to the skin and direct entry of pathogens into the lymph node.

[9], [10], [11], [12], [13], [14], [15]

Acute lymphadenitis

The presence of an infection in the body, such as a boil, a purulent wound or a scratch, promotes the entry of bacteria into the lymphatic channel. The lymph brings the pathogenic flora to the lymph nodes, which become inflamed. So there is acute lymphadenitis, which manifests itself as a sharp, growing soreness, an increase in temperature and a worsening of the general condition.

[16], [17], [18], [19], [20], [21], [22], [23]

Subacute lymphadenitis

A very rare disease - subacute lymphadenitis in clinical manifestations in many ways resembles an acute inflammatory process in the lymph nodes. Differentiate this pathology by the primary immune response. The subtype of the species is characterized by a more intense red coloration of the skin in the region of the infected lymph node, which has a dense consistency than in the acute lymphadenitis. To confirm the diagnosis, a visual examination is not enough, therefore, cytological and histological examination is used.

Cytology reveals macrophages with a large number of cellular particles and leukocytes, as well as follicular hyperplasia at the cellular level. The analysis reveals single mast cells, basophilic cells and a huge number of lymphoblasts. The histological method allows to define a sharp outline of lymphatic follicles, an increase in blood vessels filled with blood.

In subacute form, a significant increase in body temperature is possible if pus formation occurs. In other cases, the temperature is close to subfebrile.

Chronic lymphadenitis

The chronic course of lymphadenitis is a consequence of an acute process or occurs as an independent disease, bypassing the acute stage. This difference is associated with microorganisms, pathogens.

Chronic lymphadenitis is accompanied by an increase in the nodes (often painless) and the preservation of their shape. The lymph node is not connected to nearby tissues, it has a round or oval shape. There are cases when the affected tissues of the lymph node are replaced by granulation cells, often sprouting beyond the node and thinning surrounding tissues. After a while, the skin breaks, a fistula is formed. Chronic inflammation can occur with the release of a small amount of pus, oozing outward and drying up in the form of a crust.

[24], [25], [26], [27], [28]

Generalized lymphadenitis

Simultaneous inflammation of several lymph nodes or their successive lesions is a generalized lymphadenitis. A fairly rare disease is a consequence of a primary infectious process, for example, generalized tuberculosis. Often the disease manifests itself and proceeds brightly with pronounced intoxication, and also progresses rapidly. In this case, all groups of lymph nodes are significantly enlarged, the inflammation rapidly envelops nearby tissues, spreading to internal organs. The generalized form can acquire a chronic course, gradually depleting the defenses of the body.

Inflammation of lymph nodes of generalized type is possible with the following diseases:

• bacterial infections - tuberculosis, syphilis, sepsis, etc .;
• tumors malignant / benign - leukemia, lung cancer, sarcoidosis, etc .;
• autoimmune problems - dermatomyositis, rheumatoid arthritis, lupus, etc .;
• accumulation diseases - Niemann-Pick disease and Gaucher disease;
• reactions to medicines and chemical compounds - pollinosis, allergic manifestations on drugs.

Hemorrhagic lymphadenitis

Hemorrhagic lymphadenitis is a special form of inflammation of the lymph nodes, in which dysfunction of capillary permeability leads to blood saturation of the lymph node. This is observed when anthrax or plague is affected.

Sibiriazvennoe inflammation is characterized by lymphangitis and regional lymphadenitis, but the increase in lymph nodes is painless. Inflammatory process has a prolonged course. Initially, the nodes that are in the immediate vicinity of the carbuncle are affected, and then the distant ones. However, suppuration of the lymph nodes is extremely rare.

Granulomatous lymphadenitis

Granulomatous lymphadenitis is characterized by the presence of granulomas or the formation of groups of histiocytes. On the course of the disease is divided into granulomas with epithelioid histiocytes and a purulent process.

Granulomatous inflammation develops as a result of the presence of mycobacteria (tuberculosis), spirochetes (syphilis), chlamydia (felinosis, Nicola Favre disease), pasteurell (adenitis, tularemia), and micrococcus (brucellosis) in the patient's body. Purulent granulomatous inflammations provoke chlamydia, cat scratch disease, diseases caused by microparasites (leishmania, turullas, toxoplasma, etc.).

The diagnosis is confirmed by bacteriological, immunohistochemical or serological methods, as well as specific skin tests and a molecular method (PCR).

Defeat more often covers regional lymph nodes, in which pathogenic flora gathers from the entrance gate of infection, but disseminated infection can develop. The degree of node enlargement, the intensity of pain sensations depend on the course of the inflammatory disease, its features and the primary focus clinic.

Specific lymphadenitis

Serious diseases such as tuberculosis, syphilis, HIV, plague and others cause infection of the lymphatic system, which is manifested by an increase in lymph nodes. And the main disease can still be at the stage of nucleation, and the lymph nodes in time "signal" about the hidden problem.

Specific lymphadenitis is classified into:

• viral;
• tubercular;
• actinomycotic;
• fungal;
• syphilitic;
• vaccinal and others.

A specific form of inflammation of the lymph nodes is characterized by a wide range of clinical manifestations. The defeat of the cervical nodes often indicates tuberculous lymphadenitis, an increase in nodes in the inguinal zone indicates a specific peritonitis. Supraclavicular nodes react if the primary infection is located on the pulmonary apex. The pathology of regional lymph nodes is observed after inoculations. A tumor is found on one or both sides. "Baby pruritus" or scrofula also causes a generalized growth of the nodes.

Specific lymphadenitis often has a chronic form with characteristic periods of exacerbation. Symptoms of the disease vary depending on the type of infection. The causative agent is identified on the basis of a blood test.

Tuberculous lymphadenitis

Penetration of the tubercle bacillus into the lymphatic system causes an increase in the nodes of the neck and submandibular zone. Over time, the lymph nodes soften, the pathological process covers nearby cells, and when the lymph node capsule is opened, a purulent mass of a crumbly consistency is found in the gray color. Often, tuberculous lymphadenitis, developing against a background of primary or secondary tuberculosis, is the cause of symmetrical inflammation of the lymph nodes. The tubercular form of inflammation rarely extends to inguinal lymph nodes.

When differentiating the disease, it is necessary to exclude fistulas on the neck, non-specific type of lymphadenitis, metastasis of malignant tumors, lymphosarcoma. A microscopic analysis of intracapsular pus helps to establish an accurate diagnosis.

Symptoms of inflammation of the lymph nodes are largely dependent on the progression of tuberculosis and the degree of damage to the tissues of the node. Palpation at the initial phase of the lesion does not reveal the soreness that is characteristic of the caseous period of decomposition and fistula formation.

Caseous lymphadenitis

Caseous lymphadenitis is a form of tuberculous lymphadenitis characterized by caseous decay of the tissues of the lymph node. In order to understand the aspects of the formation of this process, one should turn to the concept of primary tuberculosis, which develops when microbacteria enter the lungs. Infection is possible either by aerogenic or alimentary methods. Primary tuberculosis is detected more often in childhood and is divided into stages:

• the emergence of a primary lesion in the lung;
• lymphangitis - the spread of infection to the discharging lymphocytes;
• lymphadenitis - affection of regional nodes.

In the inflammation zone, tissue necrosis is observed, and serous edema gradually develops, leading to a casein-type pneumonia. The size of the primary tuberculosis region depends on the affected area (alveolitis, lobe, acini or segment). Specific inflammation soon enough covers the adjacent to the primary focal lymphatic vessels. Formed to the root of the lung, lymphostasis and characteristic swelling with tubercles in the peribronchial and perivascular tissue make the basal nodes accessible to infection. So comes the second stage - lymphangitis, which spreads to the regional lymph nodes, where caseous necrosis soon appears. The growth of lymph nodes in size determines the total lesion and the onset of caseous lymphadenitis.

[29], [30], [31]

Nonspecific lymphadenitis

Staphylococcal and streptococcal infections are the cause of the appearance of non-specific type lymphadenitis. The primary focus of inflammation is a festering scratch or wound, erysipelas, boils, ulcers on the skin, etc. Disease-causing microorganisms affect the lymph nodes, spreading with a current of lymph, blood or directly when the node is injured.

Nonspecific lymphadenitis is classified according to the type of flow on:

• acute - more often, as a serous form. It is possible to increase one or a group of lymph nodes that are painful and elastic in consistency;
• chronic - acts as a primary disease (the result of inflammatory chronic processes: tonsillitis, dental problems, etc.) or is a consequence of acute inflammation of the lymph nodes.

The acute course is characterized by a lack of symptoms or a slight change in the general condition of the patient. The severity of the inflammatory signs of lymph nodes is largely dependent on the primary focus. Overgrowth of the disease from the serous form to the purulent stage causes the temperature increase, weakness, malaise. The next signs of the progression of inflammation will be pain syndrome and the immobility of the lymph node.

Chronic type of nonspecific process is not peculiar to the formation of pus. Lymphonoduses for a long time remain enlarged, practically painless and not soldered to surrounding tissues. Sometimes the spread of connective tissue in the lymph node is fraught with problems of lymph circulation, swelling, lymphostasis, elephantiasis.

Reactive lymphadenitis

Reactive lymphadenitis is the stage of inflammation of the lymph nodes caused by local disorders in the body. The reactive form is characterized by the development of a pathological focus in the absence of predisposing factors. For example, with tuberculous lymphadenitis, the pathogen did not give any symptoms (a latent process), only the diagnosis of enlarged lymph nodes revealed a pathogen.

It can be said that often the reactive phase accompanies the acute course of inflammation. However, it occurs in chronic disease of the exacerbation period, which is characterized by an active reaction on the part of the body.

Reactive lymphadenitis is manifested as a result of the failure of the immune forces of children or because of the prepared organism, which already knows the microorganism and there are antibodies for its suppression. Recall, a sample of mantu, showing the response of the body to the tubercle bacillus. The presence of the cuticle indicates an infection. A similar mechanism of immune recall reflects the lymph nodes.

The reactive course of inflammation is always a rapid process, which means fighting with the source of infection, when the other parts of the body's defense system have not yet "become involved in a confrontation". The reactive phase changes quite rapidly. Thus, recovery may occur if the infectious agent has been suppressed in time by the body's immune forces.

Lymphadenitis behind the ear

Often there is inflammation of the lymph nodes behind the ears. The reason for the enlargement of the node in size is the complication of suppurative and inflammatory processes in the body during the multiplication of pyogenic agents. Predisposing factors are catarrhal diseases (angina, pharyngitis, runny nose, etc.), pathology of the eyes, ears (fungal lesions, herpes, etc.) or allergic reactions.

Lymphadenitis behind the ear can be purulent / non-fleeting in nature, proceed in acute / chronic form, cover one or a group of nodes. The clinical picture of the disease manifests itself with the formation of a Bumpkin, which is painful and pain spreads into the ear, which often confuses the patient from the point of view. The general condition worsens: there is a headache, the temperature is observed in the purulent course of the disease, the pain syndrome acquires a "shooting" character, and in some cases, the redness of the skin of the area of the inflamed lymph node is possible.

The growth of BTE in size sometimes causes lymphoma, various cancers of lymph nodes. Active hair loss on the head, bothersome itching and the presence of scaling of the skin often indicate a fungal lesion. In any case, you should not independently establish a diagnosis and prescribe yourself a cure. Timely appeal to a specialist will save you from mistakes that provoke irreparable complications.

BTE Lymphadenitis

The growth of lymph nodes behind the ears signals the need to undergo a survey. Inflammation of the nodes can indicate both the reaction of the body's defenses and the presence of an infectious agent. Diseases of the throat, ears, eyes, some allergic manifestations cause the spread of pathogenic flora with a current of lymph. A large volume of pathogens, deposited in the lymph nodes, often provoke a bovine lymphadenitis. The inflammatory process can be a harbinger of serious diseases, such as cancerous tumors.

Lymphadenitis has a direct relationship with the primary lesion of a viral, fungal or viral nature. So, peeling of the skin of the head, strong hair loss and incessant itching - symptoms of a fungal disease. Frequent colds, various diseases of the upper respiratory tract make it possible for microorganisms to enter the lymphatic system. Problems with the oral cavity, untreated or neglected caries, diseases of the organs of vision are also the cause of inflammatory enlargement of the lymph nodes.

The finding of a primary and secondary focus in the immediate vicinity of the brain represents a danger to the patient in the form of complications, a severe course of the disease and a prolonged recovery. Only a timely request for medical help will avoid all negative consequences and restore health in a short time.

[32], [33], [34]

Lymphadenitis of the face and neck

The face is the site of localization of the buccal, mandibular, chin, parotid, and also the smallest lymph nodes located near the nasolabial fold and in the inner corners of the eyes. On the neck are the chains of superficial and deep (pharyngeal) lymph nodes. The pharyngeal nodes receive lymph from the posterior parts of the nasal cavity, partly from the sky zone. In the lymph nodes of the cheeks, lower and submandibular, the chin lymph flows from: the mouth cavity, the paranasal sinuses, teeth, mucous membranes, jaws, salivary glands. Diseases of these organs contribute to the spread of infection through the lymphatic system and cause lymphadenitis of the face and neck.

Inflammation of the nodes of the submaxillary, chin and cervical zones can be odontogenic or non-dental. Odontogenic processes are characterized by pathological interrelation with the dentoalveolar system, often develop against a background of periostitis of the period of exacerbation, chronic periodontitis, acute pericoronitis. Inflammations of the lymph nodes of the non-pediatric type include otogenic, rhinogenic and dental (formed as a result of stomatitis, otitis, glossitis, gingivitis, etc.).

Lymphadenitis of throat

Viruses that provoke various diseases of the upper respiratory tract (angina, pharyngitis, laryngitis, etc.) or the oral cavity (stomatitis, diphtheria, etc.), can cause inflammation of the lymph nodes in the neck, as well as in the submaxillary zone. As a secondary pathological process, throat lymphadenitis often disappears when treating the underlying cause. For example, cervical lymph nodes come to normal with appropriate therapy of angina.

Symptoms of inflammation of the lymph nodes of the throat:

• the growth of the node in size - the value varies from a small pea to a chicken egg;
• the presence of pain syndrome - discomfort is felt during swallowing or palpation;
• general malaise - weakness, fever, headache, etc.

The defeat of the lymph nodes of the throat region is possible without the accompanying disease, against the background of a significant weakening of the body's immune forces. In this case, the clinical picture is poorly expressed: there is a slight increase in lymph nodes, during the examination and when swallowing there may be a slight soreness. The patient's body, as a rule, is weakened by frequent catarrhal diseases.

Occipital lymphadenitis

The identification of the reasons for the development of the occipital lymphadenitis helps in the shortest possible time to eliminate the primary disease and cope with the inflammation of the lymph nodes. For example, the infections of the scalp, which occur against the background of dermatophytosis or lice, create conditions for the defeat of the occipital lymph nodes.

Generalized viruses serve as an important diagnostic factor for occipital lymphadenitis accompanying measles rubella. With this pathology, inflammation of the posterior nodes is also possible, and a generalized form of lymphadenopathy is sometimes formed. The symptomatology of the secondary pathological process manifests itself earlier than the skin rashes differentiate. In the case of occipital lymphadenitis, the nodes are slightly enlarged, have a soft-elastic consistency, easily shift during palpation, without pain syndrome.

To diseases that cause the growth of the occipital lymph nodes, chicken pox is included. Typical manifestations of the disease will be fever, rash on the skin, violations of the upper respiratory tract. Specific infections of syphilis and tuberculosis rarely infect the cervical and occipital lymph nodes.

Pronounced lymphadenitis

Lymphadenitis of the neck region is dangerous for immediate proximity to the brain, so it is important to diagnose the disease at an early stage and undergo appropriate treatment.

Supernumerary lymphadenitis is a common phenomenon in rubella. In addition to enlarging the lymph nodes, patients complain of limited neck movement due to severe pain syndrome. In parallel, there is inflammation of the nodes near the ears, as well as the occipital region. It is interesting that pathological growth of lymph nodes occurs earlier than the appearance of a characteristic red rash.

The identification of the causes of the inflammatory process and the growth of the volume of lymph nodes located on the back of the neck is, in most cases, a difficulty. This is due to the fact that not only an infectious disease, but also more serious ailments, such as tuberculosis, can act as a provocateur of inflammation. In the process of differential diagnosis, it is necessary to provide for the ability to form lymphoma, the development of lymph node metastases due to malignant neoplasms of the neck and head.

Mesenteric lymphadenitis

Disease of lymph nodes of the mesentery of the intestine develops more often in infants, occurs with signs of intoxication and characteristic pain of the abdominal zone. The reasons for the appearance of pathology can be many:

• viruses of acute respiratory processes (adeno- / enteroviruses);
• cytomegalovirus;
• the causative agent of tuberculosis;
• Intestinal infections (Campylobacter, Salmonella, etc.);
• staphylo- and streptococci;
• the Epstein-Barr virus.

It should be noted that a large number of lymph nodes are located in the abdominal cavity, therefore mesenteric lymphadenitis can occur when any pathogenic microorganisms of a viral or bacterial nature come from them from the primary inflammation focus.

The disease begins with an acute pain syndrome to the right of the navel, but the general condition of the patient remains stable. As the inflammation progresses, nausea, vomiting, not bringing relief, nausea, fever. The clinical picture is complemented by a violation of the stool. Such symptoms last for several days and require an immediate appeal to a specialist, since the lack of proper treatment threatens with serious complications.

Lymphadenitis of the intestine

Mesadenitis is called lymphadenitis of the intestine, which is classified into the following forms:

Nonspecific inflammation:

• simple / purulent;
• pseudotuberculous / tuberculous.

By type of flow:

• chronic / acute.

Inflammation of the lymph nodes of the peritoneal zone arises from the hematogenous pathway (through the bloodstream), directly through the intestine (saliva, sputum). The causative agents of pathology are upper respiratory tract infections, inflammatory processes of the appendix and other parts of the digestive tract. When making a diagnosis by differential diagnosis, you should exclude: •

• an attack of acute appendicitis;
• infection with helminths;
• abdominal vasculitis of hemorrhagic type;
• lymphogranulomatosis.

Lymphadenitis of the intestine is manifested by pain of the lower abdomen near the navel. The disease is accompanied by fever, nausea, a slight increase in temperature, a violation of excretory function (constipation or diarrhea). If the main focus in the upper respiratory tract, the pathological condition exacerbates the symptoms of colds (runny nose, cough, etc.).

Among the complications of the disease are isolated - suppuration of the mesenteric nodes, entailing an abscess, sepsis, intestinal obstruction due to adhesive processes.

Lymphangitis and lymphadenitis

Secondary inflammatory process in the capillaries and trunks of the lymphatic channel is called lymphangitis. Pathology is observed in purulent-inflammatory diseases as a result of superficial (scratch, wound) or deep lesions (carbuncle, furuncle). Infectious agents in most cases are strepto-, staphylococci, but in clinical practice there are such pathogens as: protey, intestinal and tubercle bacillus and other microorganisms.

Quite often simultaneously, lymphangitis and lymphadenitis of regional type are detected accompanied by puffiness, hyperemia along the course of lymphocytes, pain syndrome, fever, chills and general weakness. Manifestations of superficial lymphangitis outwardly resemble erysipelas, along the vascular bed, seals in the form of a cord or rosary are felt. The defeat of the deep vessels of the lymphatic system is not accompanied by severe hyperemia, but the swelling is clearly visible and painful sensations remain.

For diagnostic purposes, computer thermal scanning, ultrasonic angioscanning, detection of the source of infection and excretion of the pathogen are used. In the treatment of lymphangitis an important place is occupied by the elimination of the primary foci of suppuration and the use of antibiotics. Locally apply compresses and ointment dressings, use mud treatment and X-ray treatment.

Odontogenic lymphadenitis

Acute serous inflammatory process in the submaxillary lymph nodes without the necessary treatment is transformed into a new stage, called odontogenic lymphadenitis. Lymph node - increased, pain syndrome - shooting character. Often the body temperature rises, the appetite and general condition of the patient worsen. In the case of pus formation, a person is able to acquire asymmetry due to accumulated infiltration. The skin of the skin becomes swollen with a red tinge. Palpation causes discomfort. Acute purulent process covers nearby tissues, symptoms of intoxication appear.

The cause of pathology is dental disease. Infection of the oral cavity penetrates not only in the proximal jaws, but also in the parotid, buccal, chin, superficial and deep cervical lymph nodes. The pain of the area of the affected nodes increases with head movement. Difficulty with opening the mouth is only observed if the purulent process is spreading to the chewing muscles.

Complication of odontogenic lymphadenitis is an abscess or adenophlegmon.

Lymphadenitis of cervical lymph nodes

The specific character of cervical lymphadenitis of tubercular nature has a number of distinctive features:

• Affected lymph nodes are soldered to each other, but do not involve nearby tissues in the pathological process;
• more often without pain syndrome, which is confirmed by palpation;
• In most cases, the inflammation is asymmetric.

Tuberculous lymphadenitis of the cervical lymph nodes most often acquires a chronic course. And only in half of cases the primary focus is found in the lungs. In clinical practice, there are atypical forms of mycobacteria, difficult to give in to traditional therapy, so often lymph nodes have to be excised.

Presence on the head of primary syphiloma (usually a region of tongue / lips) is the cause of the appearance of cervical lymphadenitis, in which the nodes are tightly elastic, not fused with each other and the surrounding tissue, are mobile. During the examination of patients, the latter note the absence of pain, and the size of the inflamed lymph nodes varies in each specific case.

The cervical nodes of children under 5 years of age become inflamed with Kawasaki's disease, accompanied by a febrile condition, skin rash, erythema on the soles and palms. The peculiarity of the disease is that it can not be treated with antibiotics.

Lymphadenitis of the lower extremities

Lower extremities contain two groups of large nodes: popliteal and inguinal, which in turn are subdivided into superficial and deep located. The lymph from the abdominal region, the genital area and the gluteal region falls into the inguinal nodes, so the presence of infection in these organs provokes their inflammation. Viruses and bacteria that cause a pathological lesion in the legs (for example, a purulent wound) can also spread to the popliteal and inguinal nodules. Malignant tumors can metastasize to the nodes of the groin area, thereby causing their growth.

The onset of the disease is determined by an increase in lymph nodes, a painful pressure. Purulent lymphadenitis of the lower limbs causes an increase in temperature, a swelling of the affected area. Spreading of pus on nearby tissues is dangerous by the formation of phlegmon.

Therapy includes the use of antibacterial complexes under the supervision of a specialist. The lack of treatment threatens the spread of infection to neighboring lymph nodes, as well as throughout the body.

Femoral lymphadenitis

The growth of the femoral and inguinal lymph nodes is observed in the bubonic form of the plague. The disease is accompanied by a strong fever, as well as signs of intoxication. A week later the suppuration of the node develops and a lymphatic fistula is formed.

Femoral lymphadenitis is sometimes diagnosed with cat scratch disease, although axillary and ulnar lymph nodes often become inflamed. If the pathological process is started, then there is a fluctuation with purulent softening of the nodes.

The popliteal lymph nodes take the lymph from the area of the feet, therefore, it is timely to treat them with wounds, scrapes, open abscesses and other purulent formations.

Inguinal lymph nodes are inflamed due to chlamydia, pathology is caused by infections of the genital area (venereal disease, syphilis, AIDS, Nicola Favre disease). And in the focus of the lesion is often involved a group of nodes, welded together and with surrounding tissues.

The cause of femoral lymphadenitis are carbuncles, furuncles, thrombophlebitis of the lower extremities. Infections are not only bacterial in nature, but are caused by viruses and protozoa. If it is impossible to determine the root cause of inflammation, the inflammation continues in the lymph node, which can lead to suppuration and melting of the node.

[35], [36], [37], [38], [39]

Lymphadenitis of the abdominal cavity

Infectious practice indicates a wide spread of nonspecific mesenteric lymphadenitis, which is most often found in childhood, but is also detected in adult patients.

Mesadenitis or lymphadenitis of the abdominal cavity is formed in acute respiratory processes, under the influence of causative agents of intestinal diseases, and also as a result of the presence of bacteria, which provokes mononucleosis and tuberculosis. The peritoneum zone is a favorite breeding ground for pathogens. If the immune system can not cope with the number of viruses, then the main impact falls on the lymph nodes of the mesentery.

The first signs of pathology are easily confused with the usual indigestion or symptoms of intoxication. The pain is localized near the navel on the right, more down the abdomen. The pain syndrome increases with the development of inflammation, acquiring a aching, cramping character of varying intensity. The condition is supplemented by fever, nausea, vomiting, impaired excretory function. The formation of pus in the capsule of the affected lymph node is expressed by chills, fever, tachycardia and a sharp deterioration in the state of health.

Lymphadenitis of the abdominal cavity requires qualified treatment, otherwise complications such as peritonitis, adhesions of the peritoneum, abscess and septicemia are possible.

Lymphadenitis of the lungs

Inflammation of the intrathoracic lymph nodes is a form of primary tuberculosis, which develops immediately after infection. Such a disease has become widespread especially among children, during adolescence, which is associated with vaccination and insufficiently strengthened immunity of patients of this age group.

Lymphadenitis of the lungs varies in different ways, depending on the location of the inflammation, the extent of the pathological focus and the increase in lymph nodes. Symptoms of the disease:

• cough, as in whooping cough, especially excruciating the patient at night;
• overgrowth of dry, unproductive cough in wet with sputum discharge;
• noisy breathing;
• irritability;
• night chill;
• feverish condition;
• pain in the chest;
• signs of intoxication;
• weakness.

Clinical practice is known cases of asymptomatic disease, when lung lymphadenitis is diagnosed only when a routine examination. The help in differentiating pathology is exacerbated by the increase in surface nodes.

Inflammation of lung tissue is often combined with lymphadenitis and lymphangitis. The defeat of the lymph nodes is revealed by X-ray methods.

Lymphadenitis of the breast

The mammary gland is conventionally divided into four parts:

• two quadrants outside;
• two quadrants inside.

Lymph outflow from the outer quadrants enters the axillary lymph nodes. The inner quadrants of the breast are associated with the parasternal lymph nodes. It should be noted that the mammary gland undergoes changes in various stages of the menstrual cycle, during pregnancy and breastfeeding.

Under regional inflammation is understood as a local lesion of lymph nodes. Symptoms of the disease begin with a pathological process in the nodes of the armpit, the area of the mammary glands, sub- and supraclavicular lymph nodes. Lymphadenitis of the breast most often provokes strepto- and staphylococci, less often - gono- and pneumococci. Infection comes from the primary inflammation focus located directly on the chest (purulent wounds, skin diseases), or by lymphogenous / hematogenous pathway from other affected organs and systems.

The clinical picture includes: the increase and soreness of the lymph nodes, the skin over the affected node is hyperemic and tense. The patient's condition worsens with the formation of a purulent inflammation in the focus.

Left-sided lymphadenitis

Lymphadenitis is a disease that causes a single inflammation of the lymph node (local lesion) or a group of nodes (regional damage). Pathology can be detected from one or both sides, more often in the armpits and groin. The active growth of lymph nodes in size and sharp soreness indicates the development of a pathological focus.

Complication after vaccination BCG is a tuberculous inflammation of the lymphatic system, to which children are susceptible. The cause of the disease are:

• decrease in the resistance of the body due to frequent colds, with severe diathesis, rickets, etc .;
• inoculation of premature infants;
• the introduction of an excessive amount of vaccine.

The consequence of vaccination will be axillary left-sided lymphadenitis with the characteristic pain syndrome, often accompanied by lymphangitis.

Atypical mycobacteria of the face and in the oral cavity provoke one-sided inflammation of the lymph nodes of the lower jaw. The defeat of the cervical nodes on the left or right is due to the infectious inflammatory process in the body (tonsillitis, influenza, tonsillitis, pneumonia and others).

Right-sided lymphadenitis

Right-sided lymphadenitis occurs in various pathologies. For example, the culprits of inflammation of the lymph nodes on the right lower from the navel are infections of a viral etiology such as: gastroenteritis, ENT diseases. Attacks proceed in an acute form, resembling an inflammation of an appendix with the expressed symptoms of intoxication.

The enlargement of submandibular lymph nodes on the right side causes the pathology of the oral cavity of the same part of the face (untreated caries, gum disease, various chronic diseases).

The only sign of a mononucleosis of infectious nature is inflammation of the cervical lymph nodes on one side or symmetrically. With odontogenic lymphadenitis, the face of the patient becomes skewed to the side where the pathological process of the lymph node was formed. If there is an infected tooth on the right side of the jaw, then right-sided lymphadenitis develops. Inflammation begins with nearby nodes (the area of the main reservoir), later signs of the disease are detected during the course of the lymph flow or spread by blood flow.

Bilateral lymphadenitis

The expressed bilateral lymphadenitis is formed as a result of:

• infectious mononucleosis;
• syphilis secondary type;
• infiltrative lesion;
• the detection of toxoplasma;
• therapy with phenytoin and other diseases.

When infecting with primary syphilis, the symmetrical inflammatory process of the inguinal and submandibular nodes is widespread to the size of a large bean or nut. In parallel, the pathology is detected in the lymphatic vessel leading to the affected lymph node.

Such a disease, like rubella, provokes an increase in the behind-the-back, zadnesheynyh and occipital nodes more often from two sides. The growth of lymph nodes is noted in the absence of a characteristic red rash. Complaints of patients are reduced to pain when turning the neck.

Odontogenic source of infection in acute or chronic leukemia, as a rule, is localized in the lymph nodes of the neck, submandibular zone and on the face. In this case, inflammation is more often unilateral, but there is also a bilateral defeat due to a decrease in the body's defenses.

[40], [41], [42], [43], [44]

Supraclavicular lymphadenitis

When the supraclavicular lymph nodes are inflamed, lymphoma, infectious and tumor processes of the breast organs, infections and tumor neoplasms of the peritoneum organs should be excluded. Tumors of the gastrointestinal tract often cause an increase in lymph nodes above the clavicle, mainly on the left. Metastases in the area of supraclavicular lymph nodes can also give rise to neoplasms of the genital, chest, and lungs.

An important differential sign is supraclavicular lymphadenitis. For example, the growth of the node in the right supraclavicular fossa is detected with a malignant lower lobe lesion of the lung.

Inspection and diagnosis of inflammation of supraclavicular nodes are performed as follows:

• the patient is in a sitting position with his hands down, his gaze is directed forward;
• the doctor is standing behind the patient;
• the chance of finding enlarged nodes in the supraclavicular fossa increases in the supine position;
• a Valsalva test is performed, helping to move the angle closer to the skin surface (sometimes even a slight cough helps).

Lymphadenitis in adults

The body of an adult can resist various viruses and bacteria. This is made possible by the lymphatic system providing protective and drainage functions. The increase in lymph nodes indicates the presence of an infection in the body and that the immune system has reacted by providing antibodies to disease-causing micro-organisms.

Lymphadenitis in adults often occurs asymptomatically or against the background of a slight deterioration in well-being. First of all cervical, submaxillary, axillary and inguinal nodes become inflamed. The cause of pathology is purulent processes of various organs (furuncle, erysipelas, etc.), severe diseases (tuberculosis, plague, etc.). Factors-provocators of lymphadenitis in adult patients are: stress, hypothermia, a decrease in protective forces. As a primary disease, inflammation of the lymph nodes is extremely rare with direct infection of the node in case of injury (trauma).

Lymph nodes of the groin area become inflamed more often in adulthood and indicate problems with the organs of the genital area, can foretell the presence of a venereal disease. Lymphadenitis of cervical nodes is considered a rather serious pathology in adults and requires immediate consultation of a dentist, an otolaryngologist.

Lymphadenitis in children

Inflammation of lymph nodes in childhood appears much brighter and more intense than in adult patients. Lymphadenitis in children is provoked by various infections, often the upper respiratory tract. Such diseases as: tonsillitis, SARS, tonsillitis, caries, etc. Increase the submandibular lymph nodes. In clinical practice, cases of involvement of cervical, popliteal, axillary nodes are much less common. Inguinal lymphadenitis in infants is even more rare, differentiating as a result of infringement of inguinal hernia.

Lymphadenitis in pregnant women

Inflammation of the lymph nodes during the gestation of the baby is due to infectious and inflammatory processes and a decrease in immunity. Lymphadenitis in pregnant women mainly proceeds in a catarrhal and purulent form.

Purulent inflammation is dangerous for its consequences:

• lymphangitis - the disease spreads to the walls of lymphatic vessels;
• thrombophlebitis - damage to the circulatory system;
• a violation in the work of organs or systems of the organism of the future mother.

Chronic processes often occur during pregnancy, for this reason, women are recommended to be examined before conception. A visit to the dentist and an otolaryngologist is compulsory.

The detection of lymphadenitis after pregnancy requires an immediate appeal to a specialist. Therapy is carried out with the help of antibiotics, more often cephalosporins or macrolides. Purulent formations in the lymph nodes are subject to surgical treatment.

Lack of proper and timely treatment threatens irreparable consequences for the fetus (delay in development, infection, etc.). The presence of chronic inflammation can affect subsequent pregnancies.

What is dangerous for lymphadenitis?

Progression of the inflammatory focus in the lymph nodes often entails hemorrhagic, fibrinous, serous purulent changes. Lymphadenitis of the neglected stage without proper treatment provokes irreversible processes: tissue necrosis, abscess formation, and chorious destruction of lymph nodes, sepsis (blood infection).

Simple inflammation does not spread over the lymphatic capsule. Pathology with destructive manifestations covers nearby tissues, increasing the affected area several times. Nonspecific form of the disease is peculiar to grow into thrombophlebitis with the formation of metastatic foci of infection (septicopyemia, lymphatic fistula).

The chronic inflammatory process is dangerous because in most cases it proceeds secretly, without significant symptoms, indicating a decrease in the body's defenses and threatening degeneration of the lymph nodes. Typical complications of lymphadenitis of a chronic nonspecific type are: swelling, elephantiasis (proliferation of connective tissue), lymphostasis, dysfunction of lymph circulation.

Consequences of lymphadenitis

Lymphadenitis is frightening of the possibility of spreading infection, cancer cells through the body through the bloodstream or the lymphatic system. The absence of an effective and correct treatment regimen can lead to death.

The consequences of lymphadenitis concern the violation of lymph circulation, the penetration of pus into the surrounding tissue, the development of elephantiasis, the formation of torticollis in toddlers.

[45], [46], [47], [48], [49], [50], [51], [52], [53]

Complications of lymphadenitis

Without the necessary treatment, lymphadenitis threatens with disability and even death of the patient. Complications of lymphadenitis:

• osteomyelitis;
• abscess;
• encephalitis;
• meningitis;
• arthritis of the septic species;
• sepsis.

[54], [55], [56], [57], [58], [59]

Diagnosis of lymphadenitis

Lymph nodes of a healthy person can be palpable with difficulty. It is possible to do this with a lean physique in childhood and adolescence. The growth of nodes in size is an important criterion for differentiating diseases on an early form, but signals the presence of viruses and bacteria in slow, latent processes.

The initial diagnosis of lymphadenitis involves the palpation of inflamed nodes, after which instrumental and laboratory techniques are prescribed:

• study of blood composition;
• histological analysis (taking a sample of tissue from the affected node);
• when lymphadenitis of a specific species, focus on the possibility of contact with the carrier of tuberculosis and make skin tests with laboratory testing (blood, sputum), as well as x-rays;
• purulent inflammation requires surgical opening of the capsule of the lymph node, if necessary - draining the wound;
• an increase in inguinal nodules is a signal for the exclusion of a hernia in the groin;
• the examination of children begins with suspicion of Quincke's edema, tumor formation of the cervical zone and exclusion of congenital cysts;
• often used - ultrasound, counseling ENT doctor, computed tomography, HIV test.

[60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70]

Blood test for lymphadenitis

Quantitative and qualitative characteristics of the composition can reveal a blood test for lymphadenitis. In addition to the general analysis, the leukoformula and the LDH (lactate dehydrogenase) level, characteristic of leukemia and lymphoma, are counted. Excess of ESR content indicates inflammatory and tumor processes. Required examination of the peripheral blood smear for the purpose of determining infectious mononucleosis.

Uric acid and transaminase (indicating hepatitis) in the analysis of blood for biochemistry are the basic criteria for systemic pathologies (autoimmune diseases, malignant neoplasms).

[71], [72], [73], [74], [75], [76], [77], [78]

Lymphadenitis on ultrasound

Ultrasound-based research helps to track the effectiveness of antibiotic therapy. For this purpose, the size of the affected node is fixed before and after treatment.

Lymph nodes are normally oval or bean-shaped, arranged in groups. The characteristics of the nodes (shape, size, structure, number, location) vary depending on the age, individual characteristics of the patient's body.

Lymphadenitis on the uzi is marked by a number of features:

• nodes are enlarged in size;
• the lymph node capsule is tense;
• the vascular pattern is strengthened;
• cortical and near-cortical zones are considerably expanded;
• is determined by puffiness;
• may have anechogenous areas;
• hyperplastic and blocked nodes are observed;
• sometimes metastatic changes are detected.

Thanks to ultrasound, it is possible to identify the relationship of the lymph node and adjacent tissues-the presence of a connection, the presence of connective tissue, the preservation of the integrity of the capsule of the node, the spread of the tumor process, and adherence to nearby organs (for example, a vessel).

Treatment of lymphadenitis

Lymphadenitis therapy primarily depends on the form of the inflammatory process (acute / chronic course, specific / non-specific nature of the lesion). At the initial stage, lymphadenitis treatment combines conservative methods with physiotherapy and gentle regimen. An important place is to eliminate the primary focus of infection: purging a purulent wound, installing a drainage system, etc. When a pathogen is identified, antibacterial therapy is prescribed. In case of purulent inflammation of the lymph node, the capsule is opened and cleaned. For chronic inflammation of the lymph nodes, the main task will be to get rid of the source of infection.

Which doctor treats lymphadenitis?

Inflammation of the lymph nodes is the reason for applying to the therapist, which sends to the consultation of an endocrinologist, surgeon or oncologist. The choice of a specialist largely depends on the nature of the course of lymphadenitis and the severity of the initial lesion. Often, an infectious disease specialist, a hematologist or a rheumatologist is required to be examined.

The duration of treatment for a specific type of lymphadenitis depends on the severity of the underlying ailment and the correctness of the therapeutic regimen.

Prevention of lymphadenitis

Prevention of acute and chronic type of inflammation of lymph nodes is the timely treatment of primary diseases: tonsillitis, tonsillitis, purulent skin lesions, osteomyelitis, rhinitis, gingivitis, boils, carbuncles and various infectious diseases (influenza, ARVI, etc.). Prevention of lymphadenitis also includes anti-caries measures: systematic visits to the dentist for the treatment of caries, stomatitis and other pathological foci of the oral cavity.

Nursing mothers are recommended to carefully monitor the hygiene of the mammary glands, not to allow the development of lactostasis. In cases of infectious diseases it is important to comply with all the prescribing doctor's instructions regarding antibacterial therapy. Do not independently reduce the period of taking antibiotics or replace the prescribed drug with another drug.

Preventive measures to prevent inflammation of the lymph nodes are the timely removal of splinters, the treatment of abrasions, microcracks and cuts with the imposition of antiseptic dressings.

Immunocorrecting programs help to increase the defenses of the body and more effectively combat the pathogenic microflora.

Prognosis of lymphadenitis

Nonspecific acute lymphadenitis at the onset of development in the provision of quality treatment often has a favorable prognosis. The destructive course of the inflammatory process terminates with the destruction of the lymph node and subsequent scarring. Progression of acute forms of lymphadenitis of the extremities provokes impaired lymphatic drainage, the formation of lymphostasis, and subsequently - to elephantiasis.

Purulent type of inflammation threatens with periadenitis (pathology extends to surrounding tissues), an abscess or phlegmon / adenophlegmon that requires prolonged treatment is formed around the melted node. The outcome of the disease is often thrombophlebitis, lymphatic fistula.

Prognosis of chronic lymphadenitis is favorable in establishing the root cause of inflammation and timely therapy. Negative consequences may be scarring, swelling of the tissue over the affected node. As a result of contraction and consolidation of the lymph node, connective cells are spreading, and lymph circulation is disturbed.

Lymphadenitis is able to pass independently in the case of timely and effective treatment of the main purulent-inflammatory disease. Therefore, at the first symptoms of inflammation of the lymph nodes it is necessary to visit the doctor and follow his prescriptions exactly.