INFECTIONS

Introduction

Serious infections that can develop within the affected tissues are a serious complication associated with lymphedema.  The risk of infection increases when lymphedema is not controlled by conservative management strategies and appropriate precautions to prevent infection entering through any wound or puncture.

The risks of lymphedema related infections are due to:

• The swelling of lymphedema compromises the health of the skin.  Healthy intact skin is the body’s primary line of defense against invading pathogens.  Normal skin is protected by a film known as the acid mantle.  The acidic nature of this film discourages such pathogens.  When skin is swollen, the acid mantle is disrupted and is not as effective in stopping invading pathogens.

• Protein-rich, stagnant lymph within these swollen tissues creates an environment that pathogens love!  This lymph has nutrients that allow the pathogens to thrive.  This stagnant lymph can also contain pathogens and damaging toxins that would normally hae been removed with  the normal flow of lymph.

• The deep skin folds resulting from the lymphedema are an ideal breeding ground for fungal infections.  The area within the folds are warm, moist, and dark.  This creates an ideal environment for fungi such as tinea pedis (athlete's foot) and tinea cruris (jock itch).

Erysipelas 

Erysipelas is an acute infection typically with a skin rash, usually on any of the legs and toes, face, arms, and fingers. It is an infection of the upper dermis and superficial lymphatics, usually caused by A Streptococcus bacteria on scratches or otherwise infected areas. Erysipelas is more superficial than

cellulitis, and is typically more raised and demarcated. Signs and symptoms may include high fever, chills, shaking, headaches, fatigue or vomiting; a general feeling of un-wellness. The rash is typically red, warm and can be painful. It can change and grow in surface area in a very short period of time (a few hours to 48 hours)

Cellulitis 
Cellulitis is a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Signs and symptoms include an area of redness which increases in size over a few days. The area of redness may be blotchy with irregular borders, there may be swelling in the area. While the redness often turns white when pressure is applied, this is not always the case. The area of infection is usually painful, and the person may have a fever and feel tired. It is an aggressive infection which can affect lymphatic transport capacity. Group A Streptococcus and Staphylococcus are the most common of these bacteria, which are part of the normal flora of the skin, which normally cause no actual infection while on the skin's outer surface. If you are suspicious about the possibility of either of these infections, please see your doctor immediately. A course of antibiotics either oral or via injection is necessary to control the infection. 

Printable Resources for Cellulitis
Cellulitis & Lymphedema ~ What You Need to Know
Lymphedema and the Risk of Infection

Lymphangitis

Lymphangitis (lim-fan-JIGH-tis) is an infection involving the lymphatic vessels that is most commonly caused by the spreading of an acute streptococcal or staphylococcal infection of the skin.  The presence of lymphangitis suggests that an infection is progressing and should raise concerns of spread of bacteria to the bloodstream.

Known as sepsis, a bacterial infection in the bloodstream can spread to all of the body systems within a matter of hours.  Therefore, at the first signs of lymphangitis, you should seek medical treatment immediately.

Symptoms of Lymphangitis:

• Malaise, loss of appetite, headache, and muscle aches
• Red streaks from infected area to the armpit or groin (these may be faint or obvious)
• Swollen lymph nodes
• Chills and fever

Sweets Syndrome
Sweet's syndrome undefined also known as acute febrile neutrophilic dermatosis undefined is a rare skin condition marked by fever and painful skin lesions (raised papules that appear mainly on your arms, neck, face and back.

The exact cause of Sweet's syndrome isn't always known. In some people, it's triggered by an infection, illness or certain medications. Sweet's syndrome can also occur with some types of cancer.

The most common treatment for Sweet's syndrome is corticosteroid pills, such as prednisone. Signs and symptoms often disappear just a few days after treatment begins, but recurrence is common.

Sweet's syndrome is marked by an abrupt eruption of small red bumps on your arms, neck, face or back — often after a fever or upper respiratory infection. The bumps grow quickly in size, spreading into painful clusters up to an inch or so in diameter and treatment should be sought promptly.

Fungal Infections

Fungal infections occur most often when the genitalia, legs and feet are affected by stage 2 or stage 3 lymphedema.

Athlete’s Foot, which is caused by the fungus tinea pedis, occurs on the feet and between the toes.  Jock itch, which is caused by the fungus tinea cruris, thrives in the genital area.  These infections occur when the right combination of conditions exists including:

• A warm, dark humid environment, such as between the toes.
• Any change in the health of the skin.
• Lowering of the body's natural resistance.

Tinea Pedis Symptoms

• Pain, burning, and itching
• Drying, cracking, and scaling of the skin
• Blistering
• Swelling

These infections are difficult to treat and prevention is the best approach, which includes:·  maintain cleanliness by changing shoes and socks as often as necessary controlling moisture by using an antiperspirant powder or spray; routinely using an anti-fungal ointment and/or powder, as recommended by your healthcare provider.

Jock itch can be treated with over-the-counter ointments; however, it is advisable to see your physician for professional advice.  Once the condition is under control, anti-fungal powders or sprays may be recommended for daily use as a preventive measure.

References

Living Well with Lymphedema by A. Ehrlich, A. Vinjé-Harrewijn PT, CLT-LANA, and E. McMahon PhD. Lymph Notes, 2005.

Lymphedema Diagnosis and Therapy 2-E edited by H. Weissleder and C. Schuehhardt. Kagerer Kommunikation, 1997.

Lymphedema Management: The comprehensive Guide for Practitioners by J.E. Zuther. Thieme, 2005, pages 249-250.

The Lymphatic System Pathology by B. Lasinski in Implications for the Physical Therapists 2-Ed by C.C Goodman, W.G. Boissonnault, and K.S.Fuller. Saunders, 2003, pages 477-508.

Used with permission - © LymphNotes 2008.

http://www.mayoclinic.org

This information does not replace the advice of a qualified health care professional.