Lymphadenitis
Marian Grosser studied human medicine in Munich. In addition, the doctor, who was interested in many things, dared to make some exciting detours: studying philosophy and art history, working on the radio and, finally, also for a Netdoctor.
More about the experts All content is checked by medical journalists.Doctors understand lymphadenitis to mean inflammation of the lymph nodes. For example, it can affect the lymph nodes in the neck or lower jaw, which can then be felt as pea-sized indurations. Often the unpleasant inflammation of the lymph nodes is the result of a cold. There is seldom anything more serious behind it. Nevertheless, you should have a long-standing swelling of the lymph nodes clarified. Here you will find out the most important information about the symptom of lymphadenitis.
Brief overview
- What is lymphadenitis? Inflammation of the lymph nodes, usually in response to an infection.
- Causes: Mostly viruses (e.g. cold or flu viruses), less often bacteria (such as chlamydia), fungi or parasites. Tumor cells or rheumatoid diseases are also rarely the trigger.
- When to the doctor If the inflammation lasts longer than three weeks, there is no identifiable cause of the swelling and / or side effects such as sweating, fatigue or weight loss occur.
- What the doctor does: examinations to clarify the cause (e.g. palpation of the lymph nodes, throat swab). If necessary, initiate appropriate therapy (e.g. with antibiotics for bacterial infection, rarely surgical removal of the lymph nodes).
Lymphadenitis: description
The medical term "lymphadenitis" stands for inflammation of the lymph nodes. It is mostly the lymph node's response to infection. But there are several other reasons that can cause lymph nodes to swell (see below).
Doctors generally refer to a disease of the lymph nodes as lymphadenopathy. Lymphadenitis is a special form of lymphadenopathy.
What are lymph nodes
The lymph nodes (Nodi lymphoidei) are part of the lymphatic system, which is important for the immune system, among other things:
The lymph vessels run through the entire body and represent an important transport system for the immune cells (lymphocytes). In addition, the lymph vessels transport excess tissue fluid that the finely branched blood vessels (capillaries) cannot absorb. This fluid reaches the large body veins via the lymphatic system and thus back into the bloodstream. Ultimately, this is a vascular system that is parallel to the arteries and veins, but which is not strictly separated from them, but is connected to them.
The lymph nodes are located all along the lymphatic vessels - as small watchdog and filter stations, so to speak. They are permanently perfused with lymph fluid, which they filter. Most of them are usually around five to ten millimeters in size, relatively flat and more oval than round. They are particularly important where important drainage areas converge (e.g. in the groin or on the neck). The lymph nodes in these areas can therefore be up to 20 millimeters in size.
How does lymphadenitis come about?
When filtering the lymph fluid, the lymph nodes "search" for foreign material. For this purpose, they are equipped with different types of immune cells (lymphocytes) in different stages of development. These can recognize exogenous material such as viruses or bacteria (or their components) and then multiply strongly in order to take targeted action against the pathogen.
The germs do not have to reach the lymph nodes first. Wherever there is an infection in the body, there are already fewer lymphocytes to fight the invaders. Certain immune cells then transport small fragments of destroyed pathogens to the lymph nodes, so to speak to represent the attackers. These then send reinforcements in the form of newly formed immune cells to the focus of infection. Some of the immune cells produced are also stored in the lymph nodes in case they are needed again at some point.
The increased production of immune cells causes the lymph nodes to swell. In this activated state, they are one to two centimeters in size, and no longer flat, but spherical. Nevertheless, they still appear relatively soft and can be moved a little. Sometimes they also hurt when you squeeze them, but that doesn't necessarily have to be the case. All of this together gives the typical picture of lymphadenitis.
Because the lymph nodes swell up in response to an infection, doctors also speak of reactive lymphadenitis. As soon as the infection subsides, the lymphadenitis also goes down - the lymph nodes have shrunk back to their normal size after a few days.
Lymphangitis
Sometimes the pathogen smoke directly infects lymph nodes and vessels. In addition to lymphadenitis, there is also lymphangitis, i.e. an additional inflammation of the lymphatic system. It is noticeable as a red stripe on the skin that spreads along the path of inflammation.
Laypeople often speak of blood poisoning in this picture, but neither lymphadenitis nor lymphangitis have anything to do with blood poisoning in the medical sense (sepsis). The latter is life-threatening, whereas the inflammation of the lymph vessels is rather harmless. In rare cases, however, it can result in real sepsis.
What types of lymphadenitis are there?
On the one hand, lymph node inflammation can be classified according to its course:
- acute lymphadenitis: inflammation of the lymph nodes that has only recently existed due to a recent infection
- chronic lymphadenitis: inflammation of the lymph nodes that has existed for a long time because its cause has become chronic
On the other hand, a classification according to localization is possible:
- Regional lymphadenitis: only the lymph nodes in a certain area of the body are inflamed.
- Generalized Lymphadenitis: This is where the lymph nodes are inflamed all over the body. However, this only happens very rarely and only under certain circumstances, for example in the context of an HIV infection.
Regional lymphadenitis is more common in some parts of the body than others. Lymph node inflammation is particularly common in the neck, lower jaw and face. Many pathogens get into the airways through the mouth and nose and spread through the pharynx and throat. The closest lymph nodes then react first and enlarge, which sometimes interferes with swallowing. Doctors refer to such an inflammation of the lymph nodes on the neck as lymphadenitis colli.
In principle, tonsillitis is also a form of lymphadenitis: the tonsils, as the tonsils are also called, are ultimately nothing more than collections of small lymph nodes.
A special form of lymph node inflammation is the so-called mesenteric lymphadenitis. This affects special lymph nodes in the so-called ileoceal region. This is the point where the small intestine merges into the large intestine. Either certain bacteria trigger mesenteric lymphadenitis (specific) or it arises as a side effect of a (systemic) viral disease affecting the whole body.
Lymphadenitis: causes and possible diseases
Whenever the immune cells discover structures in a lymph node that do not belong to their own body, they start the reaction described above - lymphadenitis develops. In the vast majority of cases, pathogens are the trigger.
The body's own cells can very rarely lead to lymphadenitis, namely when these cells are so strongly modified by genetic changes (mutations) that they are no longer recognized as the body's own. This is the case with many tumor cells, which is why some cancers can also lead to inflammation of the nearby lymph nodes.
In addition, rheumatoid diseases can also cause lymph node inflammation. In such a case, the immune system does not react to a trigger, but is rather the cause of the lymphadenitis (autoimmune disease).
Which pathogens cause lymphadenitis?
Ultimately, all forms of pathogen can trigger lymphadenitis. Viruses, bacteria, fungi, and even some parasites can cause the lymph nodes to swell. Especially germs that lead to inflammation in the ear, nose and throat area are among the main culprits. The result is very often lymphadenitis colli.
The following viruses are common causes of lymphadenitis:
- Rhinoviruses - often the cause of a classic runny nose.
- Influenza viruses - cause the real flu.
- Parainfluenza viruses - cause flu-like symptoms but have nothing to do with real flu.
- Adenoviruses - like parainfluenza viruses, often implicated in respiratory infections.
- Epstein-Barr virus (EBV) - the causative agent of Pfeiffer's glandular fever.
- Pathogens causing "teething troubles" - e.g. measles and rubella
Viral infections are more often the cause of lymph node inflammation. But there can also be various bacteria behind it, for example:
- Haemophilus influenzae
- Staphylococci and streptococci
- Moraxella catarrhalis
- Chlamydia
- Mycobacterium tuberculosis (causative agent of tuberculosis)
- Treponema pallidum (causative agent of syphilis)
- Yersinia (trigger of specific mesenteric lymphadenitis)
Fungal infections and parasitic diseases such as toxoplasmosis are only very rarely responsible for lymphadenitis.
Lymphadenitis: When Should You See a Doctor?
In itself, it is completely normal for the lymph nodes to swell as part of an infection. Ultimately, this only shows that the immune system is doing its job. However, as soon as the causative illness subsides, the lymphadenitis should also subside.
A visit to the doctor is only advisable if the lymph node inflammation lasts longer than three weeks - even if that does not necessarily mean that there is something serious behind it.
If lymph nodes swell for no apparent reason, you should also always have this checked out by a doctor. Because then it may not be a reactive lymphadenitis, but the inflammation has another cause that requires targeted treatment.
Important alarm signals for which you should make an appointment in the practice are also side effects such as night sweats, rapid weight loss and unusual tiredness. These so-called B symptoms can indicate cancer. In contrast to normal lymphadenitis, the lymph nodes in this case may grow well over two centimeters in size, are difficult or impossible to move and often feel rather hard. In addition, they almost never hurt.
Lymphadenitis: what does the doctor do?
Investigations
First, the doctor collects the patient's medical history (anamnesis) in conversation with the patient. He asks, for example, how long the lymph node swelling has existed, whether an infection has recently occurred or is still present (e.g. cold) and whether there are other symptoms (such as fever, tiredness).
This is followed by a physical exam. Among other things, the doctor will palpate the swollen lymph nodes and pay attention to features such as size, consistency, mobility and sensitivity to pain. In the case of lymphadenitis, he also inspects the surrounding structures more closely, for example to identify possible entry points for pathogens.
If there are any questions or if the doctor wants to rule out other possible causes, he or she may perform additional tests, such as x-rays or ultrasound examinations, blood tests, or throat swabs. For examination purposes, he can also take small pieces of tissue from an affected lymph node (biopsy).
Therapy of lymphadenitis
If bacteria are the cause of lymphadenitis, the doctor may prescribe antibiotics. He decides this on an individual basis, however, because the use of these drugs is often not necessary at all.
In the case of viral causes of lymph node inflammation, however, one can only wait and see. There are usually no specific drugs here.
In rare cases, the doctor surgically removes lymph nodes, for example if they have been swollen for an unexplained cause over a long period of time or if they become repeatedly infected and cause complications.
All in all, the prognosis for lymphadenitis is very good.
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