Lymph nodes - are filters that clean the lymph from bacteria, viruses, toxins and cellular debris.All of these agents fall into the lymph from peripheral tissues and neutralized by immune cells in the lymph nodes.In addition, they also occur maturation of T-cell immunity: T-helper and T-killer cells, which are responsible for the anti-tumor and anti-viral defense.
Lymph nodes that collect lymph from certain parts of the body are called regional.From the lower limbs, perineum and genitals lymph flows through the inguinal lymph nodes.They lie on either side of the crotch region in the inguinal ligament and the large vessels of the lower extremity, covered from top to subcutaneous fat and skin.Inflammation of the lymph node is called lymphadenitis groin groin.The disease occurs in both sexes and is more common in children, young and mature people.
should be understood that not any increase in the lymph nodes in the groin is called lymphadenitis.This reaction occurs under the influence of viral infections, excessive sun exposure, autoimmune processes, overheating and indicates the activation of T-cell immunity.Immune cells in nodes actively proliferate and develop, which leads to functional hyperplasia (an increase amount) of lymphoid tissue.In healthy people, may be increased by up to 5 groups of lymph nodes that is not considered a pathology.Ending in -um word means lymphadenitis inflammatory changes in lymph node tissue which will be discussed below.
In the majority of cases bubonadenitis cause pathogenic and opportunistic microorganisms.They penetrate into the lymph nodes of the source of inflammation, which is localized in the external genitals, perineum or lower extremity tissues.The main causative agents of lymphadenitis include:
- Mycobacterium tuberculosis;
- Yersinia pestis (Yersinia pestis);
- fransiella tulyarensis (the causative agent of tularemia);
- virus encephalitis;
Usually, inflammation inguinal lymph nodes develops against the background of the underlying disease as a manifestation of dissemination of the pathogen with the current lymph.The appearance lymphadenitis bring the following states:
- boils lower limb and perineum;
- infected abrasions, cuts, wounds;
- festering sores;
- bone osteomyelitis of the lower limbs;
- erysipelas skin of the lower extremities, lower abdomen, buttocks;
- venereal disease (syphilis);
- fungal infection of nails and skin stop;
- cellulitis or abscess in the tissues of the lower limb and perineum.
Sometimes lymphadenitis - it is one of the signs of a growing tumor of lymphoid or other tissues:
- Hodgkin's disease;
- metastatic melanoma, located on the lower limbs, perineum, buttocks;
- metastatic tumors of the external genitalia.
in each age and gender group can identify the most common causes of lymphadenitis:
- children - infected abrasions and wounds of the lower extremities, swelling of lymphoid tissue, osteomyelitis;
- in women - sexual infections (syphilis, chlamydia), suppurative processes of the vulva (vulvitis, Bartolini), infected venous leg ulcers, erysipelas inflammation of the skin;
- in men - sexually transmitted diseases (syphilis, chlamydia), inflammatory diseases of the external genitalia (balanoposthitis, urethritis), boils on the buttocks, lower limbs, tumors of lymphoid tissue.
What happens in the lymph nodes
inflammation regardless of the reason always runs on the same type of scenario.Any of the above factors (viruses, bacteria, cancer cells) damage the lymph node structure, resulting in damaged cells of biologically active substances are allocated.Last trigger a cascade of responses designed to stop the further spread of the pathogen.These include:
- vasodilation, leading to stagnation of blood in the area of the lymph node;
- increase vascular permeability and plasma of immune cells;
- output of the liquid portion of the blood in the lymph node tissue with the formation of edema;
- migration of leukocytes from the blood stream into the cavity of a lymph node.
would seem that the lymph nodes are filled with immune cells, why are they not in a position to cope with the pathogen?The fact that T-cells are working in close collaboration with other immune cells, and without their help, "do not see" the enemy.Moreover, their main function - is the destruction of the body's own cells, where there are any changes.For antimicrobial protection meet blood neutrophils and monocytes, they flock in great numbers in the inflammation to a distress call.
Further developments depend on what stage will be able to destroy the enemy:
- serous inflammation ends at the stage of formation of edema and immune activation;
- purulent - with the death of a large number of neutrophils, bacteria, and lymph node cells;
- abscess - with purulent melting lymph node capsule and distribution process on the adjacent subcutaneous fat.
Increased lymph nodes - is the main clinical sign of inguinal lymphadenitis.They stick out from under the skin in the form of rounded formations (bump in the crook of his legs in the groin), the skin over them is normal or flushed, they are painful on palpation.The total pattern is such that the more pronounced destructive process in the lymph nodes, the worse the condition of the patient.
purulent lymphadenitis is accompanied by severe pain in the groin, because of which the patient is forced to limit the movement in the hip joint.Any attempt to take a limb stretches the inguinal ligament and causes him considerable suffering.Limited purulent cavity sometimes independently opened with the expiry of her yellow-green dough.When distributing process with the formation of cellulitis patient's general condition is deteriorating:
- his temperature rises to 39-40 degrees C
- aching muscles and joints, headache, lack of appetite.
At the beginning of the inflamed lymph nodes are mobile and not soldered to the underlying tissues.Gradually, the process captures the subcutaneous fat and the capsule adjacent nodes, resulting in the formation still painful lymph node packages.The skin over them is usually changed - it acquires a bluish-purple color stagnant, which is stored for a long time in the form of hyperpigmentation spots.
described the clinical picture - the result of the impact of nonspecific microflora (staphylo-, streptococcus, E. coli, Proteus, Klebsiella).Specific pathogens cause typical only for them to change in the tissues, which we consider below.Most of these diseases occur both in adults and in children.Features inguinal lymphadenitis in children - a violent reaction of the lymphoid tissue inflammation with a marked increase in the lymph nodes.
Cat scratch disease - felinoz
disease develops within 1-2 weeks after the scratch or bite of a cat (usually homeless kittens) infected with a pathogenic species of chlamydia.In place of the healed abrasions formed red spot, which is gradually transformed into a small skin sores.Another regional lymphadenitis develops, forming a large bubo in a couple of weeks.The patient's condition at this time was rapidly deteriorating, he develops a high fever and signs of severe intoxication.
disease develops slowly festering bubo occurs after 2-3 weeks.Often, it formed a fistula, through which stands out a thick greenish pus.To confirm the diagnosis of important contact with the cat in history, long-term course of the disease, the detection of antibodies in the patient's blood.Learn more about the symptoms and treatment of felinoza.
Tuberculosis Mycobacterium tuberculosis enter the inguinal lymph nodes is rare, usually from the gastrointestinal tract, bones and skin of the lower extremities, genitals.They are well protected from the aggression of the body's immune and freely travel through the lymph vessels to the lymph current.Mycobacterium deposited in one or multiple lymph nodes of one group and cause them to specific inflammation.
In tuberculous lesions emit 3 types of lymphadenitis:
- infiltrative - occurs in the lymph nodes increased proliferation of T-lymphocytes, they significantly increase the unit volume and make it the consistency of thick.benign course of the disease, maloboleznenny nodes, not soldered to surrounding tissues, the skin over them is not changed.
- Caseous - cavity lymph node tissue decays with suppuration and the formation of curd mass kroshkovidnoy (caseous necrosis).Outwardly, they increase in size, become dense, painful, soldered to the underlying tissues and skin.The skin reddens the site of inflammation, in some cases, the holes are formed on its surface (fistulas), which communicate with the cavity lymph node.Through them out pus and caseous masses outside their healing occurs slowly, through the formation of scar.
- induratum - characterized by a prolonged course, weak expression of the inflammatory process and the transformation of lymphoid tissue in the scar.Lymph node shrinks, becomes fixed, very dense.Tenderness to palpation of moderate or weak, she gradually comes to naught.
TB lymphadenitis accompanied by a low fever, fatigue, weakness, weight loss.Diagnosis is confirmed by the release of the contents of the node M. tuberculosis (see. How is tuberculosis).
chlamydia - the most common form of chlamydial infection in Europe.Infection occurs through unprotected sexual intercourse.Initially small painless erosion formed on the genitals, which quickly heals without treatment.After 1.5-2 months in the groin increases one or more lymph nodes, they are soldered together, with the tissue, the skin over them blush.
gradually soften nodes, on the surface of the through-holes are formed through which excreted yellow-green pus.At the time of the patient's condition worsens festering: it increases body temperature and symptoms of intoxication occur.The outcome of the disease in some cases formed elephantiasis - pronounced swelling of the entire lower limb on the affected side due to violation of lymphatic drainage.Diagnosis is confirmed by the detection of specific antibodies in blood protivohlamidiynyh.
bubonadenitis men and women often causes pale treponema - the causative agent of syphilis.Increased lymph nodes occurs in the first stage of the disease, from a few weeks of infection, which is sexually transmitted.At the site of the introduction of infection formed dense painless bump up cm in diameter.Within 7-10 days the inguinal lymph nodes increases, usually on both sides.
All changes are imperceptible to the patient character, since it does not bring any discomfort.Diagnosis of the disease is carried out by detecting specific antibodies in the blood and in moving treponemes smears from the genital tract.
bubonic form of the plague
The disease is rare in the modern world, but pockets of natural circulation to this day there are pathogen in Central Asia (Uzbekistan, Tajikistan).Increased migration increases the risk of importation of the plague in our country, so there is some epidemiological vigilance against her.The disease is transmitted through fleas or rat bite, and then the person becomes contagious to others.
most often occurs with the formation of plague buboes not far from the place of infection occurrence.Bubonic - it is a large (3-5 cm), inflamed lymph node, which occurs in the oral pronounced decay of tissues and abscess.When the plague its contours vague, he quickly soldered to surrounding tissues, the skin over it is red-cyanotic.The general condition of the patient is extremely difficult, exhausting his high fever and general intoxication of the organism.Confirmation of the diagnosis is performed by bacteriological culture media on seeding material from the patient (blood discharge from the bubo).
Bubonic form of tularemia
In our country, the disease occurs in the steppe and forest steppe zones (Bashkiria, Smolensk region, Orenburg region, Dagestan).Infection occurs through contact with rodents and skins through the bites of blood-sucking insects.Bubonic formed far away from the inoculation site.
tularemia bubo has clear contours, not soldered to the skin and adjacent lymph nodes.He slowly increases in size, abscess occurs no earlier than the third week of the infection, the reverse process is also long-term development.The patient suffers from moderate, pain in the groin tolerant and do not violate human activity.Diagnosis is confirmed by detection of antibodies in the blood to the pathogen and allergy tests with tularemia toxin.
Isolated increase in inguinal lymph nodes with metastasis occurs in these tumors from surrounding tissue and, in some cases - in the beginning of lymphoma or Hodgkin's disease.Metastases specific cause inflammation, in which the affected node becomes so dense that its hardness is compared to a tree.Pain with weak or absent altogether, the surrounding tissue in the inflammatory process is involved.
When tumors of lymphoid tissue are increasing all the lymph nodes groin group.The patient's condition is deteriorating slowly, gradually, it is characterized by severe weakness and weight loss.Increasing the temperature to 38-39 ° C occurs during the decay of the tumor tissue, with chlamydia fever is transferred easily.Diagnosis is confirmed by cytological examination of lymph node content - it detected the abnormal cells.
Diagnosis Diagnosis of the disease is established on the basis of medical history, patient complaints, inspection and palpation of the inguinal region.To determine the cause of lymphadenitis doctor uses laboratory tests and instrumental methods of research.
History and complaint
Onset may be acute or gradual, depending on the characteristics of the pathogen.They play an important role data unprotected sex, lower limb injuries, contact with a cat, is present in the immediate environment of patients with tuberculosis or syphilis.Patients complain of:
- discomfort in the groin area;
- increase in inguinal lymph nodes;
- pain when walking, movement in the hip joint;
- feeling the heat and tension in the groin;
- redness of the skin over the inguinal nodes;
- formation on the skin fistula, through which pus / fluid / curdled mass.
inspection and palpation
When viewed from the groin doctor pays attention to the size of the lymph nodes, their mobility, the severity of the inflammatory process.On the active inflammation say such features as:
- sharp pain on palpation of lymph nodes;
- pronounced swelling of the tissues that surround the lymph node;
- node immobility due to its fusion with the surrounding tissues;
- plotnoelasticheskoy consistency lymph node;
- bright red color of the changed node.
softening sore assembly center - a sign of purulent cavity formed therein.If it spontaneously wall opened and the process captures the subcutaneous fat, is found in the groin painful area seal without clear boundaries - cellulitis.Fistulous passages on the skin look like openings through which pus and necrotic mass.