Inguinal lymphadenitis: symptoms, treatment,diagnosis, causes of inflammation of the lymph nodes in the groin

Update: December 2018

Lymph nodes are filters that clean the lymph from
bacteria, viruses, toxins and products of cellular decay. Everything
these agents enter the lymph from peripheral tissues and
neutralized by immune cells in the lymph nodes. In addition, in them
is the maturation of the T-cell immunity: T-helper cells
and T-killers who are responsible for the antitumor and
Antiviral protection of the body.

Lymph nodes that collect lymph from a specific part of the body,
are called regional. From the lower limbs, perineum and
genital lymph flows through the inguinal lymph nodes. They are lying
to the right and left of the perineum in the area of ​​the inguinal ligament and large
vessels of the lower limbs, covered with subcutaneous fat
fiber and skin. Inflammation of the groin lymph nodes is called
lymphadenitis of the inguinal region. The disease occurs in both individuals.
sex and more often develops in children, young and mature people.

It should be understood that not any enlargement of the lymph nodes in the groin
called lymphadenitis. A similar reaction occurs when exposed
viral infections, excess sun exposure, autoimmune
processes, overheating and evidence of the activation of T-cell
link immunity. Immune cells in the nodes actively multiply and
develop, which leads to functional hyperplasia (increase
quantity) of lymphoid tissue. Healthy people can be increased
up to 5 groups of lymph nodes, which is not considered pathology. Ending in
the word lymphadenitis means inflammatory changes in the tissue
lymph nodes, which will be discussed below.

The reasons

Overwhelmingly, inguinal lymphadenitis causes
pathogenic and conditionally pathogenic microorganisms. They penetrate
lymph nodes from the focus of inflammation, which is localized in the outer
genitals, perineum, or in the tissues of the lower limb. TO
The main causative agents of lymphadenitis include:

  • staphylococcus;
  • streptococci;
  • Mycobacterium tuberculosis;
  • chlamydia;
  • Yersinia pestis (plague wand);
  • franciella tularensis (causative agent of tularemia);
  • rickettsia;
  • tick-borne encephalitis virus;
  • HIV;
  • spirochetes

TOак правило, воспаление паховых лимфоузлов развивается на фоне
main disease, as a manifestation of pathogen dissemination with
lymph current. TO появлению лимфаденита приводят следующие
states:

  • boils of the lower limb and perineum;
  • infected abrasions, cuts, wounds;
  • suppurative trophic ulcers;
  • osteomyelitis of the bones of the lower extremities;
  • erysipelas of the skin of the lower limbs, lower half
    belly, buttocks;
  • sexually transmitted diseases (syphilis);
  • fungal infection of the nails and skin of the feet;
  • phlegmon or abscess in the tissues of the lower limb and
    crotch

Sometimes lymphadenitis is one of the signs of a growing tumor.
lymphoid or other tissues:

  • lymphomas;
  • Hodgkin’s disease;
  • metastasis of melanoma, located on the lower extremities,
    crotch, buttocks;
  • metastases of tumors of the external genital organs.

In each sex and age group, the most frequent
causes of lymphadenitis:

  • children have infected abrasions and wounds of the lower extremities,
    tumors of lymphoid tissue, osteomyelitis;
  • women – genital infections (syphilis, chlamydia), purulent
    processes of the vulva (vulvitis, bartholinitis), infected trophic
    ulcers of the lower limbs, erysipelas of the skin;
  • in men, venereal diseases (syphilis, chlamydia),
    inflammatory diseases of the external genital organs (balanoposthitis,
    urethritis), boils on the buttocks, lower limbs, tumors
    lymphoid tissue.

What happens in the lymph nodes

Inflammation, regardless of the cause, always proceeds according to the same type.
the script. Any of the above factors (viruses, bacteria,
tumor cells) damage the structure of the lymph node, resulting in
biologically active substances are released from damaged cells.
The latter trigger a cascade of responses designed to
stop further spread of the pathogen. TO ним
relate:

  • dilation of blood vessels leading to stagnation of blood in the area
    lymph nodes;
  • increased vascular permeability to plasma and immune
    cells;
  • the output of the liquid part of the blood in the tissue of the lymph node with the formation
    edema;
  • leukocyte migration from the bloodstream to the lymphatic cavity
    node.

TOазалось бы, лимфоузлы наполнены иммунными клетками, почему они
not able to cope with the pathogen? The fact is that
T lymphocytes work closely with other immune cells.
cells and without their help “do not see” the enemy. TOроме того, их основная
function is the destruction of the body’s own cells, in which
There have been any changes. Responsible for antimicrobial protection
neutrophils and blood monocytes, it is they who abound
rush into the focus of inflammation on the distress signal.

Further development of events depends on what stage
manage to destroy the enemy:

  • serous inflammation ends at the stage of edema formation
    and activation of immunity;
  • purulent – with the death of a large number of neutrophils, cells
    lymph nodes and bacteria;
  • флегмона – при гнойном расплавлении капсулы lymph nodes and
    spreading the process to the adjacent subcutaneous fat
    fiber

TOлиническая картина

Увеличение лимфоузлов — это  основной клинический признак
inguinal lymphadenitis. They bulge out from under the skin in the form of rounded
formations (bump on the crook of the leg in the groin area), the skin above them
normal or hyperemic, they are painful on palpation.
The general pattern is such that the more pronounced the destructive
the 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 restrict movement in
hip joint. Any attempt to withdraw limb stretches
inguinal ligament and causes him considerable suffering. Limited
purulent cavity sometimes self-opens with the expiration of
her yellow-green thick mass. With further distribution
process with the formation of cellulitis general condition of the patient sharply
getting worse:

  • his temperature rises to 39-40 degrees C
  • aching muscles and joints, headache, lack of appetite.

At the beginning of the process, the inflamed lymph nodes are mobile and not fused to
subject tissues. Gradually, the process captures
subcutaneous fatty tissue and the capsule of adjacent nodes, as a result
what are formed immobile painful packages of lymph nodes. TOожа
above them is usually changed – it acquires a purple-bluish
stagnant staining that persists for a long time
hyperpigmentation spots.

The described clinical picture is the result of exposure.
nonspecific microflora (staphylo-, streptococci, intestinal
sticks, protea, klebsiella). Specific pathogens cause
characteristic only for them change in tissues, consider which
below. Most of the listed diseases are found as
adult and in childhood. Inguinal features
lymphadenitis in children is a violent reaction of lymphoid tissue to
inflammation with a marked increase in lymph nodes.

Cat scratch disease – felinoz

The disease develops within 1-2 weeks after scratching or
A cat bite (most often stray kittens) infected with one of
pathogenic species of chlamydia. In place of a healed abrasion is formed
a red spot that gradually transforms into a small
cutaneous ulcer. In a couple of weeks, regional
lymphadenitis, a large bubo is formed. Condition of the patient to this
the time is dramatically worsening, he has a high fever and
signs of severe intoxication.

The disease develops slowly, bubo suppuration occurs
after 2-3 weeks. Often a fistula is formed in it, through which
out thick greenish pus. For confirmation
diagnosis is important contact with the cat in history, a long course
disease, the detection of antibodies in the blood of the patient. More about
symptoms and treatment of felinosis.

Tuberculosis

Mycobacterium tuberculosis gets into the inguinal lymph nodes rather
rarely, usually from the gastrointestinal tract, bones and skin of the lower
limbs, genitals. They are well protected from immune
body aggression and travel freely through the lymphatic vessels
с lymph current. Mycobacteria are deposited in one or several
lymph nodes of one group and cause in them specific
inflammation.

In tuberculous lesions, 3 types of lymphadenitis are distinguished:

  • Infiltrative – in the lymph nodes is enhanced reproduction
    T-lymphocytes, they significantly increase the volume of the node and make it
    consistency dense. The course of the disease is benign, nodes
    slightly painful, not soldered to the surrounding tissues, the skin above them is not
    changed.
  • TOазеозный – в полости лимфоузлов происходит распад ткани с
    suppuration and the formation of curd crumb mass
    (caseous necrosis). Externally, they increase in size,
    become dense, painful, soldered to the underlying tissues
    and skin. TOожа в месте воспаления краснеет, в ряде случаев на ее
    surfaces are formed holes (fistula) that communicate with
    полостью лимфоnode. Pus and caseous masses come out through them.
    out, their healing is slow, through the formation
    scar.
  • Indurative – characterized by a long course, weak
    the severity of the inflammatory process and the transformation of the lymphoid
    tissue in the scar. Lymph node decreases in size, becomes
    motionless, very dense. Soreness to palpation moderate
    or weak, it gradually fades away.

Tuberculosisный лимфаденит сопровождается невысоким повышением
fever, fatigue, weakness, weight loss.
The diagnosis is confirmed by isolating mycobacterium from the site contents.
tuberculosis (see how tuberculosis is transmitted).

Inguinal lymphogranulomatosis

Inguinal lymphogranulomatosis – это наиболее распространенная форма
chlamydial infection in Europe. Infection occurs when
unprotected sexual intercourse. Initially on genital
small painless erosion is formed in the organs, which quickly
heals without treatment. After 1.5-2 months in the groin increases one
or several lymph nodes, they are soldered among themselves, with tissues,
skin over blushes them.

Gradually, the nodes soften, on their surface are formed
through holes through which yellow-green stands out
pus. AT момент нагноения состояние больного getting worse: у него
body temperature rises and intoxication occurs. AT
the outcome of the disease in some cases formed ivory – pronounced
swelling of the entire lower limb on the affected side due to a violation
lymph drainage. The diagnosis is confirmed by detection in the blood.
specific anti-Chlamydia antibodies.

Syphilis

Inguinal lymphadenitis in men and in women often causes pale
Treponema – the causative agent of syphilis. Swollen lymph nodes occur
in the first stage of the disease, after a few weeks from infection,
which occurs sexually. At the site of infection
forms a painless dense tubercle up to cm in diameter. AT
for 7-10 days, the inguinal lymph nodes are enlarged, usually from both
parties.

Everything изменения носят незаметный для больного характер, так как не
bring no discomfort. Diagnosis of the disease is carried out by
detection in the blood of specific antibodies and motile treponem in
smears from the genital tract.

Bubonic plague

The disease is rare in the modern world, but
natural foci of circulation of the pathogen to this day exist in
countries of Central Asia (Uzbekistan, Tajikistan). Gain
migration processes increases the risk of plague being carried into our country,
therefore, there is a certain epidemiological vigilance
in her regard. The disease is transmitted through the bite of a flea or rat,
after which the person becomes contagious to others.

Most often, the plague proceeds with the formation of buboes near
places of infection. Bubon is a large (3-5 cm) inflamed
lymph node, in the cavity of which there is a pronounced decay of tissues and
suppuration. When the plague of his contours fuzzy, he quickly soldered to
окружающими тканями, skin over ним багрово-синюшная. General state
the patient is extremely difficult, he is exhausted by high fever and general
intoxication of the body. Confirmation of the diagnosis is carried out by
bacteriological culture of nutrient media from
the patient (blood separated from bubo).

Bubonic form of tularemia

AT нашей стране заболевание встречается в степных и лесостепных
zones (Bashkiria, Smolensk region, Orenburg region,
Dagestan). Infection occurs when контакте со шкурками грызунов и
through the bites of bloodsucking insects. Bubon is formed not far from
pathogen introduction sites.

Tularemia bubo has clear contours, is not welded to the skin and
adjacent lymph nodes. It slowly grows in size,
suppuration occurs not earlier than the 3rd week of infection, the opposite
The development of the process is also long. The patient’s condition suffers
moderately, pain in the groin is tolerable and does not disrupt activity
person The diagnosis is confirmed by detection in the blood. антител к
pathogen and allergic test with tularemia toxin.

Tumor lesion

An isolated increase in the inguinal lymph nodes occurs when
metastasis of tumors from nearby tissues and in a number of
cases – at the beginning of lymphoma or lymphogranulomatosis. Metastases
cause a specific inflammation in which the affected node
it becomes so dense that it is compared in hardness with
tree Pain when this is weak or absent altogether,
surrounding tissues are not involved in the inflammatory process.

When lymphoid tissue tumors increase all lymph nodes
inguinal group. The patient’s condition deteriorates slowly, gradually,
characterized by severe weakness and weight loss. Temperature rise
up to 38-39 degrees C occurs when the disintegration of the tumor tissue, with
lymphogranulomatosis fever is easily tolerated. Diagnosis
confirmed by cytological examination of the contents of the lymph nodes – in
atypical cells are detected.

Diagnostics

Diagnosis болезни устанавливается на основании анамнеза, жалоб
patient, examination and palpation of the groin area. To establish
causes of lymphadenitis the doctor uses laboratory tests and
instrumental research methods.

Anamnesis and complaints

The onset of the disease can be acute and gradual, depending on
features of the pathogen. Data on unprotected play an important role.
sex, lower limb injuries, contact with a cat, presence in
the immediate environment of patients with tuberculosis or syphilis. Sick
complain of:

  • groin discomfort;
  • an increase in the inguinal lymph nodes;
  • pain when walking, movements in the hip
    joint;
  • feeling of heat and tension in the groin;
  • redness of the skin over the inguinal nodes;
  • fistula formation on skin
    pus / fluid / cheesy mass.

Examination and palpation

When examining the groin area, the doctor notes the size
lymph nodes, their mobility, the severity of the inflammatory process.
Signs of active inflammation include:

  • sharp tenderness of the lymph node with palpation;
  • pronounced swelling of the tissues surrounding the lymph node;
  • immobility of the node due to its adhesion with others
    tissues;
  • плотноэластическая консистенция lymph nodes;
  • bright red color skin over a modified knot.

Softening the center of the inflamed site is a sign
formed purulent cavity inside it. If its wall
spontaneously opened and the process captures the subcutaneous fat
fiber, a painful area is found in the groin area
seals without clear boundaries – phlegmon. Fistulous passages on the skin
look like holes through which pus is released and
necrotic masses.

In the tumor process, inflammation is less pronounced.
degrees:

  • lymph node enlargement insignificant;
  • skin redness is weak or absent;
  • узлы не спаиваются с подлежащими tissues;
  • moderate or subtle pain;
  • the lymph nodes are firm to the touch (“potatoes in a bag”).

Laboratory and instrumental tests

For confirmation диагноза врач назначает:

  • complete blood count – during the inflammatory process occurs
    decrease in color index, increase in the number of leukocytes,
    ESR acceleration;
  • biochemical blood test – lymphadenitis causes an increase in
    serum concentrations of C-reactive protein, seromucoid, with
    tumors of the lymphoid tissue, hyperproteinemia occurs (excessive
    protein content in plasma);
  • urinalysis – in adults with inflammation possible
    detection of protein in the urine, in children – ketone bodies;
  • blood test for specific antibodies to pathogens – they
    allow you to establish the cause of inflammation;
  • microscopic examination – examination under a microscope
    the contents of the lymph node gives information about the nature of the inflammation,
    возбудителе и наличии опухолевых cells;
  • bacteriological culture of material from the lymph node on nutrient
    environment – the growth of a colony of microorganisms occurs, due to which
    it is possible to determine the species, the type of pathogen and its sensitivity to
    antibiotics.

Among the instrumental methods used:

  • X-ray – allows you to identify changes in the lungs
    for tuberculosis, to detect calcifications in the lymph nodes;
  • Ultrasound – examines the size of the site, the presence and nature of the content,
    condition of adjacent tissues, violation of lymphatic drainage;
  • biopsy of the inguinal lymph node – it is punctured with a needle and taken
    the contents of the syringe for further investigation;
  • PET – is prescribed for suspected metastases in the inguinal
    lymph nodes to detect the primary tumor.

Principles of treatment

ATопросами лечения пахового лимфаденита занимаются различные
experts depending on the underlying pathology. Most often he
comes into view:

  • infectious disease specialists
  • surgeons
  • dermato-venereologists.

Inguinal lymphadenitis in women is sometimes led by gynecologists, if he
combined with pathology in their profile. ATо многих случаях отдельную
lymphadenitis therapy is not carried out, as it independently passes
after the elimination of the causative disease. If the lymph nodes are within
a long time does not return to the original size, spend
сеансы прогревающей физиотерапии (УATЧ, магнит, лазер).

Active treatment requires cases of purulent inflammation of the lymph nodes.
The patient is prescribed a course of antimicrobial drugs wide
spectrum of action, anti-inflammatory and antihistamines.
To prevent the soldering of the lymph nodes in some cases spend
electrophoresis with enzyme preparations (lidazoy).

When maturation of the purulent cavity, the formation of fistulas, phlegmon
surgery is performed. Doctor under local
anesthesia opens the lymph node, removes pus and destroyed from it
tissue, washing its cavity with an antiseptic solution and loosely
sutured with several stitches. AT узле остается дренаж, по которому
inflammatory exudate comes out and is repeated
промывание лимфоnode.

ATоспаление паховых лимфоузлов в большинстве случаев – это не
a separate disease, and a sign of an infectious or tumor
процесса в области нижних конечностей и crotch Attempts
self eliminate lymphadenitis is akin to symptomatic
treatment that relieves the patient’s condition, but in no way
affects the development of the disease itself. For the appointment of adequate
treatment and determination of the cause of the disease must be visited by a doctor and
get tested.

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