Patients with lymphoedema are at an increased risk for infections. There are numerous reasons for this.
Normally the body is protected by a fine acid layer on the surface of the skin, which prevents bacteria and other pathogens from entering. However, lymphoedema patients’ skin tends to be dry and scaly, causing a disruption of the protective acid layer. In addition, these patients may have deepened skin folds due to lymphoedema, which cause moisture to collect in them, which creates a breeding ground for bacteria.
The fact that the swelling in lymphoedema patients causes the disruption of their local immune defence in the affected tissues only further complicates this situation. Once bacteria are able to enter lymphoedematous tissue, protein and accumulated waste products present in these tissues provide an ideal breeding ground for them, leading to infection. Even where there is only minimal lymphoedema, the swelling may compromise the body’s natural defence mechanisms in such a way that they may not be able to fight these invaders sufficiently, resulting in infection.
Apart from the slowing down of removal of waste products, the action of macrophages, which ingest foreign particles and infectious microorganisms, becomes compromised. They become overwhelmed by the excess load of protein-rich fluid, and work more slowly – eventually they may even become inactive, which then further compromises the immune defence of the body.
The initial onset of lymphoedema, as well as the worsening of existing lymphoedema, is frequently associated with the occurrence of infections. It is thought that these infections result in increased fibrosis of lymph vessels and lymph nodes, thus further complicating lymphoedema.
Common infections include:
This is an acute infection of the skin and deeper tissues characterized by painful swelling, redness of the skin, and heat. Cellulitis is frequently caused by streptococcus, and sometimes by staphylococcus bacteria, which enter the tissues through the skin via cuts, abrasions or breaks. Ironically, these bacteria are present in the normal skin flora and do not cause an infection while on the skins outer surface.
This acute dermal infection is also caused by streptococcus bacteria. It affects the skin and tissues located just underneath the skin, including lymphatic vessels and nodes.
Erysipelas is one of the most common infections in lymphoedema and tends to recur. A rapid onset accompanied by fiery red oedema with raised and distinct margins in the affected area, as well as its rapid spreading through superficial lymph vessels, which contributes to the formation of fibrosis in the affected tissues, is typical for this infection.
Typical symptoms include swelling, redness, fever, headache, sometimes vomiting and chills. Erysipelas usually has a well marked edge.
Lymphangitis is an infection of the lymphatic vessels and most frequently results from an acute streptococcal infection of the skin, which is often associated with cellulitis. Less frequently it can also result from a staphylococcal infection. The infection may spread to the blood stream causing a potentially life threatening emergency. Symptoms include red streaks from the infected area to the armpit or groin, together with fever, pain, headache and enlarged lymph nodes.
What to Do in Case of an Infection
If you have lymphoedema, DO NOT WAIT and DO NOT IGNORE any sign of an infection! Seek immediate medical treatment to prevent further complications!
Individuals who are at a high risk for lymphoedema must remain alert to the signs of infection, as these symptoms are often the first signs of the onset of lymphoedema. In such cases, quick intervention may help to delay the onset of lymphoedema, as well as prevent the infection. You need to know that the problem may aggravate and potentially become life threatening if timely care is not taken.
Antibiotics should be administered as soon as possible. Penicillin-based medications are used either orally, if no systemic infection is present, or by intra-venous application. Oral penicillin is administered for a minimum of 14 days, or until the inflammation has been resolved. In some patients it may take one or two months of therapy for symptoms to completely resolve.
In cases of penicillin allergy, alternative antibiotics, such as clindamycin, or claritromycin may be used. In severe cases hospitalization may be necessary.
Lymphoedema patients with a history of recurrent infections should always have a two-week supply of antibiotics on hand, particularly when they travel.
Manual Lymph Drainage treatment is always suspended during episodes of acute infection and fever. In order to prevent excessive swelling, light compression should be applied during these episodes, if the patient can tolerate it.