Infections Related to Lymphedema 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 proper treatment and appropriate precautions. 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 should have been removed by 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 in warm, moist, and dark. This creates an ideal environment for fungi such as tinea pedis (athlete's foot) and tinea cruris (jock itch). Cellulitis Cellulitis (sell-you-LYE-tis), also known as lymphangitis, is an infection that spreads freely, quickly, and uncontrollably within the deeper tissues of the skin. Cellulitis becomes a life-threatening emergency when it spreads through the lymphatic or circulatory systems and can reach vital organs and other body parts. This type of infection requires prompt treatment with antibiotics. Cellulitis is usually caused by the bacteria staphylococcus aureus that normally live on the skin. Any break in the skin, no matter how small, provides an opening for them to march in, multiply, and thrive. Even a simple act such as shaving a swollen leg could be an invitation to infection. Symptoms of Cellulitis Malaise (a general sense of not feeling well) Flu-like symptoms Chills and fever Discoloration (redness, or streaky red lines) Rash Tissues that feel hot and tender Sudden swelling Itching Pain Erysipelas Erysipelas is visible just below the ankle bone. Erysipelas (er-ih-SIP-eh-las) is a painful skin infection that affects the skin plus the subcutaneous tissues and lymphatic structures that are located just under the skin. This is in contrast to cellulitis which thrives within the deeper tissues; however, erysipelas also requires prompt treatment with antibiotics. Erysipelas is caused by the bacteria Streptococci. These pathogens, which normally live harmlessly on the skin, can enter through any break in the skin such as a scratch, pinprick, or the cracks caused by athlete’s foot. Erysipelas invades rapidly and spreads through the lymphatic vessels. This damages the lymph vessels and increases the formation of fibrosis in the affected tissues. This damage further disrupts the flow of lymph. Erysipelas, which is one of the most common complications of lymphedema, tends to recur and there appears to be a correlation between the frequency of erysipelas infection and the stage of lymphedema. Symptoms of Erysipelas An expanding area of redness of the skin that most often occurs in the region of the ankle Itching Pain High fever, and chills Swelling and tenderness of the regional lymph nodes. 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 treatmentimmediately . 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 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. This includes: maintain cleanliness by changing shoes and socks as often as necessary; controlling moisture by using an antiperspirant powder or spray; and routinely using an antifungal 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, antifungal powders or sprays may be recommended for daily use as a preventive measure. http://www.lymphnotes.com/article.php/id/323/ Necrotizing Fasciitis and Lymphedema Introduction Necrotizing fasciitis (NF) is a bacterial infection caused by a Group A streptococcus. These bacteria usually cause relatively mild illnesses such as a strep throat. On very rare occasions, these bacteria cause the severe and life-threatening disease known as NF. [1] NF, commonly known as flesh-eating bacteria, can destroy the skin, the fat under the skin, and the adjacent muscle tissues. It also produces gangrene-like tissue changes resulting in tissue death, body system failure, and frequently death. Those who survive the initial infection, the severe skin and soft tissue damage produced by NF can cause secondary lymphedema to develop. The lymphedema is caused by the disruption of the normal functioning of the lymphatic system in the affected tissues. Lymphedema Does Not Cause NF Lymphedema is the result of damage to the lymphatic system caused by the NF related tissue destruction. Although those with lymphedema are at high risk of developing an infection, cellulitis is the infection most commonly associated with lymphedema. Cellulitis and NF are not the same. One difference is that cellulitis travels through the blood and lymphatic systems and can damage tissues distant from the original wound. Another difference is that NF is a rare infection. Despite the differences, cellulitis is still a dangerous infection and is a medical emergency that requires prompt medical treatment. To learn more read the article titled Cellulitis. Prevention One common factor shared by NF and cellulitis is that they enter the body through even the smallest break in the skin. The skin care precautions you take because of lymphedema also help to protect you from other bacterial infections that invade through a break in the skin. Michael’s Story The onset and treatment of NF is best described as a nightmare. To better understand this, read Michael’s story, which was posted by a Lymph Notes member. For more information visit the National Necrotizing Fasciitis Foundation web site