POST-TRAVEL: LYMPHADENOPATHY

Swollen lymph nodes after or during a trip need not necessarily result from an exotic disease. When managing a problem of swollen lymph nodes, a distinction should be made between regional lymphadenopathy and generalised lymph node swelling. In addition it is important to know whether there is fever and whether the problem is an acute or a chronic one. The causes can generally be divided into infections, neoplastic causes, infiltrative diseases and non-infectious immunological reactions.

1 Localised lymph node swelling

Elbow, armpit. Usually due to local sepsis with cosmopolitan organisms (streptococci, staphylococci). It occasionally concerns a rare pathogen: Mycobacterium marinum, cutaneous leishmaniasis, cat scratch disease, tuberculosis, tularemia. Lymph node invasion by a mammary carcinoma is one possibility in axillary lymphadenopathy.

Neck. Pharyngitis is the most frequent cause. Swollen neck nodes occur in 25% of the early West African trypanosomiasis cases (Winterbottom sign). The parasite can be detected via punction and aspiration of the node. Blood analysis and lumbar puncture should be carried out. Tuberculosis of the lymph nodes of the neck (scrofulosis) is usually unilateral. Pharyngeal diphtheria causes massive regional nodular swellings, the same applies for oropharyngeal anthrax. A swollen cervical lymph node can occasionally be a first sign of Hodgkin’s lymphoma.

Groin. An infected leg wound is the most frequent cause. An ulcerative sexually transmitted disease, such as primary syphilis, chancroid or donovaniosis, must also be considered. Wuchereria bancrofti can cause adenopathy, often in the groin (occasionally with formation of sterile abscesses). Bubonic plague will at first often be characterised by very painful, necrotising inguinal lymph nodes. The anal canal drains the lymph to the inguinal nodes (significant for metastases). Onchocerciasis can be responsible for "hanging groin", large hard fibrastic non-tender swollen lymph nodes.

2 General lymph node swelling

Toxoplasmosis, mononucleosis, HIV, secondary syphilis, brucellosis, rat bite fever, kala azar (visceral leishmaniasis), recurrent fever (borreliosis), dengue, sarcoidosis, Hodgkin's and non-Hodgkin's lymphoma, leukaemia. Specific tests are indicated. One should also check whether hilar lymphadenopathy and/or hepatosplenomegaly are present. An ultrasound or CT scan of the abdomen will identify any retroperitoneal lymph nodes.

3 Medications that may cause lymphadenopathy

Allopurinol

Atenolol

Captopril

Carbamazepine (Tegretol)

Cephalosporins

Gold

Hydralazine

Penicillin

Phenytoin

Primidone

Pyrimethamine (Daraprim)

Quinidine

Sulfonamides

Sulindac