Risk Factors of Lymphangitis in Patients with Lymphedema at Vajira Hospital Risk Factors of Lymphangitis in Lymphedema Patients
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Abstract
OBJECTIVE: Lymphangitis is a complication often found in lymphedema. It affects patient’s quality of life, morbidity, cosmetic, and functional ability. Potential risk factors of lymphangitis were studied in lymphedema patients of Vajira Hospital.
METHODS: This study is a retrospective study. That is, data of lymphedema patients of Vajira Hospital from January 2007 to December 2018 were collected. Demographic data of patients’ gender, age, underlying diseases, BMI, symptoms, site, onset, stages, causes, and types were analyzed to address risk factors using the SPSS program.
RESULTS: There were 140 patients participating, consisting of 12 males and 128 females, 78 of which had lymphangitis while the other 62 patients did not have lymphangitis. The average age of patients was 60.09±12.05 years and the average body mass index (BMI) was 28.73±7.81 kg/m2. There were 75 patients having arm lymphedema and 65 patients having leg lymphedema. Additionally, 11 patients had primary lymphedema and 129 patients had secondary lymphedema. The most common complication of lymphedema was lymphangitis (p < 0.001). There was a higher chance for Campisi stages 3, 4 rather than Campisi stages 1, 2 (p < 0.01). The significant presence of wounds was a risk of infection (p < 0.044) in lymphedema patients. The average body weight of patients who had infection was estimated at 74.26 kg, which was higher than that of the non-infected patients, which was at 66.16 +/- 14.67 kg (p = 0.037).
CONCLUSION: It is suggested to treat lymphedema since the initial stage, before the symptom reaches its late stage, to reduce the chance of lymphangitis. Besides, patients should be advised to beware of wounds and immediately receive wound treatment to lessen the rate of lymphangitis. Moreover, patients with lymphedema and higher weight are of major concerns as they have more chance to get infected.
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References
Smeltzer DM, Stickler GB, Schirger A. Primary lymphedema in children and adolescents: a follow-up study and review. Pediatrics 1985;76(2):206-18.
Lymphatic filariasis: fourth report of the WHO Expert Committee on filariasis. World Health Organ Tech Rep Ser 1984;702:3-112.
Rockson SG, Rivera KK. Estimating the population burden of lymphedema. Ann NY Acad Sci 2008;1131(1):147-54.
Passik SD, Newman ML, Brennan M, Tunkel R. Predictors of psychological distress, sexual dysfunction and physical functioning among women with upper extremity lymphedema related to breast cancer. Pyschol Oncol 1995; 4:259–63.
Tobin MB, Lacey HJ, Meyer L, Mortimer PS. The psychological morbidity of breast cancer-related arm swelling. Psychological morbidity of lymphoedema. Cancer 1993; 72(11):3248-52.
Ozaslan C, Kuru B. Lymphedema after treatment of breast cancer. Am J Surg 2004;187(1):69-72.
Stewart FW, Treves N. Lymphangiosarcoma in postmastectomy lymphedema; a report of six cases in elephantiasis chirurgica. Cancer 1948;1(1):64-81.
Damstra RJ, van Steensel MA, Boomsma JH, Nelemans P, Veraart JC. Erysipelas as a sign of subclinical primary lymphoedema: a prospective quantitative scintigraphic study of 40 patients with unilateral erysipelas of the leg. Br J Dermatol 2008;158(6):1210-5.
Masmoudi A, Maaloul I, Turki H, Elloumi Y, Marrekchi S, Bouassida S, et al. Erysipelas after breast cancer treatment (26 cases). Dermatol Online J 2005;11(3):12.
El Saghir NS, Otrock ZK, Bizri AR, Uwaydah MM, Oghlakian GO. Erysipelas of the upper extremity following locoregional therapy for breast cancer. Breast 2005;14(5):347-51.
de Godoy JM, da Silva SH. Prevalence of cellulitis and erysipelas in post-mastectomy patients after breast cancer. Arch Med Sci 2007;3:249-51.
de Godoy JM, de Godoy MF, Valente A, Camacho EL, Paiva EV. Lymphoscintigraphic evaluation in patients after erysipelas. Lymphology 2000;33(4):177-80.
Tsao H, Johnson RA. Bacterial cellulitis. Curr Opin Dermatol 1997;4:33-41.
Swartz MN. Clinical practice. Cellulitis. N Engl J Med 2004;350(9):904-12.
Cox NH, Colver GB, Paterson WD. Management and morbidity of cellulitis of the leg. J R Soc Med 1998;91(12):634-7.
T e e r a c h a i s a k u l M , E k a t a k s i n W , Durongwatana S, Taneepanichskul S. Diet, C-reactive protein levels and cellulitis in patients with lymphedema: a cross-sectional study. J Med Med Sci 2011;2:1297-1301.
Dupuy A, Benchikhi H, Roujeau JC, Bernard P, Vaillant L, Chosidow O, et al. Risk factors for erysipelas of the leg (cellulitis): case-control study. BMJ 1999;318(7198):1591-4.
Lewis SD, Peter GS, Gómez-Marín O, Bisno AL. Risk factors for recurrent lower extremity cellulitis in a U.S. Veterans Medical Center population. Am J Med Sci 2006; 332(6):304-7.
Tartaglione G, Pagan M, Morese R, Cappellini GA, Zappalà AR, Sebastiani C, et al. Intradermal lymphoscintigraphy at rest and after exercise: a new technique for the functional assessment of the lymphatic system in patients with lymphoedema. Nucl Med Commun 2010; 31(6):547-51.
Mortimer PS, Levick JR. Chronic peripheral oedema: the critical role of the lymphatic system. Clin Med (Lond) 2004;4(5):448-53.
Morpeth SC, Chambers ST, Gallagher K, Frampton C, Pithie AD. Lower limb cellulitis: features associated with length of hospital stay. J Infect 2006;52(1):23-9.
Bergkvist PI, Sjöbeck K. Relapse of erysipelas following treatment with prednisolone or placebo in addition to antibiotics: a 1-year follow-up. Scand J Infect Dis 1998;30(2):206-7.
McNamara DR, Tleyjeh IM, Berbari EF, Lahr BD, Martinez J, Mirzoyev SA, et al. A predictive model of recurrent lower extremity cellulitis in a population-based cohort. Arch Intern Med 2007;167(7):709-15.
Cox NH. Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg: a series with community follow-up. Br J Dermatol 2006;155(5):947-50.
Kalawat TC, Chittoria RK, Reddy PK, Suneetha B, Narayan R, Ravi P. Role of lymphoscintigraphy in diagnosis and management of patients with leg swelling of unclear etiology. Indian J Nucl Med 2012;27(4):226-30.
Soo JK, Bicanic TA, Heenan S, Mortimer PS. Lymphatic abnormalities demonstrated by lymphoscintigraphy after lower limb cellulitis. Br J Dermatol 2008;158(6):1350-3.
Chiu TW. Management of secondary lymphoedema. Hong Kong Med J 2014; 20(6):519-28.
Ellis Simonsen SM, van Orman ER, Hatch BE, Jones SS, Gren LH, Hegmann KT, et al. Cellulitis incidence in a defined population. Epidemiol Infect 2006;134(2):293-9.
Dobner J, Kaser S. Body mass index and the risk of infection-from underweight to obesity. Clin Microbiol Infect 2018;24(1):24-8.
T e e r a c h a i s a k u l M , E k a t a k s i n W , Durongwatana S, Taneepanichskul S. Risk factors for cellulitis in patients with lymphedema: a case-controlled study. Lymphology 2013;46(3):150-6.
Picard D, Klein A, Grigioni S, Joly P. Risk factors for abscess formation in patients with superficial cellulitis (erysipelas) of the leg. Br J Dermatol 2013;168(4):859-63.
Mokni M, Dupuy A, Denguezli M, Dhaoui R, Bouassida S, Amri M, et al. Risk factors for erysipelas of the leg in Tunisia: a multicenter case-control study. Dermatology 2006;212(2): 108-12.
Karppelin M, Siljander T, Vuopio-Varkila J, Kere J, Huhtala H, Vuento R, et al. Factors predisposing to acute and recurrent bacterial non-necrotizing cellulitis in hospitalized patients: a prospective case-control study. Clin Microbiol Infect 2010;16(6):729-34.
Pereira de Godoy JM, Galacini Massari P, Yoshino Rosinha M, Marinelli Brandão R, Foroni Casas AL. Epidemiological data and comorbidities of 428 patients hospitalized with erysipelas. Angiology 2010;61(5):492-4.
Bartholomeeusen S, Vandenbroucke J, Truyers C, Buntinx F. Epidemiology and comorbidity of erysipelas in primary care. Dermatology 2007;215(2):118-22.
Surrun SK, Ahmad MT, Afzal Sh, Tan BH, Siriwong W, Chapman RS. The risk factors and clinical characteristics of cellulitis: a hospital-based case-control study in Singapore. J Health Res 2009;23(2):81-86.
Garcia AM, Dicianno BE. The frequency of lymphedema in an adult spina bifida population. Am J Phys Med Rehabil 2011; 90(2):89-96.
Meeske KA, Sullivan-Halley J, Smith AW, McTiernan A, Baumgartner KB, Harlan LC, et al. Risk factors for arm lymphedema following breast cancer diagnosis in black women and white women. Breast Cancer Res Treat 2009;113(2):383-91.
Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014;59(2):e10-52.
Ki V, Rotstein C. Bacterial skin and soft tissue infections in adults: a review of their epidemiology, pathogenesis, diagnosis, treatment and site of care. Can J Infect Dis Med Microbiol 2008;19(2):173-84.
Kumar PJ, Clark ML. Infectious diseases, tropical medicine and sexually transmitted infections. 8th ed. Edinburgh: Saunders Elsevier; 2012. p. 76–81.
Ramakrishnan K, Salinas RC, Agudelo Higuita NI. Skin and soft tissue infections. Am Fam Physician 2015;92(6):474-83.
Chlebicki MP, Oh CC. Recurrent cellulitis: risk factors, etiology, pathogenesis and treatment. Curr Infect Dis Rep 2014;16(9):422.