結節性淋巴管炎（Nodular Lymphangitis）簡介

Nodular Lymphangitis

結節性淋巴炎主要的特徵為病原菌由皮膚感染處沿淋巴管形成發炎小結節，大部分是因Sporothrix schenclcii、Mycobacterium marinum、Francisella tularensis、Nocardia brasiliensis、Leishmania（Viannia） panamensis/guyanesis。流行病學的考量，職業、旅遊史、動物接觸史的詢問，臨床上的表現及潛伏期長短有助於預測這些特別的病原體。Sporotrichosis通常發生在圜丁，這是結節性淋巴炎最容易確認的原因。因接觸淡、海水時受傷，需考慮marinum感染。而潛伏期1-5天，在最初的傷處有疼痛下疳（chancre）樣傷口及明顯觸痛淋巴炎，則意謂著有tularemia感染。從原感染處有明顯的膿狀分泌物，可能與Francisella及A/ocard/a感染有關。若對於經驗性治療失敗，傷口應作組織切片檢查。詳細的病史及理學檢查，輔以組織切片對大部分的病患應能提供更完善治療的參考。

Nodular lymphangitis is mainly characterized by inflammatory nodules formed due to infection with pathogens entering the lymphatic system from the skin portal. This disease is usually caused by Sporothrix schenckii, Mycobacterium marinum, Francisella tularensis, Nocardia brasiliensis, Leishma-nia (Viannia) panamensis, or Leishmania guyanesis. These pathogens can be distinguished according to the epidemiology, patient’s occupation, patient’s history of travel, animal contacts, clinical presentation, and duration of incubation of the pathogen. Sporotrichosis, usually observed in gardeners, can be easily identified. M marinum should be considered when the patient’s wound has been in contact with fresh water or salt water. Tularemia is strongly presumed when the patient develops painful chancre-like wound and obvious tender lymphangitis after 1-5 days incubation of the pathogen. Obvious pus discharge from the primary wound is suggestive of infection with Francisella or Nocardia. Biopsy of the wound should be performed for histopathological examinations if the infection shows poor response to empirical therapy. Detailed recording of the medical history, physical examinations, and histopathology will help in deciding the optimal treatment for patients with nodular lymphangitis.