An immunologist spoke about the combination of organ damage with COVID-19

A little about biopsy

Lymph node biopsy has two main goals:

• Detection of cancer;
• Detection of the infectious process in the lymph nodes.

Lymph nodes are an important element of the body's immune system, acting as “barriers” to the lymphatic vessels.

Lymph penetrates all internal organs and tissues of a person through lymph vessels. But along with lymph, unwanted bacteria and cancer cells can penetrate. And here the lymph nodes retain cancer cells. Such lymph nodes are called regional.

As the cancer develops, it can give metastases, which primarily affect nearby organs. Oncological diseases of the lungs and lymphoproliferative diseases more often metastasize to the supraclavicular and cervical lymph nodes.

Diagnosis of lymph nodes makes it possible to understand whether there are pathogenic cells in them.

In most cases, manipulation is carried out using a needle and syringe. This process is called a needle aspiration biopsy.

By enlarging, lymph nodes often signal the presence of pathologies, some of which are:

• The lesion is metastatic;
• Lymphomas;
• Sarcoidosis.

Using diagnostic techniques, the doctor has the opportunity to determine the optimal treatment tactics. The technique is highly informative, but it is necessary to remember: a positive result of the study remains so, but a negative one may also be erroneous.

The latter occurs more often due to the fact that pathogenic cells simply do not enter the removed material (biopsy).

After the procedure, the biopsy specimen is examined histologically or immunohistochemically.

The problem is that the biopsy obtained during puncture manipulation is not enough to conduct these studies.

An excisional lymph node biopsy is a procedure to remove the lymph nodes. It is performed through small incisions. As a result of the intervention, the lymph node is completely removed, using local anesthesia for pain relief.

After removal of the lymph node, it is sent for histological examination.

This approach makes it possible:

• Detection of lymphomas;
• Determining the type of disease;
• Determination of optimal treatment tactics.

If pathogenic cells are identified as a result, surgical intervention is used.

Contagious diseases that cause itching in the groin

First of all, these may be.

Scabies

It is characterized by two-point rashes all over the body. There are most of them in the skin folds, including the inguinal folds. A special symptom is that the skin itches more at night.

Pubic lice

Even a condom does not protect against them, since these insects live in the hair surrounding the genitals. With a careful examination through a magnifying glass, a urologist-venereologist can see them.

Fungi

Most often these are fungi of the genus Candida, transmitted through sexual intercourse. Along with redness and itching in the groin, the man will have inflammation and plaque on the head of the penis, and white discharge from the urethra.

Sometimes irritation in the inguinal folds is caused by ordinary saprophytic skin fungi. The spots in a man's groin will be in the shape of a ring, with swelling of the skin around the edge.

Other sexually transmitted diseases

Chlamydia, ureaplasmosis, and genital herpes occur after sexual intercourse with a sick partner. Unpleasant sensations in the groin are accompanied by pain when urinating and discharge from the urinary canal. The inguinal lymph nodes become denser.

In the photo: fungal rashes

Indications and contraindications

In most cases, the procedure is indicated to identify cancerous tumors.

Thus, in case of skin melanoma, the sentinel lymph nodes located in close proximity to the tumor site are examined. This helps determine the stage of the disease, as well as determine treatment tactics.

Suspicion of lymphoma is another indication. When the lymph node is removed and examined, the doctor has an idea of ​​the exact type of pathology, which, in turn, is crucial when choosing treatment tactics.

The procedure may be indicated for the purpose of identifying non-oncological diseases, such as tuberculosis, lymphadenopathy, sarcoidosis, etc.

There are a number of other indications for conducting research:

• Lack of results in long-term treatment of enlarged lymph nodes;
• Enlarged lymph nodes can be felt during palpation, but there is no pain, there are signs of intoxication;
• Lymph node size > 1 centimeter.

Any intervention has a number of contraindications. In the case of the described technique, they become:

Core biopsy of the breast

• Suppuration of the lymph nodes and adjacent tissues;
• Poor blood clotting;
• Curvature of the cervical spine, some others.

Causes and risk factors

Lymph node cancer has several age peaks during which the disease is diagnosed more often. This is the period from 15 to 30 years, people over 50 are also at risk. It is during this time that the risk of developing lymphoma is higher. The exact causes of the disease are unknown. Doctors cite only risk factors that increase the likelihood of developing lymphoma:

• prolonged interaction with harmful substances;
• HIV infection and other types of immunodeficiency;
• smoking and alcohol abuse;
• radiation exposure;
• living in unfavorable environmental conditions;
• pregnancy over 35 years of age;
• Epstein-Bar virus;
• genetic inheritance.

Stages

Different types of lymphomas can have different degrees of spread throughout the body. Taking this into account, there are 4 stages of lymph node cancer.

• First. Only one area is affected; cancer develops in the lymph nodes in the armpit, neck, etc.
• Second. The tumor process has already spread to 2 or more groups of lymph nodes.
• Third. In addition to the lymph nodes, the diaphragm and one organ outside the lymphatic system are affected.
• Fourth. At the last stage, tissues outside the lymphatic system are affected, and in several parts of the body at once. The disease invades vital organs, so treatment becomes less effective.

How to do it

The patient needs to prepare for the procedure in advance.

To do this, he must pass urine tests prescribed by the doctor. When examining the cervical lymph nodes, an X-ray examination may be prescribed. It is necessary to exclude kyphosis of the spine.

Excisional biopsy is otherwise called open: it requires access to the lymph node. The manipulation is carried out in the operating room.

Before the intervention, the required area is treated and numbed. As we have already noted, local anesthesia is more often used; in some cases, intravenous anesthesia may be indicated.

In the projection of the lymph node, the doctor makes an incision in the skin, after which he separates the tissue and, having reached the lymph node, removes it.

After completion of the manipulation, the incision is sutured. The duration of the entire procedure can range from ten minutes to half an hour. It all depends on the complexity.

When to see a doctor

Lymph node cancer requires timely detection at the earliest stage, since the prognosis of recovery depends on this. If you have risk factors or symptoms of the disease, you should immediately consult a doctor for appropriate diagnostic measures. In the case of cancer of the lymphatic system, the patient requires the help of an oncologist. In our oncology center on 2nd Tverskoy-Yamsky lane. House 10 employs the best specialists who specialize in the diagnosis and treatment of various types of oncology.

What after?

The patient receives doctor's recommendations regarding the recovery period. Usually this period proceeds quickly and easily and does not require serious restrictions.

The results of the study are ready a week to ten days after the procedure. This is quite long because the process of preparing sections is labor-intensive. In addition, sometimes there is a need to clarify the diagnosis using immunohistochemistry.

Having received the conclusion from the laboratory, the doctor makes a final diagnosis and prescribes the necessary treatment.

Treatment of lymph node cancer

The treatment regimen for lymphoma depends on many factors: the location of the tumor, its spread throughout the body, size and the presence of metastases in other tissues and organs. The best results are achieved by an integrated approach that combines several treatment methods.

Chemotherapy

Lymph node metastases from cancer require mandatory chemotherapy. It is considered a universal treatment method and is used both independently and in combination with other methods. The essence of chemotherapy is the intravenous administration of special antitumor drugs that destroy cancer cells. Such drugs also act on healthy tissue, which leads to side effects, but when metastases spread, this is the only method of treatment.

Surgery

Surgical treatment for lymph node cancer involves their complete removal. This method is also considered quite effective, since it minimizes the risk of relapse of the disease. Surgery for lymph node cancer is performed with resection of several regional nodes, which is necessary to reduce the likelihood of recurrent cancer.

Cervical, submandibular, inguinal and axillary lymph nodes are removed under local anesthesia, and deeper ones - under general anesthesia. The excised portions can be used for histology and correct diagnosis.

Radiation therapy

The use of radiation therapy is recommended in conjunction with surgical treatment. This method allows you to destroy cancer cells that may have remained after surgery. Radiation therapy is also used at an early stage as preparation for surgery to reduce the size of the tumor.

Bone marrow transplantation

Today, another new method is used in the treatment of lymph node cancer - donor bone marrow transplantation. This operation makes it possible to give very optimistic prognoses, especially at an early stage of the disease.

Separate groups of antibiotics that are used for inflammation of the lymph nodes

Penicillins

Penicillins are historically the first antibiotics to be actively used in clinical practice. Their indisputable advantage was the wide range of bactericidal effects that this group of drugs had.

But due to their active long-term use, many bacterial pathogens have developed resistance to penicillins. However, some of their representatives continue to be actively used in clinical practice for the treatment of lymphadenitis. Penicillins are available in the form of injections and tablets. The most commonly used drugs from this group are the following:

• Amoxicillin;
• "Augmentin" (a combination of amoxicillin and clavulanic acid).

Penicillin therapy for lymphadenitis lasts at least five days. Their advantages include low toxicity and the ability to use during pregnancy and immediately after birth.

The main disadvantage is that many patients experience allergic reactions to the drugs.

Cephalosporins

The first-line drugs that are actively prescribed for bacterial lymphadenitis or suspicion of this pathology are cephalosporins. They belong to the group of beta-lactam medications, so named because of their structural molecule. They have a pronounced bactericidal effect, as well as low toxicity, which allows them to be prescribed to patients of any age.

Most cephalosporins exist only in injectable form, so they are mainly used in hospitals.

There are now five generations of this group of antibiotics. For the treatment of lymphadenitis, the third (in the first line) and fourth (in the second) are mainly used. The most commonly used drugs are:

• ceftriaxone;
• cefixime;
• cefoperazone;
• ceftazidime;
• cefepime;
• cefpir.

Among the main disadvantages of cephalosporins is the fairly frequent development of hypersensitivity reactions to them of varying severity (from ordinary redness of the skin to anaphylactic shock).

They should also not be prescribed if you are intolerant to any other beta-lactam drug (penicillins, carbapenems or monobactams).

Sometimes there is a transient increase in the amount of creatinine and urea in the blood plasma.

Macrolides

If a patient has hypersensitivity to beta-lactams, macrolides are first prescribed. They belong to bacteriostatic drugs that can inhibit protein synthesis by microbial cells. Macrolides are the least toxic drugs compared to antibiotics.

Also, their significant advantage is the ability to accumulate in the lymphatic tissue of the body, so their use is highly effective. Additionally, they are well tolerated by the patient. Macrolides are mainly prescribed in the absence of serious complications. Most often prescribed:

• azithromycin;
• clarithromycin.

Among the side effects that are used for inflammation of the lymph nodes in the neck, it should be noted the development of dyspeptic disorders (nausea, vomiting and diarrhea), a transient increase in the amount of liver enzymes and the development of cardiac arrhythmias in patients with organic heart pathologies.

Antibiotics in the arsenal of a local pediatrician for the treatment of respiratory diseases

Although the diagnosis and treatment of respiratory pathology in children occupy a leading place in the work of a pediatrician, antibacterial therapy is required in almost only 6–8% of patients in this category - mainly with otitis, sinusitis, streptococcal sore throat, lymphadenitis, pneumonia, as well as bronchitis caused only by mycoplasma and chlamydia. Unfortunately, both here and abroad, the excessive use of these drugs has not been eliminated - they are sometimes used in 30–80% of children with acute respiratory viral infections (ARVI). Without bringing any benefit, this practice increases the risk of developing flora resistance and side effects, and also disorients the doctor: having not received the effect of an antibiotic for a viral infection, the doctor switches to reserve drugs, which also do not have an effect. Therefore, the main question is: are antibiotics indicated for this patient? — a positive decision should only be made for a proven (or probable severe) bacterial infection. And although it is rarely possible to prove the bacterial nature of acute respiratory diseases (ARI), the accumulated data allows the doctor with a high probability not only to identify such children, but also to outline the range of probable pathogens and their sensitivity to antibiotics. IN

forms of respiratory pathology are presented for which the prescription of an antibiotic is and is not indicated, as well as a symptom complex that allows one to suspect pneumonia in the absence of clear physical data, and the values ​​of inflammatory markers for which the administration of an antibiotic is justified.

IN

the main pathogens of bacterial acute respiratory infections are presented; It is obvious that the range of pathogens of acute respiratory infections in children is small, which facilitates the choice of a drug that acts on the probable causative agents of a particular disease. These data for antibiotics that should be used in outpatient settings are given in

.

Fortunately, penicillin resistance of pneumococci circulating among the Russian population (less than 10% of strains) is many times lower than, for example, in the countries of South-West Europe (40–50%). But it should be taken into account that among children in preschool institutions (preschool institutions) and especially in boarding schools, 50–60% of isolated pneumococcal strains are resistant to penicillin. Pneumococci remain 100% sensitive to amoxicillin (as well as ceftriaxone), but are resistant to co-trimoxazole, tetracycline, gentamicin and other aminoglycosides. Resistance of pneumococci to penicillins is not associated with the production of lactamase (it is caused by the loss of penicillin-binding proteins), therefore the use of inhibitor-protected penicillins does not increase the effectiveness of treatment. Resistance of pneumococci to macrolides is growing faster (up to 15–20% of strains in some regions); to a lesser extent, it is growing to 16-membered macrolides: josamycin, midecamycin, spiramycin.

Haemophilus influenzae (both non-capsular and type b) in Russia are sensitive to amoxicillin, doxycycline, 2nd and 3rd generation cephalosporins, and all aminoglycosides. But these pathogens are not sensitive to penicillin, cephalexin, cefazolin, and most macrolides - except for azithromycin (its use for otitis and sinusitis is limited by its low concentration in the corresponding cavities).

Under the influence of treatment, H. influenzae produces lactamases that inactivate lactam drugs (including penicillin and amoxicillin), therefore, in previously treated children (as well as in children from preschool education), amoxicillin/clavulanate or cefuroxime axetil are used from the beginning of treatment.

Group A beta-hemolytic streptococcus (GABHS) is sensitive to all antibiotics except aminoglycosides, but in some regions the frequency of macrolide-resistant strains can reach 15%. Moraxella catarrhalis, capable of producing lactamase, usually isolated from previously treated children, is sensitive to macrolides, cephalosporins, aminoglycosides, but resistant to amoxicillin.

Staphylococcus aureus rarely causes “outpatient” forms of respiratory tract damage (purulent sinusitis, cervical lymphadenitis); it is generally not sensitive to penicillins, there are strains resistant to cephalexin and amoxicillin/clavulanate, and its sensitivity to macrolides decreases rapidly if treatment lasts more than 5–7 days. The drugs of choice are cephalexin orally, and for more severe forms - oxacillin (parenteral), and in case of resistance to it - vancomycin.

In outpatient practice, drugs of first choice are prescribed if there is no reason to suspect the presence of drug resistance (

). For the vast majority of forms, oral forms of penicillins, cephalosporins of the first and second generations and macrolides are effective; they are most reliably administered in a pediatric dosage form - granules, Solutab dispersible tablets or syrup, which allows precise dosing.

The most used drug of first choice is amoxicillin (Flemoxin Solutab, etc.), it accounts (by weight) for 1/3 of all antibiotics produced in the world. Its bioavailability is higher than that of oral ampicillin, which has displaced the latter from the pediatrician’s arsenal. Other first-choice drugs: phenoxymethylpenicillin (Ospen syrup) and cephalexin are used only for the treatment of streptococcal tonsillitis, and macrolides are used for “atypical” infections (mycoplasmosis and chlamydia), as well as for the treatment of coccal infections in patients with allergies to penicillins.

second-choice drugs is started only in the case of previous (within the last 2–3 months) antibiotic therapy, as well as in case of nosocomial infection (in a child who became ill 1–3 days after discharge from the hospital). The most used drug is amoxicillin/clavulanate (Amoxiclav, Augmentin, Flemoklav Solutab), effective against both pneumo- and streptococci, as well as Haemophilus influenzae and Moraxella. Second-generation cephalosporins (cefuroxime axetil - Zinnat, which is much more active than cefaclor against pneumo- and streptococci) are also effective as second-choice drugs. Age-specific dosages are used, however, for amoxicillin/clavulanate and Zinnat, a number of instructions indicate underestimated (20–30 mg/kg/day) doses, which may be insufficient (see observation) - they should not be lower than 45–50 mg/kg/ days

Third-choice drugs (reserve, usually parenteral) are used only in cases of multidrug resistance, usually in a hospital setting.

are not used for respiratory pathology due to the increasing resistance of pneumotropic flora to them, as well as third-generation oral cephalosporins - ceftibuten (Cedex) and cefixime (Suprax), which may not be sufficiently active against coccal flora, in particular pneumococci.

Oral antibiotics are not used for severe acute processes. These include purulent sinusitis (occurs with swelling of the cheek or periocular tissue), it often requires surgical intervention, lymphadenitis with signs of purulent inflammation (adhesion to hyperemic skin, fluctuation). In children with croup, it is important to exclude epiglottitis - a bacterial inflammation of the epiglottis, which also causes inspiratory stridor as in viral croup, but with febrile temperature, intoxication, pain when swallowing in the absence of a barking cough, and dysphonia. Epiglottitis is characterized by increased dyspnea in the supine position, neutrophilic leukocytosis, and requires early intubation to prevent asphyxia. These diseases, as well as pneumonia complicated by pleurisy and destruction, require hospitalization, before which a broad-spectrum drug, ceftriaxone (80 mg/kg), should be administered parenterally, which should be in the emergency department and every local doctor.

In other cases, oral medications are used (). acute otitis media is suspected (or diagnosed by otoscopy), it is adequate to prescribe amoxicillin at a dose of 50 mg/kg/day, or amoxicillin/clavulanate at the same dose (overcoming the resistance of non-capsular hemophilus and moraxella), or, in a recently treated child, in a dose of 80–100 mg/kg/day of amoxicillin to overcome the possible reduced sensitivity of pneumococci in the middle ear cavity. In the latter case, it is advisable to use Augmentin or Flemoklav Solutab with a 7:1 ratio of amoxicillin and clavulanic acid. The duration of treatment is 10 days for children under two years of age and 7 days for older ones.

The same treatment tactics are effective for non-purulent bacterial sinusitis , which is diagnosed in the second or third week of acute respiratory infections while nasal congestion persists, often also fever, and pain in the projections of the sinuses.

Great difficulties arise in the treatment of acute tonsillitis , which in only 30% of cases is caused by GABHS, and in the rest by adenovirus or Epstein-Barr virus (infectious mononucleosis). They are equally characterized by an acute onset, fever with or without chills, sore throat when swallowing, hyperemia, swelling of the tonsils, often also of the uvula and soft palate, purulent detritus in the lacunae, plaque, enlarged lymph nodes (without suppuration). Streptococcal tonsillitis differs from viral tonsillitis in the absence of cough and catarrh, conjunctivitis, soreness of the lymph nodes and a drop in temperature 24–48 hours after the prescription of the antibiotic. Adenoviral tonsillitis is distinguished by conjunctivitis and nasopharyngitis, mononucleosis - nasopharyngitis, enlargement of the liver and spleen, and the appearance of wide-plasma lymphocytes in the blood. A positive culture makes the diagnosis of GABHS infection indisputable, as does an increase in antistreptolysin-O (ASL-O), therefore, such studies are indicated in all cases of acute tonsillitis.

In case of proven streptococcal tonsillitis, as well as in cases where the etiological diagnosis is unclear (especially in children over 6 years of age and in spring), one of the penicillins, cephalexin or macrolide is prescribed, which leads to a drop in temperature after 14–36 hours, confirming the diagnosis of streptococcal tonsillitis; in these cases, treatment should be continued for up to 10 days (for azithromycin - at a dose of 12 mg/kg/day - 5 days). If there is no effect, the antibiotic can be discontinued, leaving only symptomatic treatment.

If the lower respiratory tract is affected (its signs are tachypnea or dyspnea, the presence of wheezing, shortening of the percussion sound), it is important to differentiate viral bronchitis from pneumonia, in the vast majority of cases - bacterial.

Viral bronchitis, the most common form of damage to the lower respiratory tract (75–300 per 1000 children), is important to differentiate from bacterial pneumonia, the frequency of which is significantly lower (4–15 per 1000 children). This is all the more important because the complication of viral bronchitis, including bronchiolitis in infants, with bacterial pneumonia is extremely rare. A low-grade fever speaks against pneumonia (with the exception of chlamydial forms in the first months of life, in which the leading symptom is tachypnea) or if the initially febrile temperature drops to low-grade within 1-3 days. The abundance of wheezing typical for bronchitis or signs of obstruction are observed only with “atypical” mycoplasma pneumonia - they are asymmetrical and are often accompanied by a shortening of the percussion sound. Asymmetry of wheezing is also observed in bronchitis caused by mycoplasma, which is an indication for radiography. For typical (pneumococcal, hemophilus) pneumonia, if there is wheezing, it is local, often against the background of hard or weakened breathing over the lung area, often with shortening of the percussion sound (observation). Unfortunately, these local signs are not detected in all patients with pneumonia.

Thus, based on physical data, it is usually not difficult to exclude typical pneumonia and prescribe symptomatic therapy for viral bronchitis. If pneumonia is suspected (in the absence of threatening symptoms), the starting drug is amoxicillin 50 mg/kg/day, and in recently treated children amoxicillin/clavulanate 50 mg/kg/day or cefuroxime axetil - 40–60 mg/kg/day, which, As a rule, they give a quick effect. Lack of effect usually indicates an “atypical” etiology of pneumonia and requires changing the drug to a macrolide.

Infection with mycoplasma, which causes about half of all pneumonia in children over 5 years of age (it is difficult to draw a line between pneumonia and bronchitis with a loose pulmonary infiltrate), should be suspected in case of persistent (5–10 days) high temperature, usually with mild toxicosis (not causing severe anxiety for parents ), with mild catarrhal symptoms and conjunctivitis, with profuse, fine-bubble (as in infants with bronchiolitis) wheezing, but heard asymmetrically. A characteristic symptom is the lack of effect from the administration of amoxicillin and other lactam drugs; The administration of any macrolide in an age-related dose leads to apyrexia and a decrease in the symptoms of bronchitis within 1–3 days.

Local pediatricians often misinterpret the symptoms of these two types of pneumonia, prescribing “stronger” cephalosporins, which do not produce an effect, for more “noisy” (accompanied by an abundance of wheezing) atypical pneumonia, and “weaker” macrolides for typical pneumonia with a minimum of wheezing. In some cases of typical pneumonia, macrolides provide a quick effect, but due to the increasing resistance of pneumococcus, they may not have an effect. Therefore, one should strive to make starting appointments according to the more likely form of pneumonia. Relying on the detection, for example, of antibodies to mycoplasma is not reliable, since in the first week there may not yet be IgM antibodies, and PCR can detect the antigen in carriers.

To confirm or exclude a bacterial infection, so-called markers of bacterial inflammation are usually used - levels of leukocytosis, C-reactive protein, and, more recently, also procalcitonin. It is not uncommon to see a child with ARVI without visible bacterial foci, who receives antibiotics only because he has a leukocytosis of the order of 10–15 × 109/L. In most of these patients, ARVI progresses smoothly without the use of antibiotics. It has been proven that only leukocytosis > 15×109/l, absolute neutrophil count > 10×109/l and/or band > 1.5×109/l (as well as C-reactive protein (CRP) > 30 mg/l and procalcitonin > 2 ng/ml) more or less reliably indicate the possibility of a bacterial infection, while lower numbers are quite common in viral infections. Thus, in children with ARVI, bronchitis, croup, leukocytosis 10–15×109/l occurs in 1/3, CRP 15–30 mg/l – in 1/4 of patients. With tonsillitis caused by adenoviruses and the Epstein–Barr virus, in 1/3 of children, leukocytosis is in the range of 10–15 × 109/l, and 1/3 is above 15 × 109/l; CRP levels of 30–60 mg/l are detected in 1/4 of children, and in 1/3 - above 60 mg/l.

It should also be taken into account that with bacterial infections leukocytosis is not always observed: for example, with purulent otitis and typical pneumonia in 40% of patients, leukocytosis does not exceed 15´109/l, and with catarrhal otitis and atypical pneumonia - in 90%.

Literature

1. Baranov A. A. (chief editor). Clinical recommendations. Pediatrics. Edition 2. M.: Geotar-Media. 2009.
2. Baranov A. A. (ed.). Guide to outpatient clinical pediatrics. M.: Geotar-Media. 2006.
3. Baranov A. A. Russian national pediatric formulary. M.: Geotar-Media. 2009.
4. Union of Pediatricians of Russia. Scientific and practical program “Acute respiratory diseases in children. Treatment and prevention." M., 2002.
5. Tatochenko V.K. Pneumococcal infection is an underestimated threat // Children's infections. 2008, no. 2.
6. Tatochenko V.K. Antibiotic and chemotherapy of infections in children. M. IPK-Continent Press, 2008.

V. K. Tatochenko, Doctor of Medical Sciences, Professor

SCCD RAMS , Moscow

Table 1.

Table 2.

Table 3.

Table 4.

Observation

Nastya K., 4.5 years old, was admitted on the 4th day of illness, accompanied by a temperature of 39 °C and cough. Two doses of Flemoklav Solutab 15 mg/kg did not produce any effect.

On admission: obsessive cough, redness of the right cheek, shortening of the right lung above, no wheezing. Blood: L - 31.6 ´ 109/l, p/i - 29%, p/i 57%, ESR 36 mm/hour, CRP 60 mg/l, PCT 10 ng/ml.

A dose of Flemoklav Solutab 45 mg/kg led to a drop in T° by the end of the day, a rapid improvement in the condition and normalization of the picture in the lungs after 2 weeks. The course of treatment is 5 days.

Diagnosis: lobar pneumonia

Causes of inflammation of the lymph nodes in the neck

Often various infections in the body can cause inflammation, such as:

• staphylococci;
• coli;
• streptococci;
• purulent stick.

People with low immunity are more likely to develop lymphadenitis. But it also happens that with good immunity you can suffer from harmful microorganisms and get lymphadenitis. This can happen against the background of an infectious disease or during a period when the body is not yet fully strengthened.

Factors influencing inflammation of the lymph nodes in the neck:

• due to metabolic disorders in the body;
• due to acute inflammatory processes in the nasopharynx;
• due to an allergic reaction;
• due to consumption of alcoholic beverages in large quantities;
• due to a pathological process that affects connective tissue;
• due to cancer;
• due to pathology of the thyroid gland;
• due to HIV infection in the body.

When various microorganisms carrying an infection enter the human body, the lymphatic system blocks them, and the entire infection is localized in the lymph nodes. Because of this, the inflammatory process occurs. But the pathology of this disease can be either acute or develop into a chronic condition.

An important point in this situation is early detection of the disease and its timely treatment. Due to the fact that the lymph node can become inflamed due to a serious illness, there is no point in ignoring this pathology. In this case, you should contact a specialist.

Types of lymph node dissection

Depending on the location of the primary tumor focus, different groups of lymph nodes are removed during lymph node dissection. So lymph node dissection can be:

• mediastinal (for lung cancer, esophageal cancer);
• axillary (for breast cancer);
• pelvic (for cancer of the genital organs);
• inguinal-femoral (for cancer of the external genitalia), etc.

Depending on the scale of the intervention, lymph node dissection is divided into

• regional (deleting the nearest group of nodes);
• selective (selective);
• extended.

Our expert in this field:

Moiseev Alexey Andreevich

Oncologist, Ph.D.

Candidate of Medical Sciences

Experience: More than 19 years

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For malignant tumors of internal organs, a classification of lymph node dissection according to the levels of the removed lymph nodes is also used. Within this classification, the types are designated by the letter D with numbers from 1 to 4 next to them, where D1 is the lymph node dissection of the lymph collector closest to the tumor, and D4 is the most distant one. Each cancer disease has its own lymph node dissection standards and level system.