Dermatolymphangioadenitis (DLA)

delayed breast cellulitis, recurrent cellulitis, recurrent erysipelas, soft tissue infections, Dermatolymphangioadenitis (DLA), Flesh Eating Bacteria, Bacterial Infections, Strep Infections, bacterial cellulitis, prophylactic antibiotics

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Dermatolymphangioadenitis (DLA)

Postby patoco » Thu Jun 15, 2006 12:04 am

Dermatolymphangioadenitis (DLA)

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Dermatolymphangioadenitis (DLA)

Key Words: lymphedema, fibrosis, cellulites, lymphangitis, septic foci

In numerous articles, pages and discussions regarding a lymphedema limb with extreme fibrosis and cellulitis, I have spoken of the fact that
with extreme fibrosis (sclerosis) of the skin and subcutaneous tissues,
it becomes possible for bacteria to "hide" as it were in dense
fibrotic pockets.

These pockets (septic foci) interfere with the delivery of antibiotics
and make the treatment of any infection more complicated.
In such a situation, a treating physician must realize that with
lymphedema patients such as these, the standard ten day treatment of
oral antibiotics simply is not going to resolve the issue.

The physician absolutely must consider the use of IV antibiotics for
any extended period of time to make certain the infective bacterium is

Also, because of the increased risk of future infection, the physician
should also consider placing the patient on a preventative therapy of
daily oral antibiotics.

The following peer-reviewed articles describe in depth these serious
difficult to treat infections that are known as dermatolymphangioadenitis.


The effectiveness of long-acting penicillin (penidur) in preventing
recurrences of dermatolymphangioadenitis(DLA) and controlling skin,
deep tissues, and lymph bacterial flora in patients with "filarial"

Olszewski WL, Jamal S, Manokaran G, Tripathi FM, Zaleska M, Stelmach E.

Department of Surgical Research & Transplantology, Medical Research
Center, Polish Academy of Sciences, Warsaw, Poland.
Dermatolymphangioadenitis (DLA) is a common and serious complication of so-called "filarial" and bacterial non-filarial lymphedema of the limb,
affecting skin, lymphatics and lymph nodes. In our previous studies, we
demonstrated that more than 60% of patients revealed presence of
bacterial isolates in deep tissues, tissue fluid and lymph from the
lymphedematous limbs.

The question remained open whether elimination or
suppression of bacteria dwelling in lymphedematous tissues by
administration of low doses of penicillin for long time periods would
prevent recurrence of DLA attacks. In this study, we retrospectively
evaluated a self/community-selected group of patients with lymphedema
of the lower limbs with respect to the efficacy of long-acting
penicillin in preventing episodes of DLA.

There were no microfilariae or anti-filarial antibodies detected in the
investigated group. The questions we asked were: (a) how effective is
the benzathine penicillin in preventing recurrences of DLA attacks and
(b) how does its long-term administration influence the bacterial
spectrum of leg skin, deep tissues, lymph and lymph nodes and
sensitivity to antibiotics. Two randomly selected groups of patients,
receiving and not receiving penicillin during the same period of time,
were compared. Evidently lower recurrence rate of DLA was observed in
the treated group (p < 0.002).

There was increased prevalence of cocci and gram-positive bacilli with
a concomitant decrease of gram-negative bacilli on the foot and calf
skin surface. Simultaneously, decreased prevalence of gram-positive
cocci and gram-negative bacilli isolates in limb deep tissues and lymph
was seen. No resistance to penicillin and other tested antibiotics
developed in isolates from the skin surface, deep tissues and lymph.
We conclude that long-lasting penicillin is effective in preventing
recurrent DLA attacks.

PMID: 16184816 [PubMed - indexed for MEDLINE] ... =PubMed&...


Lymphology 29 (1996) 126-131


W.L. Olszewski

Department of Surgical Research and Transplantology, Medical Research
Center, Polish Academy of Sciences, Warsaw, Poland and the Norwegian
Radium Hospital, Oslo, Norway


Dermatolymphangioadentis (DLA) is a common and serious complication of obstructiveperipheral lymphedema. The clinical characteristerics of
acute DLA are local tenderness and erythema of the skin, sometimes red
streaks along the distribution of the superficial lymphatics
and enlarged inguinal lymph nodes.

Systemic symptoms include malaise, fever and chills. In its subacute or
latent form, only skin involvement is observed. Each episode of DLA is
commonly followed by worsening of leg swelling. Numerous clinical
studies suggest that administration of antibiotic drugs interrupt the
acute episodes and prevent their recurrence. We investigated the
clinical course of lymphedema with respect to the prevalence of DLA in
patients receiving injections of long-acting penicillin (benzathine
penicillin). Forty-five randomly selected patients with obstructive
lymphedema of the lower limbs were included in an open clinical trial.

The inclusion criteria was stage II-IV lymphedema of postsurgical,
posttraumatic, and postdermatitis type with at least 3 previous
episodes of DLA. Benzathine penicillin (PCN) was given after the last
presenting episode of DLA in a dose of 1,200,000 u, intramuscularly at
3-week intervals, for at least one year. Each patient was reevaluated
at 3-month intervals.

They were instructed in early diagnosis of DLA and reported promptly to
the responsible senior surgeon with prodrome symptoms of recurrent DLA.

The duration of lymphedema before initiation of therapy was 7 months to
40 years and the frequency of DLA was 1-6 episodes per year. PCN
administration lasted for at least one year but was extended in all
patients because of the tendency for recurrence of DLA after cessation
of PCN injections. In 26 of these patients, PCN administration extended
to over 5 years and in 2 over 10 years.

Recurrent episodes of DLA occurred in the PCN-treated group during one
year follow-up in only 4 of the 45 patients (9%). The frequency
episodes in 3 patients with recurrent DLA was 1-2/year; in one patient,
no positive effect of PCN therapy was observed.

There were no apparent side effects of long-term PCN therapy.
These data, although evaluated without a placebo group, suggest that
long-term PCN administration decreases the frequency of DLA attacks and furthermore provide justification for carrying out a double-blind randomly placebo-controlled clinical trial of the efficacy of prophylactic
antibiotic drug treatment in forestalling DLA episodes.
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