In-Service Exam
Lymphedema - 2002





Which of the following is the most common infectious cause of secondary lymphedema worldwide?

(A) Actinomyces israelii
(B) Candida albicans
(C) Coccidioides immitis
(D) Mycobacterium tuberculosis
(E) Wuchereria bancrofti

The correct response is Option E.

In the United States, secondary lymphedema is most likely to occur as a complication of surgery, radiation therapy, or malignant tumors. Infectious causes are more common worldwide; the most common is infection with Wuchereria bancrofti organisms, which directly invade the lymph nodes. Filariasis has been shown to be the most common noninfectious cause of secondary lymphedema worldwide.

Actinomyces israelii typically produces infection in immunocompromised patients. Although this organism is normally found within the oral cavity, it can cause infection throughout the body.

Candida albicans is a normal inhabitant of the gastrointestinal tract and the female genitourinary tract that also causes infection in patients with compromised immune systems. Overgrowth of Candida organisms can also be a complication of antimicrobial therapy.

Coccidioides immitis is a fungus that inhabits hot, dry, and dusty climates, including portions of the western and southwestern United States. Pulmonary symptoms are associated.

Mycobacterium tuberculosis infection occurred in epidemic proportions several centuries ago, resulting in severe pulmonary manifestations, but has since been controlled through mass screening procedures, including skin testing and chest radiographs. This organism does not typically result in secondary lymphedema.

References
1. Kobayashi MR, Miller TA. Lymphedema. Clin Plast Surg. 1987;14:303-313.
2. McGrath MH. Infections in the hand. In: McCarthy JG, ed. Plastic Surgery. Philadelphia, Pa: WB Saunders Co; 1990;8:5529-5556.
3.. Moran JF. Surgical treatment of pulmonary tuberculosis. In: Sabiston DC, ed. Textbook of Surgery. Philadelphia, Pa: WB Saunders Co; 1991:1729-1737.
4. Scott SM. Pulmonary infections. In: Sabiston DC, ed. Textbook of Surgery. Philadelphia, Pa: WB Saunders Co; 1991:1709-1717.