Treatment of Recurrent Tropical Lymphangitis

Abstract

Recurrent tropical lymphangitis is very prevalent in Puerto Rico, and the internist is confronted with the problem of treatment for such cases. For a period of one year we have treated 3 series of cases with streptococcus vaccines and streptococcus filtrates. On the results obtained is based this report.

The vaccine used in the first group was prepared from 2 strains (S.T.M. strains L₉ and L₁₂) of beta-hemolytic streptococci isolated from small ulcers on the feet of each of 2 cases of recurrent lymphangitis during acute attacks, after passage through a mouse and incubation for 48 hours at 37°C. in tryptic digest broth. It contains approximately 1,200,000 dead organisms per cubic millimeter. Fourteen unselected cases have been treated with this vaccine. The injections were given subcutaneously every Tuesday and Saturday over the anterior aspect of the lower third of the thigh of the affected lower extremity. The initial dose was usually 600,000 organisms and the succeeding doses were increased gradually as tolerance developed; the interval between injections was lengthened according to results. The reaction from each injection was carefully recorded at the next visit; its description included a note on the severity and duration of local inflammation, the presence or absence of groin pain and development of systemic symptoms such as chilliness, feverish sensation, headache, general aches and pains. Of 14 cases treated, 7 are eliminated because they give no information as to the result of the treatment. Four abandoned treatment within 3 months. Three have only recently been added to the series. In 3 out of 7 cases, apparent benefit has been obtained from the use of the vaccine. In 3 other cases the vaccine failed completely. In a seventh case there seems to be some improvement which, however, is not very definite.