There may be general enlargement of the lymphatic glands which are rather hard, discrete and not bound down to the overlying skin. These glands may be somewhat tender or entirely painless. One of the most valuable methods of diagnosis of trypanosomiasis is by gland puncture, the juice obtained therefrom being examined in smear or inoculated into a monkey or guinea pig. Brazilian trypanosomiasis also shows glandular involvement.
Filariasis.—Varicose groin glands are frequently associated with lymph scrotum, chylocele or chyluria. The glandular masses are soft and doughy. The consistency is often that of a lipoma.
The overlying skin slips over the glandular mass. These glands are often mistaken for inguinal hernia. They do not give a tympanitic note and disappear slowly upon firm pressure with the patient lying down but return even with the pressure maintained upon assuming the upright position. There is no impulse on coughing. If a sterile hypodermic needle be inserted into the mass a chylous fluid slowly and persistently comes out of the needle drop by drop and this material may show filarial embryos.
The filarial worms Onchocerca volvulus obstruct the lymphatics and may give rise to swellings of considerable size along the course of the lymphatics.
Climatic Bubo.—The onset is gradual often accompanied by a low remittent type of fever. There is an absence of venereal sore.
These glands are only slightly tender and are often called fatigue glands as they produce a feeling of weariness after even moderate exercise. The inguinal glands of one or both sides are the ones involved but the overlying skin does not show the redness of a chancroidal or gonorrhoeal bubo. There is often a softening in the center of the affected glands.
Tsutsugamushi.—The glands which drain the area in which is located the ulcer at the site of the bite of the Kedani mite show swelling and tenderness.
Rat bite fever also shows glandular enlargement in the glands tributary to the healed infecting bite of the rat.
In tularaemia the lymph glands draining the site of the infecting bite become inflamed and swollen, often suppurating.
In leprosy the glands draining involved regions become enlarged but do not show a tendency to suppuration. The glands most frequently involved are the cervical and groin glands.