Actinomycosis - Causes, Symptoms and Treatment .MF .
Pathogenic action actinomycetes
Symptoms and forms of the disease
Diagnosis Treatment Prevention
refers to quite specific fungal disease that infects a person, and occurs with some frequency in all countries of the world.Patients with actinomycosis up to 10% of purulent lesions of various localizations.Characterized by the formation of specific granulomas with subsequent development of abscesses and fistulas points to the relevance of the disease for many medical specialties and requires a thorough differential diagnosis.
Actinomycosis - is an infectious disease of chronic course, caused by radiant mushrooms - actinomycetes, affecting both humans and animals, and characterized by the formation of the skin, mucous membranes and internal organs of specific granulomatous lesions of so-called aktinomikom.Often, the disease leads to the development of septic complications in the field of primary localization of foci of actinomycosis. Synonym disease - radiant- fungal disease.
first causality occurrence of purulent diseases of animals (cattle) with a fungal nature (radiant mushrooms) discharged 1845- 1877 years (researchers G. Bollinger, B. Langenbeck, H. Lebert).Under laboratory conditions to achieve growth of mycelium of a material from a sick person could only in 1885, which greatly facilitated the subsequent diagnosis of the disease.
But to this day no clear registration actinomycosis both in Russia and in the countries of the world.The doctors of various specialties (surgeons, dentists, dermatologists, infectious disease and others) deal with such patients, the most frequent localization of foci is the area of the neck and face (75-80% of all injuries).A disturbing fact is the development in 20% of cases, that is, every 5th patient, the visceral form of the disease with lesions of the internal organs and systems.The chronic nature of actinomycosis often due to late diagnosis of the causes of the defeat.
Causes of actinomycosis
The disease is specific microorganisms - radiant fungi of the genus Actinomyces (actinomycetes) several species (Actinomycesalbus, A. bovis, A. candidus, A. israelii, violaceus).From the name can be seen a special feature - the growth of fungi accompanied by the formation of mycelium (or colonies) in the form of threads (friends) with bulges at the end (of the form cones) ranging rays.Microscopy material staining (hematoxylin-eosin) staining reveals fungal threads in blue and pink nodules, and therefore the colonies become distinctive appearance.
Actinomycetes Actinomycetes are found as part of the normal flora (saprophytes) in the oral cavity, the cavity carious teeth on the surface of the tonsils, in the upper bronchi, digestive system, rectum and anus.Actinomycetes are widely distributed in nature, they are often found in soil and water environments, dry grass, straw.These findings make it possible to allocate as an exogenous nature of the infection, and endogenous infections (fungi spread from the interior of the human body fluids).Actinomycetes are susceptible to several antimicrobials - benzyl penicillin, streptomycin, tetracycline, chloramphenicol, erythromycin.
source of infection often can not be traced Lumpy.It is rare to find direct evidence of contact with other patients sick actinomycosis.Given the high prevalence in nature, as well as in the composition of the microflora of many organs and systems of the body revealed two types of infection: exogenous and endogenous.
mechanism of infection in the event of exogenous infection (that lately less and less) - contact-household, aerogenic with airborne dust and airborne transmission paths.With more frequent endogenous infection occurs penetration of actinomycetes with various plants in the human body, the absence of the pathogenic effect of a certain period (saprophytic existence), but may develop as a local inflammatory process and lymphogenous or hematogenous spread of infection.
susceptibility to Actinomycosis general.There was a more frequent registration of patients - men, women who exceed the proportion of patients in 1.8-2 times.The most commonly affected age group - a workable population of 21 to 40 years old.On the outcome of infection, of course, affect the original condition of the human immune system.It is evidence of an increase in the incidence of the disease during the colds, ie in the autumn-winter season.
Pathogenic actinomycetes impact on the human body
1) When endogenous infection and transient saprophytic existence may develop at the site of inflammation in the mucous membranes (mouth, mucous membrane of the gastrointestinal tract, respiratory tract mucosa).
There are risk factors for actinomycosis: reduction of infection-resistance input gate (oropharynx), which occurs due to frequent colds;reduction in body resistance due to the presence of comorbidities (diabetes, tuberculosis, liver cirrhosis, asthma, cancer, etc.), the presence of chronic inflammatory lesions;hypothermia;pregnancy;various operational interventions for chronic inflammatory processes;various anatomical abnormalities (bronhiogenny fistula neck urahusa - fistula of the bladder and the anterior abdominal fascia, etc.);injuries, wounds, bruises.
is the formation of specific granulomas (aktinomikomy) that can fester with the formation of abscesses, fistula formation.That is, the development aktinomikomy sequentially passes through three stages: infiltrative stage, abscess formation stage, stage of fistula.Purulent effects often associated with secondary bacterial infection (staphylococcus, streptococcus).The process can spread to the skin.
2) In the process of life radiant fungi produce toxins and allergens that are causing sensitization of a patient's body (allergic caution).
Clinical forms and symptoms of actinomycosis
The incubation period is unknown (it may last from several days to several years).For a long time the patient does not complain, and his state of health does not change.
Clinically distinguish several forms of the disease:
1) cervical-facial shape (this includes the maxillo-facial injuries);
3) osteo-articular form;
4) Thoracic form;
5) abdominal form;
6) urogenital form;
7) form nervous (CNS actinomycosis);
8) actinomycosis of the foot (foot Madurese or mycetoma);
9) rare forms.
cervicofacial form of actinomycosis is the most common.The process can be placed in the muscle beneath the skin and directly in the skin.Most often in the muscles (eg, chewing, in a corner of the lower jaw) appears dense nodular education plotnovata consistency.Characteristic facial asymmetry, pasty or swelling at the place of assembly, bluish tinge to the skin over the form.Gradually education palpated soft lesions (abscess or infiltration), lesions may become evident with the formation of fistulas.From fistulas follows purulent fluid sukrovichnogo nature, upon closer inspection, visible grains yellow (drusen actinomycetes).The course of this form favorable.
Actinomycosis, maxillofacial form
Cutaneous occurs in most cases secondary to neck and facial muscles with defeat.If you suffer from skin, the subcutaneous fat infiltrates appear round or oval.The process may affect the neck, cheeks, lips, move to the oral cavity, larynx, tonsils, orbit and other areas.A characteristic feature of actinomycosis - long cyanosis (cyanosis) of the skin in the lesion.Cutaneous can occur in several different ways: it can be
- atheromatous option (infiltrates in the skin have the form of atheroma and occur at a younger age),
- papulose-pustular variant (there are elevations on the skin that are subsequently convertedin pustules),
- gummy-knotted version (very dense knots),
- ulcerative variant (in severe immunodeficiency infiltrates occur with subsequent tissue necrosis and ulcerative skin lesions).
Musculo-articular form actinomycosis is quite a rare form of the disease.Developed as a result of hematogenous drift of actinomycetes or germination infiltrate neighboring tissue and organs.Risk factors are patients with injuries, injuries, injuries.There are osteomyelitis, followed by a destructive process that can form fistulas.Described osteomyelitis pelvis, spine, and other bones, joint destruction.Patients complain of pain, but the function of the affected joints suffer a little, patients retain the ability to move.
Thoracic form is the second in frequency of occurrence in humans.It is also called Thoracic actinomycosis actinomycosis or lungs.The formation of this form of actinomycosis may be preceded by a variety of chest trauma, chronic inflammation of the lungs and surgery.The disease has no acute onset, as in many pulmonary pathologies.Patients feel weakness, fatigue, low temperature (usually up to 37.5 °), there is a dry cough, which over time becomes wet (sputum purulent character mixed with blood, earthy smell or a smell of damp).There are chest pain when coughing and breathing.Education infiltration in the lung has a definite trend - spread from the center to the periphery, that is, gradually, the process involved surrounding the bronchi areas (peribronhit), pleura, chest and finally the skin.Visible changes are characterized by swelling or pasty wound site, pain on palpation (palpation), as in the form of a skin, the skin above the fireplace becomes cyanotic with a purple tint.It may also occur opening of a purulent infiltrate with fistula formation.Fistula is on the skin, fistulas can be opened both in the chest and in the waist area.Sometimes a breakthrough and a major infiltration bronchus itself, in which the patient appears copious purulent sputum by coughing.Complications are heart failure and breast cancer.Proceeds this form is usually difficult without timely medical care provided by the outcome may be unfavorable.
Actinomycosis, thoracic shape
Abdominal disease as a consequence of surgical intervention (removal of the appendix, gall stones, and others), chronic enterocolitis, intestinal obstruction, injuries, injuries.In some patients (10%) actinomycosis associated with endogenous infection.Up to 60% aktinomikom formed in the appendix, large intestine, small intestine is affected less and stomach.Patients concerned about abdominal pain, sometimes radiating to the acute bladder, rectum.Next infiltration begins to spread to the periphery, it affects "all that is on its way" - can affect the liver, spleen, kidneys, and finally the abdominal wall, a fistula formed in the final.Often the place of localization of fistulas when abdominal form is the groin, with the defeat of the rectum - perianal region.This form also runs hard, with late diagnosis and lack of treatment of specific adverse outcome in every second patient.
intestinal actinomycosis, radiography
Genitourinary form of actinomycosis - infrequent manifestation of the disease.Risk factors are chronic inflammatory diseases of the urinary system and genital organs, navy, kidney stones, surgery.Most often, the formation of infiltrates in neighboring systems, and urogenital system is affected secondarily, ie germination occurs in the pelvic organs, such as the result of abdominal form.
Nervous form (actinomycosis CNS) develops in most cases secondary to the formation of the neck-face form.The infection spreads lymphogenous, gematogennoili a contact.Formed meningitis, meningoencephalitis, or brain abscess.When distributing the bloodstream can form multiple aktinomikomy in the brain.Complaints of patients coincide with those of meningitis and encephalitis (headaches, nausea and vomiting, symptoms of cranial nerves, etc.).In the process of the spinal cord and can be involved.
Actinomycosis foot (mycetoma, Madurese foot) is characterized by the formation of a dense knot on the plantar surface of the foot or more units ranging in size from 1 cm or more on which later began to change color from reddish-purple to purple-cyanotic.Appears foot swelling, pain when walking due to swelling (nodes themselves are almost painless).Then the assembly opening and the formation of a fistula at the skin surface.Discharge fistula as well as in other forms is purulent with bloody inclusions and yellowish flecks drusen actinomycetes, has the smell of the earth, or foul-smelling.Often, the process can progress and move to the rear of the foot, the surrounding muscle tissue, tendons, bone tissue.The process usually unilateral, has a chronic (decades).
rare forms affect organs and systems such as the thyroid, tonsils, nose, middle ear, tongue, organs of sight, salivary gland, pericardium.
Diagnosis of actinomycosis
1. The preliminary diagnosis - clinicoanamnestic.In the primary treatment of the patient properly collected history can help in the formulation of the proposed diagnosis and determine the correct algorithm of further actions of the doctor.What matters is the patient's history of life, injury, surgery, presence of chronic foci of infection.Clinically, the initial stage of the disease is difficult to diagnose, most patients turn to doctors of various specialties for a long time before the correct diagnosis will be exposed.
Differential diagnosis is carried out with purulent lesions of the skin, subcutaneous fat, osteomyelitis of different etiology, pulmonary tuberculosis, tumors, aspergillosis, histoplasmosis, nocardiosis, lung abscess, appendicitis, peritonitis, secondary meningitis and meningoencephalitis of different etiologies, pyelonephritis, prostatitis, uterine fibroidsand many other zaboelvaniya.
In step abscess and fistula formation diagnosis formulation facilitated in favor of actinomycosis.
2. The final diagnosis is exposed after laboratory and instrumental examination of the patient.
A) Isolation of the culture of actinomycetes in the fistula pus, biopsies of the affected tissues.Cultures of sputum, mucus, throat and nose do not have a diagnostic value in connection with the possible detection of saprophytic actinomycetes.To research the planting material for Wednesday Saburo, followed by microscopy of colonies grown.Preliminary results after 3 days, the final - in 10-12 days.
actinomycetes isolated culture of ray fungi
macroscopically infiltrative show granulomas (aktinomikomy), the disintegration of tissues, purulent transformation aktinomikom, fibrosis and the formation of scar tissue in the final, similar to cartilage, having the form of "cell".
microscopically detected in the outbreak of actinomycosis: the proliferation of tissue necrosis and disintegration of cells of the central part of the granuloma formation of fibrous structures on the periphery, the presence ksantomnyh cells and the development of fibrosis.There are 2 options aktinomikomy: destructive or initial stage of development (granulation tissue composed of connective tissue cells and polymorphonuclear leukocytes, a tendency to the disintegration of cells and fester, Druze actinomycetes) and destructive-productive or secondary stage (to the above cells join lymphoid, epithelioid,