Actinomycosis

Actinomycosis is a chronic infectious disease of humans and animals caused by anaerobic ray fungi.

The main source of the disease is endogenous anaerobic actinomycetes, which are human saprophytes with especially high tension in the oral cavity, upper respiratory tract and intestines. Activation and pathogenization of ray fungi are facilitated by: decreased resistance of the body due to diseases - tuberculosis, diabetes, colds and chronic skin diseases, hypothermia and injuries, especially open ones. Most often, the source of endogenous infection is diseased teeth: periodontal disease, caries, plaque, etc.

A specific granuloma, actinomycosis, is formed around the radiant fungus that has penetrated into the submucosal layer or subcutaneous tissue. It has a characteristic structure (spongy appearance due to decay and, at the same time, fibrosis with the formation of scar, cartilage-like tissue). Granuloma has a tendency to spread. Most often, it spreads by contact along the "shortest straight line", regardless of anatomical boundaries (even malignant tumors do not provide such growth), from the center to the periphery and towards the surface of the skin. The main clinical feature: pain occurs only in the initial period of granuloma formation, subsequently, despite decay, the process is painless or slightly painful; only the addition of a secondary infection makes the process more pronounced; general changes in the body are nonspecific.

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Thoracic actinomycosis

It accounts for 10-20% of other localizations. The apex of the right upper lobe is mainly affected in primary infection; in case of germination from the abdominal cavity - the right lower lobe. Pain is inconstant, radiating to the scapula and right arm. Progressive weight loss is characteristic, up to cachexia. Sputum is small in quantity with streaks of blood, but when the abscess breaks through into a large bronchus, it is secreted abundantly. In case of subpleural location - clinical picture of persistent dry pleurisy. Chest radiographs show intense darkening of the lung tissue, compaction, hilar lymph nodes. The radiographic picture resembles pulmonary tuberculosis (but in case of actinomycosis there is no response to anti-inflammatory treatment) and lung cancer (but in case of actinomycosis there is no peribronchitis and bronchostenosis, the interlobar groove grows).

Actinomycosis of the mammary gland is accompanied by the formation of an infiltrate, which opens onto the skin as a fistula with discharge in the form of grains (actinomycete druses).

Abdominal actinomycosis

It accounts for 10-20% of other localizations. In most cases, it is located in the cecum and vermiform appendix: the onset of the disease is acute with the development of acute appendicitis (appendectomy is justified). The mucous membrane is not affected, the process spreads along the serous membrane, forming a powerful infiltrate in the abdominal cavity with the subsequent development of adhesive disease. Often the infiltrate opens onto the skin with the formation of a fistula. The second route of spread is into the retroperitoneal tissue with the formation of psoitis or paranephritis and the small pelvis with the formation of pelvic peritonitis and damage to the internal and external genitalia or paraproctitis, which opens outward with the formation of a fistula. In this case, the kidneys, ureters, uterus; bladder, penis and testicles can be affected.

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Actinomycosis of bones

Changes in the bones are varied in nature, due to the combination of destruction and proliferation. The periosteum is affected first, then the cortex and spongy bone substance. The periosteum thickens, compacts, and can calcify. Calcification of the intervertebral ligaments radiographically gives the "bamboo stick" symptom. The destruction focus can be of different sizes, but is always surrounded by a powerful capsule of osteosclerosis. With actinomycosis, cartilage is never damaged, therefore, even with powerful destruction, there is no limitation of mobility in the joints and spine, and its curvature does not form.

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Actinomycosis of the face

It is observed in 65% of all forms of actinomycosis and accounts for 6% of chronic pathology with which people seek help in cosmetology clinics. The most common are cutaneous, subcutaneous and subcutaneous-muscular forms. The addition of a secondary infection changes the clinical picture and makes it more vivid. It is characterized by the appearance of an infiltrate at various depths (in the cutaneous form it is combined with pustules) with a slow and painless course, then perifocal edema and hyperemia appear, the infiltrate opens outward with a fistula with scanty discharge. The appearance of new infiltrates is characteristic. The process may involve the bones of the face.

Diagnosis is complicated by the frequent addition of secondary infection, as well as the presence of saprophytic ray fungi. Identification when staining smears with hematoxylin and eosin is difficult; to identify pathogenic fungi, staining according to Ziehl-Neelsen or Shabadash is necessary, which is generally available to any laboratory.

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