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Actinomycosis
Last reviewed: 19.11.2021
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Actinomycosis is a chronic infectious disease of humans and animals caused by anaerobic radiant fungi.
The main source of the disease is endogenous anaerobic actinomycetes, which are saprophytes of a person with particularly high stress in the oral cavity, upper respiratory tract and intestines. Activation and pathogenization of radiant fungi contribute to: decrease in resistance of the body due to diseases - tuberculosis, diabetes mellitus, cold and chronic skin diseases, hypothermia and trauma, especially open. Most often, the source of endogenous infection is the sick teeth: paradontosis, caries, plaque, etc.
A specific granuloma is formed around the submucosal layer or subcutaneous tissue of the radiant fungus, an actinomycoma having a characteristic structure (a spongy appearance due to decay and parallel with this fibrosis with the formation of scar tissue, cartilaginous tissue). Granuloma has a tendency to spread. It is most often spread by a contact route along the "shortest straight line", regardless of anatomical boundaries (such growth is not given even by malignant tumors), from the center to the periphery and towards the surface of the skin. The main clinical feature: pains occur only in the initial period of granuloma formation, in the future, despite the decay, the process is painless or painless; only the attachment of a secondary infection makes the process more vivid; general changes in the body are nonspecific.
[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]
Thoracic actinomycosis
It is 10-20% of other localizations. The top right upper lobe is mostly affected during primary infection; when sprouting from the abdomen - the right lower lobe. Pains are unstable, they give in the scapula and the right arm. Progressive weight loss, down to cachexia, is characteristic. Sputum small amount with blood veins, but with the breakthrough of the abscess in the large bronchus is abundant. With subpleural arrangement - clinic of persistent dry pleurisy. On chest radiographs, intense darkening of the lung tissue, consolidation, radical lymph nodes is noted. Radiological picture resembles pulmonary tuberculosis (but with actinomycosis there is no response to anti-inflammatory treatment) and lung cancer (but with actinomycosis there is no peribronchitis and bronchoconstriction, the inter-furrow furrows).
Actinomycosis of the mammary gland is accompanied by the formation of an infiltrate, which is opened on the skin with a fistula with a discharge in the form of grains (druses actinomycetes).
Abdominal actinomycosis
It is 10-20% of other localizations. In most cases it is located in the cecum and vermiform appendage: the onset of the disease is acute with the development of a picture of acute appendicitis (appendectomy is justified). Mucous is not affected, the process spreads through the serous membrane, forming a powerful infiltrate in the abdominal cavity with the subsequent development of a commissural disease. Often the infiltrate opens onto the skin with the formation of a fistula. The second way of propagation into the retroperitoneal tissue with the formation of psito or paranephritis and a small pelvis with the formation of pelvic peritonitis and the defeat of internal and external genital organs or paraproctitis that opens outward to form a fistula. In this case, the kidneys, ureters, uterus can be affected; bladder, penis and testicles.
[14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24]
Actinomycosis of bones
Changes in the bones are diverse in nature, due to the combination of destruction and proliferation. First of all, the periosteum is affected, then the cortical and spongy substance of the bone. The pacifier thickens, thickens, can become calcified. The calcification of intervertebral ligaments radiologically gives a symptom of a "bamboo stick". The focus of destruction can be of various sizes, but is always surrounded by a powerful capsule of osteosclerosis. With actinomycosis cartilage is never damaged, therefore, even with severe destruction, there is no restriction of mobility in the joints and spine, no curvature is formed.
[25], [26], [27], [28], [29], [30], [31], [32], [33]
Actinomycosis of the face
It is noted in 65% of all forms of actinomycosis and accounts for 6% of chronic pathology with which they are referred to cosmetology clinics. The most common are skin, 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 (with a dermal form combined with pustules) with a slow and painless course, then there is a perifocal edema and hyperemia, the infiltrate is opened outward with a fistula with a sparse discharge. Characteristic of the emergence of new infiltrates. The bones of the face can be involved in the process.
Diagnosis is difficult due to frequent attachment of secondary infection, as well as the presence of saprophytic radiant fungi. Identification of hematoxylin-eosin smears is difficult, for the detection of pathogenic fungi, coloration according to Tsil-Nelsen or Shabadash is required, which is generally available to any laboratory.