The actinomycosis

The actinomycosis is a disease that develops when injected into tissues and organs aktinomiceta and characterized by the appearance primarily in cervico-facial area, mouth, lungs, organs of abdominal cavity dense infiltrates, usually opened with the formation of fistulas with specific kroshkovatymi detachable. In humans is relatively rare. Among the animals actinomycosis occurs in cattle, less often in pigs.
Etiology. Agents of actinomycosis belong to actinomycetes (the streptomycete), widespread in nature. Main place of their habitat - soil, plants, barb cereals and other In its structure actinomyces similar to bacteria, but form long branching filaments, reminiscent of the mycelium fungi. For human and animal pathogenic some species of actinomycetes, there are aerobesand anaerobes.
In the body of humans and animals actinomyces form the so-called Druze, consisting of filamentous mycelium with radial clavate swellings, and therefore actinomyces was named radiant fungus.
The introduction of actinomycetes in the body mostly occurs through the mouth. Being as saprophytes in dental plaque, carious teeth, gingival pockets, crypts of tonsils, actinomyces under certain conditions (secondary infection, allergic States) may become pathogenic organism. Less common causative agents of actinomycetes can get into the body with the air into the lungs through the skin tissue and through the mucous membrane of the oral cavity and gastrointestinal tract with foreign bodies (osti cereals).
Pathological anatomy. Lumpy in the tissues develop infectious granulema (see) with necrosis and disintegration of cells in the heart, with the development of the dense fibrous connective tissue on the periphery. The actinomycosis has a tendency to spread tissue and only partially but the lymphatic system and blood.
The clinical picture. Depending on the location and characteristics of the course are the following forms: 1) cervico-facial and oral cavity; 2) bronchoscopy; 3) pnevmatikos (see); 4) the abdominal wall and organs of the abdominal cavity; 5) skin; 6) bones, joints; 7) of the spine; 8) the nervous system; 9) generalized.
The actinomycosis cervico-facial and oral cavity occurs most frequently. Proceeds with normal or low body temperature. the actinomycosis cervico-facial regionCharacterized by the appearance of a limited infiltrate woody density with a bluish coloration of the skin and the formation of one or multiple fistula ( Fig. 2) with scarce kroshkovatymi pus. When joining a purulent infection process can take place rapidly, with a significant increase in body temperature. On the place closed fistulas are formed involved scars. Near often leads to new fistulas. In some cases the disease can begin with information jaws or education dense infiltrate under the jaw, or under the mucous membrane of the oral cavity. Jaw bones are included in the pathological process more often again, with the formation of the center of destruction with multiple sclerosis on its periphery and pattern of acute osteomyelitis (accession purulent infection).
The actinomycosis abdominal wall and abdominal often develops when hit actinomycetes in the Appendix and blind gut. Hence the process applied to pozadinu fiber and up to the area pocks or down, hitting the bladder (women - the uterine appendages) and other bodies. Pockets of actinomycetes can come close to the abdominal wall, forming a specific fistula (sometimes pararectal cellular, intestinal and urinary). Symptoms of abdominal actinomycosis uncertain. Most often develop slowly infiltrates, sometimes with fistula with poor kroshkovatymi content.
The lumpy skin usually develops secondarily in the transition process with neighbouring authorities, has the form gumoshnik sites with specific bluish or purple-purple coloring of the skin. While softening and opening the node is marked krokovay pus. The slow healing of the fistula, with the formation of vtyanutoj scar.
The actinomycosis bones and joints, and also actinomycosis spine arise from the transition process with neighboring organs, rarely hematogenous. Centers around the destruction of bone tissue occurs seal, process involves periosteum. The cartilage of the long-term affects, so the frets is not formed. Lumpy spine suffer shackle and the vertebral processes, therefore hump, no pain and limited mobility, typical of tuberculous spondylitis.
The actinomycosis Central nervous system is extremely rare, specific symptomatology has not.
Generalized actinomycosis occurs more frequently when the primary localization of actinomycosis in the lungs. Proceeds rapidly by type of septicopyemia. The lesions are found in all organs.
The diagnosis of actinomycosis difficult. If you suspect is skin allergic test by entering into the thickness of the skin flexor surfaces of the forearms 0.3 ml of actinolite (product lysis aktinomiceta on a nutrient medium), and at a distance of 10 cm below the place of its introduction - 0.3 ml of sterile massoperenosa broth. When saving after 24 hours on the introduction of actinolite erythema, edema of the skin and pain at zatragivanija reaction is positive; if the same symptoms on the introduction of broth disappear after 8-12 hour - negative. Another method of early diagnosis is determination of the reaction of binding complement in the blood of the patient with use of actinolite as antigen.
The diagnosis is facilitated by softening infiltrate when his puncture and examination of pus give an indication of the actinomycetes. If there revealed fistula discover a fungus or Druze it can sometimes only after repeated studies. In some cases facilitates diagnosis biopsy.
Forecast in cervico-facial and skin actinomycosis favorable, with the organ is possible a lethal outcome.
Treatment. First course of treatment in the hospital. The best result gives immunotherapy (injection of actinolite). Every 3 days subcutaneously injected first 0.5 ml of actinolite, adding each subsequent injection of 0.1 ml, while the dose reaches 2 ml course consists of 20 - 25 injection, repeated 134 - 2 forest. To suppress secondary infection - antibiotics, especially chlortetracycline hydrochloride (biomitsin, aureomycin); to increase the reactivity of the organism - blood transfusion. Applied also ftivazid, sulfadimezin, potassium iodide (up to 12 grams per day); x-ray treatments. Surgery - excision of the source is shown where it is possible. In other cases, conduct palliative surgery opening of the centers, the dissection of the fistula with their curettage.
Prevention. Measures against dust premises in the processing of cereals, careful hygiene of the oral cavity (treatment of caries of teeth and gum disease), observance of rules of personal hygiene (not to take in a mouth Solomin, plants, raw grain).