The actinomycosis

The actinomycetes (actinomycosis; from the Greek. aktis - ray and mykes - fungus) is a chronic infectious disease of humans and animals caused by radiant fungus.
The etiology and pathogenesis. The causative agent of actinomycosis - radiant fungus consists of plexus finest branching filaments (micelles) with spherical formations at the ends (the"bulb") (Fig. 1). Colonies of fungi (Druze) in most cases are detected in pus in the form of characteristic grains. In some cases, actinomyces (see) are separate levitamise or slightly branched wand-like bacteria.

Fig. 1. Cut through quite a developed Druze.

Pathogenic radiant fungus is represented by two species: anaerobic type and aerobic that with all the transitional variants are different forms of adaptation to the environment: first, to parasitic life and body, the second - for a free life in nature. Pathogenic fungus may saturators, turning into an unstructured vitreous mass. Pathogenic for humans is a fungus that normally saprophytism in the mouth and other parts of the digestive tract. The main way of implementation of fungus in the body - alimentary. You can install and pulmonary actinomycosis alimentary way of implementation of fungus, although the known cent of cases the infection occurs by airborne.
Maxillo-facial and abdominal forms comprise 80% of all forms of actinomycetes.
The fungus is distributed mainly along the fiber, so actinomycosis abdominal cavity is mostly retroalimentaciyn; maxillofacial actinomycosis occurs much more often than actinomycosis mouth, and even actinomycosis light selectively distributed on the basis of connective tissue of the body.
To implement aktinomiceta visible destruction of the bowel wall is not mandatory, although it is possible introduction of CSOs and after perforation (appendicitis, ulcer of the stomach or injured intestine. In most cases invasion leaves no visible track on the mucous membrane.
Once established, the fungus can spread and hematogenous route, causing the dissemination and even militarization. Some options fungi especially often metastasize to the brain.
The actinomycosis belongs to diseases causing sharp allergization of the organism. Therefore, several authors, first of all domestic and foreign, were able to implement in practice the immunodiagnostics and immunotherapy of actinomycetes. In the USSR it is widely used for these purposes the product of spontaneous lysis aktinomiceta (actinolite). Hypersensitivity to the antigen may remain for many years.
The incubation period can last 2-3 weeks from the moment of introduction of the pathogen. Often, however, the longer incubation.
Pathological anatomy. In place of introduction of a fungus occurs primary focus of actinomycosis - infectious granuloma (aktinomicose). Actinomycetaceae site in the section resembles a honeycomb (Fig. 2): small abscesses made of thick yellow-green pus containing "grain of sand" (Druze fungus), and immured in the dense fibrous connective tissue.
For actinomycetaceae granuloma is characterized by: 1) the presence of Friends of the fungus; 2) santonij cells; 3) the progressive growth of the coarse-fibered connective tissue.
In the centre granuloma friends around fungus prevail segmented leukocytes, lymphocytes, sometimes eosinophils; next is the area of granulation tissue rich in capillaries, lymphoid, epitelialna, plasma cells, fibroblasts, Santanyi cells; there are also giant cell cell type Pirogov - Langhans or cell type of foreign bodies, and sometimes hyaline balls (Fig. 3). Cells of the Central part of granulomas undergo fatty and necrobiosis, infiltrated their fabric is subjected to melting (suppuration), and on the periphery of the gradual maturation of granulation tissue with subsequent formation of unsightly scars.

Fig. 2. Actinomycetaceae node in the liver.
Fig. 3. Infectious granuloma lumpy. Around Druze (2) by a semicircle situated giant cells (1).

The actinomycosis is characterized by two processes - suppuration and sclerosis. With the progression of actinomycosis small abscesses merge process spreads to the adjacent organs, melting of collagen and elastic fibers, muscles, bones, cartilage. Opening of ulcers leads to the formation of long not healing fistula. Sclerosis accompanied by the formation of Scar fields cartilage density that does not have clear boundaries. Distributed process more per continuitatem, however, possible hematogenous route and very rarely lymphogenous.
Postmortem there are three forms of actinomycosis easy.
1. Surface form, primary, bronchogenic. The fungus damages only in the bronchi, not penetrating into the lung tissue. This form is characterized by the so-called surface catarrhal or catarrhal-purulent bronchitis (M. A. Skvortsov). With the progression of the process in the bronchi can occur necrosis, melting and ulceration of the mucous membrane, in the adjacent lung tissue - interstitial and chronic pneumonia; in the outcome of the formation of bronchiectasis with carnificina lung tissue.
2. Destruida form, the most common is the result of bronchogenic or haematogenous dissemination process. The lesions in the lung in this form have the size from a pea to chicken eggs and more dense consistence, on a cut wire mesh. Merging, granulomas form extensive infiltrates, sometimes covering the entire lung lobe, with decomposition and formation of single or multiple abscesses, caverns, surrounded by rough scar tissue. Macroscopic similarities with tuberculosis has allowed to carry this form into "the nonspecific pulmonary tuberculosis" (I. Century Davydov).
The dissemination process is complicated by the empyema and obliteration of pleural and pericardial cavities, mediastinitis, osteomyelitis of the vertebral bodies, sternum, ribs. May occur General amyloidosis.
3. Miliary form of actinomycosis light is a manifestation of hematogenous generalization process. Miliary yellow foci in the lungs are a small abscesses with Druze fungus. In addition to the lymph nodes, the lungs can meet metastases in the form of larger ulcers. In the abdominal cavity primary focus of actinomycosis - actinomycetaceae granuloma is usually localized in ileo-secalinum intestine, in his submucosal layer.
When distributing suppuration ulcers, adhesions, meritline abscesses, fistulas. Characteristic of the transition process on retroperitoneal fibre with subsequent involvement of paranemia, organs of small pelvis.
Tumor site in other organs of the abdominal cavity (stomach, liver) is rare; they are usually amazed again. In the liver merging granulomas form of single or multiple actinomycetaceae assemblies consisting of purulent cavities, separated layers of connective tissue. They can break into the peritoneal, pleural cavity and out.