Actinomycosis — the infectious disease caused by radiant mushrooms (actinomycetes) and having a primary and chronic current with formation of dense granulomas, fistulas and abscesses. Actinomycosis can affect not only skin, but also internals. Diagnosis of a disease is based on detection of a characteristic mycelium of mushrooms in separated and identification of growth of specific colonies at crops on nutrient mediums. In treatment of actinomycosis introduction of an aktinolizat in combination with antibiotic treatment, Ural federal district of skin, an iodine electrophoresis is applied. According to indications opening of abscesses, expeditious treatment of fistulas, drainage of an abdominal and pleural cavity is made.
Actinomycosis — the infectious disease caused by radiant mushrooms (actinomycetes) and having a primary and chronic current with formation of dense granulomas, fistulas and abscesses. Actinomycosis can affect not only skin, but also internals. Diagnosis of a disease is based on detection of a characteristic mycelium of mushrooms in separated and identification of growth of specific colonies at crops on nutrient mediums.
Causes of actinomycosis
Causative agents of actinomycosis — sort Actinomyces mushrooms often meet in the nature. They can be on the soil, plants, hay or straw. Actinomycetes get into a human body through the injured skin, at inhalation or with food. In most cases they do not cause a disease, and live on mucous eyes or a mouth as saprofitny flora. Inflammatory processes in a mouth, digestive tract or respiratory organs can lead to transition of actinomycetes to a parasitic state with development of actinomycosis. Actinomycosis also occurs at farm animals. However infection of the person from people animal or sick with actinomycosis does not occur.
Actinomycosis of skin can initially arise at penetration of actinomycetes through wounds and other damages on skin. Secondary damage of skin develops from within, upon transition of an infection from the subject fabrics (almonds, teeth, lymph nodes, muscles, a mammary gland) and internals.
Classification of actinomycosis
Depending on localization of pathological process at actinomycosis allocate the following forms:
- cervical and maxillofacial;
- actinomycosis of joints and bones;
- TsNS actinomycosis;
- foot actinomycosis (mitsetoma, Madura foot)
Duration of the incubatory period at actinomycosis is definitely not known. The disease is characterized by the long and progressing current and 10-20 years can proceed. In an initial stage at the patient the normal health remains, but at damage of internals a state to become heavy, there is a kakheksiya.
Skin actinomycosis most often affects submaxillary, sacral area and buttocks. It is characterized by emergence in hypodermic cellulose of consolidations and cyanotic-crimson coloring of skin over them. Consolidations have spherical shape and practically do not cause painful feelings. In the beginning they very dense, then are softened and opened with formation of badly healing fistulas. In purulent separated fistulas there can be a blood impurity. Sometimes at it there are yellow grains — Druzes of actinomycetes.
Actinomycosis of skin happens 4 types. At ateromatozny option which occurs generally at children infiltrates remind ateroma. Bugorkovo-pustulezny actinomycosis begins with education in skin of the hillocks passing into deep pustula, and then and fistulas. Formation of knots of cartilaginous density is characteristic of gummozno-knotty option. Ulcer actinomycosis, as a rule, develops at the weakened patients. At it the stage of suppuration of infiltrate comes to an end with a necrosis of fabrics and formation of an ulcer.
Cervical and maxillofacial actinomycosis is widespread more than others and meets in several forms: with defeat of intermuscular cellulose (a muscular form), hypodermic cellulose or skin. Process can extend on a face and a neck, occupying bays, language, getting into a throat, a trachea and an eye-socket. At a muscular form characteristic infiltrate is most often formed in chewing muscles, causing a trizm and resulting in asymmetry of the person.
Thoracic actinomycosis begins with cold symptoms: the general weakness, subfebrilitt, dry cough. Then cough to become damp, the mucopurulent phlegm having taste of copper is allocated and began to smell lands. Gradually aktinomikotichesky infiltrate spreads from the center to a chest wall and comes to skin, forming at the same time the fistulas going from bronchial tubes. Such fistulas can open not only on the surface of a thorax, but also in a waist and even a hip.
Abdominal actinomycosis often imitates sharp surgical pathology (intestinal impassability, appendicitis, etc.). It extends to intestines, a liver, kidneys, a backbone and can reach a forward wall of a stomach with formation of the intestinal fistulas opening on skin. Actinomycosis of a rectum proceeds with a clinical picture of a paraproktit. Actinomycosis of urinogenital bodies — a rare disease which arises again upon transition of an infection from an abdominal cavity more often.
Actinomycosis of joints and bones usually arises at distribution of process of other bodies. Damage of joints is not followed by considerable violation of their function, and actinomycosis of bones proceeds as osteomyelitis. Distribution of infiltrate to the surface of skin leads to formation of fistulas. Mitsetoma begins with emergence on a sole of several dense "peas" over which skin gradually gets brown-violet coloring. The number of consolidations increases, there is a puffiness, the form of foot changes and purulent fistulas are formed. Sinews, muscles and bones of foot can be involved in process.
Diagnosis of actinomycosis
At development of a characteristic clinical picture of actinomycosis diagnostics does not cause difficulties. However it is important to make the correct diagnosis in an initial stage of actinomycosis. Detection of actinomycetes in a phlegm, dabs from a pharynx or a nose has no diagnostic value as it is observed also at healthy people. Therefore for a research take separated fistulas or carry out a chrezkozhny puncture of the struck body. The usual microscopy of the studied material can reveal Druzes of actinomycetes that allows to make the preliminary diagnosis of actinomycosis quickly. The subsequent carrying out reaction of immunofluorescence (REEF) with specific anti-genes is directed to definition of a species of actinomycetes.
Difficulties make those cases of actinomycosis at which the Druze is not present in the studied material that is observed in 75% of a disease. In such cases the only reliable way of diagnostics are a crops of pus or biopsiyny material on the Aloes environment. The full and reliable research of crops on actinomycosis can take more than 2 weeks. But in 2-3 days at microscopy it is possible to find colonies, characteristic of actinomycosis. At a research of crops growth of the accompanying microflora and its sensitivity to antibiotics is surely considered.
Serological diagnosis of actinomycosis, unfortunately, is not rather specific. And methods of PTsR-researches concerning this disease are in a development stage so far.
Treatment of actinomycosis
Treatment of actinomycosis is carried out by intramuscular and hypodermic introduction of an aktinolizat. Together with it the antibiotic treatment directed to suppression of the accompanying flora and the prevention of secondary infection is carried out. As well as any chronic infection actinomycosis demands the additional dezintoksikatsionny and all-strengthening therapy.
Ural federal district skin in the field of defeat, a local electrophoresis of an aktinolizat and iodine treats physiotherapeutic treatment which is used at actinomycosis. At formation of abscesses their opening is necessary. Also surgical treatment of fistulas, drainage of a pleural cavity or abdominal cavity can be required. In certain cases at big damages of lungs carry out lobectomy.
Forecast and prevention of actinomycosis
In the absence of specific treatment actinomycosis of internals can lead to a lethal outcome. Cervical and maxillofacial actinomycosis is considered the easiest form. After recovery of patients development of a recurrence is possible.
There is no specific prevention of actinomycosis. It is possible to refer respect for hygiene, the prevention of traumatizing skin, timely dental care to nonspecific prevention, inflammatory diseases of a mouth, almonds, respiratory organs and digestive tract.