Pakhovy (a venereal limfopatiya, Nicol-Favra's disease, a tropical bubo) — the chronic pyoinflammatory damage of lymph nodes caused by a hlamidiozny infection. Pakhovy begins with education and healing of an erosion then there is a purulent inflammation regionarny (more often inguinal) lymph nodes, coming to an end with their opening and scarring. In diagnostics of an inguinal limfogranulematoz identification of the activator by a bakposev, is applied by IFA, PTsR and RIF; inspections of an anorektalny zone and urinogenital bodies of the patient. Therapy of an inguinal limfogranulematoz is carried out by antibiotics and immunomodulators. If necessary surgical treatment is performed.
Pakhovy gained the greatest distribution in tropical and subtropical climate, among the population there is Africa, Latin America, Asia and Australia. Emergence of cases of an inguinal limfogranulematoz in Russia is connected generally with widely developed modern tourism. As a rule, the disease is observed at persons at the age of 20-40 years which are sexually active. At men cases of an inguinal limfogranulematoz are noted more often than at women. Generally it is seamen, the military personnel, homosexuals, travelers.
Earlier pakhovy was considered as a viral infection. However the researches conducted in venereology proved that the activator of an inguinal limfogranulematoz is the bacterium of Chlamydia trachomatis which also causes development of clamidiosis.
Infection with an inguinal limfogranulematoz comes both from the sick person, and from the infection carrier. Big epidemiological danger is constituted by women. Their symptoms of an inguinal limfogranulematoz develop later owing to what they can transmit an infection, without having at the same time any clinical manifestations and without knowing that they are infected. Infection with an inguinal limfogranulematoz occurs through mucous or the injured skin of genitals. Most often the sexual way of transmission of infection takes place, but also contact infection through objects of intimate use is possible.
Symptoms of an inguinal limfogranulematoz
Development of an inguinal limfogranulematoz comes on average in 2 weeks from the infection moment, but can arise several days later or months. In a clinical picture of a disease allocate 3 periods.
Primary period of an inguinal limfogranulematoz is characterized by emergence on the place of introduction of the causative agent of a roundish ulcer or erosion (primary affect). Its healing takes several days and does not leave any hem. Therefore for the vast majority of the diseased (more than 70%) the beginning of an inguinal limfogranulematoz passes imperceptibly and is not the cause for the address to the doctor. Usually primary affect settles down in genitalia, but can be localized in an anus, an urethra, a rectum. After oral sexual contact affect can be found on mucous a mouth, lips, almonds, a throat.
The secondary period of an inguinal limfogranulematoz is shown in 14-30 days from the first symptoms of a disease. It is connected with distribution of hlamidiya on the lymphatic ways leading to development of a regionarny limfangit and lymphadenitis. At infection damage of inguinal and femoral lymph nodes sexually takes place. At localization of primary affect in a mouth and a throat submandibular and cervical lymph nodes are surprised. Damage of lymph nodes at an inguinal limfogranulematoz is shown by pronounced inflammatory signs: increase and morbidity of lymph nodes, hypostasis and reddening of skin over them. Gradually knots turn into large hilly tumors, are accustomed to drinking with the subject fabrics and lose mobility.
Over time there is a purulent fusion of knots which is followed by their softening, formation of ulcers and fistulas through which to the surface of skin there are purulent contents. Process of suppuration can extend to the subject fabrics with damage of skin (piodermiya), bones (osteomyelitis), joints (purulent arthritis). The suppuration period often is followed by violation of the general condition of the patient: rise in temperature, fever, headache, mialgiya and artralgiya. Then there is a slow subsiding of inflammatory manifestations to reduction of the sizes of lymph nodes and scarring of fistulas. However spread of an infection on nearby lymph nodes leads to a new aggravation of an inguinal limfogranulematoz. Such course of a disease with the periods of a zatikhaniye and aggravation can take several years. Then, in the absence of treatment, pakhovy passes into the following stage.
The tertiary period of an inguinal limfogranulematoz is connected with the expressed violation of a limfoobrashcheniye of bodies of a small pelvis leading to a limfostaz and genitorektalny elephantiasis with violation of functioning of bodies of a small pelvis. In this period of an inguinal limfogranulematoz chronically proceeding ulcerations of bodies of a small pelvis (a vagina, an urethra, a rectum) leading to formation of fistulas of a vagina, puzyrno-pryamokishechny fistulas can be observed. Localization of ulcerations in an urethra can be followed by urethra striktura with the complicated urination or an incontience of urine. At damage of a rectum development of ulcer colitis, a paraproktit, intestinal impassability is possible.
Diagnostics of an inguinal limfogranulematoz
Identification of the activator of an inguinal limfogranulematoz is carried out by the bakposev separated urethras, vaginas, a rectum, a punktat of a lymph node. Also apply the PTsR-research on hlamidiya, IFA and the REEF. The biopsy of a lymph node in the field of defeat is made for the purpose of a histologic research for an exception of its malignant metastasis.
The conclusions of adjacent experts are necessary for the venereologist for assessment of a condition of bodies of a small pelvis and an exception of lymphadenites of other etiology at suspicion on a pakhovy limfogranulematoz: gynecologist, urologist, proctologist, limfolog; given gynecologic survey, a kolposkopiya, an uretroskopiya, a rektoromanoskopiya, ultrasonography of bodies of a small pelvis, UZDG of lymphatic vessels of a small pelvis.
Differential diagnostics of an inguinal limfogranulematoz is carried out with inguinal lymphadenitis, genital tuberculosis, secondary syphilis, metastasises of malignant tumors to lymph nodes at cancer of an anus, a rectum, penis, a small egg, a vagina.
Treatment of an inguinal limfogranulematoz
Antibiotic treatment of an inguinal limfogranulematoz is performed by tetratsiklina, macroleads or ftorkhinolona. Treatment is combined with the all-strengthening and immunomodulatory therapy. In the started cases of an inguinal limfogranulematoz, at formation of fistulas, urethras or development of intestinal impassability, surgical intervention is required.