Etiology and epidemiology of pulmonary actinomycosis
Pathogens are disease pnevmomitsetam and occupy an intermediate position between the bacteria and fungi. Actinomycetes isolated from soil, water, known prevalence of certain species of animals. A person infected with spores of actinomycetes airborne and alimentary paths, and through contact with contaminated soil or water. The disease often occurs in spring and summer. Men are sick 3 times more often than women. Actinomycosis is widely distributed in different countries.
Pathogenesis and pathologic anatomy of pulmonary actinomycosis
The disease occurs as a result of exogenous infection and as a result of activation of endogenous infection (saprofitiruyuschih aktinometsitov in the human body). Development of the disease helps decrease the immunological resistance against chronic diseases, use of cytotoxic drugs, corticosteroids and other immunosupressoroz after pregnancy and childbirth, as well as tissue trauma. Of the centers of the primary containment pathogens hematogenic or lymphogenous spread to various organs, causing the appearance of metastatic lesions of actinomycosis. In the development of the disease are set to specific sensitization to actinomycetes and joining pyogenic flora.
Pathologic basis of actinomycosis is a specific granuloma - aktinomikoma, the initial stage of which is formed of young connective tissue and polinuklearov. With the development in the central part of the granuloma necrosis, fibrosis of the surrounding tissue is observed, there ksantomnye cells. Scar tissue riddled with ulcers and resembles a sponge. In the future, there epiteliokidnye cells, lymphocytes and plasma cells, there is hyalinization of scars.
In the central part aktinomikomy can detect drusen actinomycetes, surrounded by white blood cells and subjected to further phagocytosis, calcification, or transformation into glassy spheres.
Clinic lung actinomycosis
Standard Classification of actinomycosis is not created. The incubation period of the disease varies from several days to several years. There are primary and secondary actinomycosis with localization in the lungs (10-20%), gastrointestinal tract, genitourinary, central nervous system, bones, skin, or having a generalized nature.
In the case of the central localization of the lungs (bronchial and Pulmonary form) clinical symptoms may be uncharacteristic and Just noticeable. As the disease progresses there are cough, dull pain in the chest, irregular fever, increased sweating. Later released muco-purulent expectoration, often streaked with blood containing dense grain-Druze actinomycetes.
When subplevralnoy localization aktinomikomy (pleuro-Pulmonary form) clinical signs appear early and are expressed more clearly: marked pain in the chest according to the location of the hearth, often in the sides of the chuck and the region, aggravated by coughing or deep inspiration, as well as the movement of the patient, is characterized by a dry painful cough, bad fever. Auscultation reveals pleural friction rub, dry and moist rales of various sizes. As the formation of an abscess the condition of patients worsens, they lose weight. After breaking into the lumen of the bronchus abscess released copious mucous and bloody sputum with dense grains, druses. In the case of breaking the abscess into the pleural cavity developing encysted pleurisy. Perhaps the defeat of the mediastinum with subsequent spread of inflammation in the retroperitoneal space. There may be abscesses in the soft tissues of the chest, osteolysis and periostitis of ribs and vertebrae, followed by the formation of fistulas, which stands out from the thick pus from the dense granules. There is a purulent lesion of the breast, pericardium and heart.
X-rays in the early stage reveals patchy infiltrates around the bronchi and blood vessels, increase in mediastinal lymph nodes and edges, or friendly defeat vertebrae characteristic seal of the pleura. The process may be limited to one segment or capture the whole lot. During a long illness, if untreated, develop cachexia and anemizatsii patients.
The diagnosis of actinomycosis is based on the detection of characteristic clinical and instrumental signs of illness and is complemented by the identification of drusen of actinomycetes in the sputum, or purulent discharge from the fistula in the study of native preparations and staining of Ziehl - Neelsen. Serological diagnosis developed enough. The differential diagnosis is carried out with pulmonary tuberculosis, tumors and other pnevmomikozami.
Prevention of pulmonary actinomycosis has not been developed.
Treatment of pulmonary actinomycosis
The basis of therapy is aktinomnkoza immunoantibiotikoterapiya. Patients prescribed aktinomitsetnuyu polyvalent vaccines administered intradermally intramuscularly in IPT gradually increasing doses over 1-3 months. in the form of repeated courses at intervals of 1 month. At the same time used sulfa drugs (Sulfidine, sulfapyridine, etc.), and during an exacerbation - antibiotics. Showing transfusion, the appointment of biogenic stimulators. According to the testimony used surgical treatment.