Disease sexually transmitted:

Late congenital syphilis

Abdominal actinomycosis

  • What is Abdominal actinomycosis
  • What triggers / Causes of Abdominal actinomycosis
  • Pathogenesis (what is happening) at the time of Abdominal actinomycosis
  • The symptoms of Abdominal actinomycosis
  • Diagnosis of Abdominal actinomycosis
  • Treatment of Abdominal actinomycosis
  • Prevention of Abdominal actinomycosis
  • Which doctors should be consulted if You have Abdominal actinomycosis

What is Abdominal actinomycosis -

Actinomycosis (synonyms: lučistogribkovym disease - Aktinomykose -. - actinomycose - Franz.) - chronic disease caused by various species of actinomycetes. Characterized by lesions of various organs and tissues with the formation of dense infiltrates, which are then suppurate with fistula and distinctive skin lesions.

What triggers / Causes of Abdominal actinomycosis:

Pathogens include various species of actinomycetes, or radiant mushrooms. The main ones are the following: Actinomyces Israeli, Actinomyces bovis, Actinomyces albus, Ac. violaceus. Actinomycetes grow well on nutrient media, forming colonies of irregular shape, often with glowing edges. Pathogenic for many species of farm and laboratory animals. In pathological material are in the form of drusen, which are yellowish lumps with a diameter of 1-2 mm. microscopy in the center of drusen detected the accumulation of the filaments of the mycelium, and on the periphery - flask-shaped swellings. When stained with hematoxylineosin the Central part of the druses is colored blue, and the flask in pink. Meet Druze in which the rim of the flask of cells is missing. Actinomycetes are sensitive to penicillin (20 U/ml), streptomycin (20 µg/ml), tetracycline (20 μg/ml), chloramphenicol (10 μg/ml) and erythromycin (1,25 µg/ml).
Epidemiology. Actinomycosis is common in all countries. They are ill people and farm animals. However, cases of human infection from sick people or animals is not described.
The causative agents of actinomycosis are widely distributed in nature (hay, straw, soil, etc.). Actinomycetes are often found in healthy people in the oral cavity, dental plaque, the lacunae of the tonsils, the mucous membrane of the gastrointestinal tract. Have the value of both exogenous and endogenous methods of infection.Абдоминальный актиномикоз

Pathogenesis (what is happening) at the time of Abdominal actinomycosis:

The most common is an endogenous path of infection. Actinomycetes are widely distributed in nature, particularly in plants, can get with plants in the body and to be present on the mucous membranes as a saprophyte. The transition of actinomycetes from saprophyticus in a parasitic state contribute to inflammatory diseases of the mucous membranes of the oral cavity, respiratory and gastrointestinal tract. At the site of introduction actinomycetes formed infectious granuloma, which grows into the surrounding tissue. In the granulation tissue abscesses arise, which, breaking, form a fistula. Skin lesions have a secondary character.
Education plays the role of suppuration and secondary, mainly staph infection. Antigens radiant fungi leads to specific sensitization and allergic restructuring of the body (hypersensibility delayed or tuberculin-type), and antibodies (complimentative, agglutinins, precipitin, etc.).

The symptoms of Abdominal actinomycosis:

Actinomycetaceae lesions of the abdominal and anorectal area is quite rare. Their development is associated with acute perforation of internal organs (appendicitis, diverticulitis, crypts, various peptic diseases), surgical or other traumatic lesions, including lesions swallowed bone fragments or fish bones.
Another source of pelvic and abdominal actinomycotic infections have been identified. It turned out that 10-20 women with intrauterine contraceptives uterine or vaginal rings of the uterus and cervical canal colonized by a mixed bacterial flora that includes potentially pathogenic fermenting actinomycetes, and other, predominantly anaerobic, bacteria. They almost never occur in women who are not using these devices. This colonization can serve as the starting center for the development of aggressive lumpy with lesions of the pelvic organs and may even be a source of hematogenous metastatic hepatic or intracranial actinomycotic abscesses.
The initial signs of abdominal actinomycosis is usually unexpressed and vague. They include: fever, malaise, weakness and pain, which slowly but progressive increase. During the development process, it usually resembles a slowly progressing tumors like malignant processes, type of cancer of the stomach, colon and rectum, anorectal area, or cervix. It is possible to observe large subcutaneous abscesses, extensive livid seal, or fistula, the selection of which of drusen is often the first characteristic feature of the disease. Without effective treatment of abdominal actinomycosis may spread to any adjacent tissue or organ, including the liver, spleen, kidney, fallopian tubes, ovaries, uterus, testes, bladder, rectum, or abdominal wall.

Diagnosis of Abdominal actinomycosis:

In advanced cases with the formation of fistulas and characteristic skin changes diagnosed difficulties. Harder to diagnose primary forms of actinomycosis.
Some value for the diagnosis is intradermal test with aktinolizat. However, account should be taken only positive and strongly positive samples as weakly positive intradermal test often in patients with diseases of the teeth (for example, when the alveolar Peoria). Negative results of samples is not always possible to eliminate lumpy, as in patients with severe forms they can be negative due to a dramatic inhibition of cellular immunity - they are always negative in HIV-infected. Isolation culture of actinomycetes from sputum, mucous membrane of the throat, nose has no diagnostic value, since actinomycetes are often found in healthy individuals. Diagnostic importance of DGC with aktinolizat, which is positive in 80 patients. The greatest diagnostic importance is the selection (detection) of actinomycetes in the pus from the fistula, in biopsies of affected tissues, in druses, the latter sometimes only microscopically detectable threads of mycelium. In these cases, you can try to highlight the culture of actinomycetes by planting material on Wednesday Sabur.
Actinomycosis of the lungs must be differentiated from neoplasms of the lung, abscesses, and other deep mycoses (aspergillosis, Nocardia, histoplasmosis, and tuberculosis. Abdominal actinomycosis have to be differentiated from various surgical diseases (appendicitis, peritonitis, etc.). Lesions of bones and joints - from purulent diseases.
The diagnosis of human actinomycosis is mainly based on isolation and identification of causal agents, because clinical symptoms are often misleading and histopathology and serology discomposition and nizkochastotnaya. The presence of drusen, which sometimes give a brass appearance semolina, must initiate the search of actinomycetes. However, given that only 25 samples actinomycetaceae pus contains these granules, their absence does not exclude the diagnosis of actinomycosis.
Extraction and transport of pathogenic material.
Suitable for bacteriological analysis of actinomycosis is the pathologic material - pus, discharge from the fistula, bronchial secret, granulation, and biopsies. During sampling should take precautions against pollution innate, mucosal, microflora. In all cases, when possible, pus or tissue should be obtained by percutaneous puncture. For the diagnosis of thoracic actinomycosis, bronchial secret must be received transtracheal.
Sputum examination is unreliable because it usually contains actinomycetes of the oral cavity, including pathogenic species. Transthoracic percutaneous needle biopsy or percutaneous biopsy of suspicious abdominal abscesses - often the only means of obtaining a satisfactory sample for the diagnosis of pathologic material. Transportation of samples in bacteriological laboratory should be fast enough. If a long transport is inevitable , it is necessary to use special transport media type environment Stuart, although fermenting actinomycetes less susceptible to oxidative damage than strict anaerobes.
Microscopic examination
When drusen are present, this allows fast and relatively reliable to make the preliminary diagnosis after examination at low magnification (l 100) actinomycetaceae pellets placed under the coverslip and, as a drop of 1 p-rum methylene blue. Actinomycetaceae drusen appear as particles, similar to a cauliflower with unpainted center and a blue periphery, in which the white blood cells and short filaments, sometimes with "batons", emanate from the center of the pellets. Gram-stained smears obtained by compression of granules between two panes of glass, showing filamentous, branching, gram-positive patterns that represent the pathogenic actinomycetes, as well as a variety of other gram-negative and gram-positive bacteria, which indicate the presence of related microorganisms. The presence of these bacteria is necessary to distinguish actinomycetaceae Druze from pellets formed of various aerobic actinomycetes (Nocardia, Actinomadura, Streptomyces), which never contain associated microflora. Direct and indirect immunofluorescence for the detection of specific antibodies can also be used to determine the species of actinomycetes found in the pellet of the culture.
Cultural diagnostics
To obtain reliable results, it is advisable to use transparent medium, so that the cups could be carefully reviewed to detect characteristic filamentous colonies, and grow the culture for at least 14 days. Culture can be examined every 2-3 days without changing to anaerobic conditions, eslis the purpose of obtaining a low oxygen potential method is used Fortner (1928). If you are using anaerobic jars or cups, it is advisable to make a crop on two or three environments at the same time to explore them to determine the growth of actinomycetes after 3, 7 and 14 days. Since the removal of cups from anaerobic environments usually stops further growth of microorganisms, which require long incubation unchanged anaerobic conditions.
Preliminary results of culture get in 2-3 days, when under the microscope you can see the characteristic arachnids of microcolony A. israelii, A. gerencseriae or P. propionicum. Confirmation of preliminary microscopic or early cultural diagnoses unambiguous identification of pathogenic species of actinomycetes may take 14 days or more. This is necessary to reliably identify the differences between actinomycetes and fermenting morphologically similar contaminants received from the mucous membranes of the patient, as well as similar aerobic actinomycetes of the genera Nocardia, Actinomadura and Streptomyces. Detailed bacteriological analysis of concomitant microflora may also be useful for selection of appropriate antibiotic therapy.
Molecular methods, like genetic research or polymerase chain reaction (PCR), currently being developed in the future may be able to allow for more rapid diagnosis of actinomycosis.
Serological diagnosis
Actinomycetaceae infection does not necessarily stimulate a humoral immune response, which can detect the available laboratory methods. However, none of the methods used in a great variety of antigens used did not provide satisfactory results because of problems with sensitivity and specificity (Holmberg, Nord and Wadstrмm 1975, Holmberg 1981, Persson and Holmberg 1985).
Абдоминальный актиномикоз
Abdominal actinomycosis

ru/" target="_blank">Treatment of Abdominal actinomycosis:

Best results are obtained by the combination of causal treatment (antibiotics) and immunotherapy (aktinolizat). With neck and maxillo-facial form prescribed dentists inside of 2 g/day and the duration of the course at least 6 weeks. You can also assign tetracycline in large doses (0.75 g 4 times daily for 4 weeks or 3 g per day within the first 10 days, and then 0.5 g 4 times a day for the next 18 days). Erythromycin is prescribed by 0.3 g 4 times a day for 6 weeks. When abdominal forms and lumpy light prescribed large doses of penicillin (10 000 000 IU/day or more) intravenously within 1 - 1.5 months, then switch on phenoxy-methylpentyl in a daily dose of 2-5 g for 2-5 months. Layering a secondary infection (staphylococci, anaerobic microflora) prescribe longer courses of dicloxacillin or antibiotics of the tetracycline group, anaerobic infections - metronidazole. For immunotherapy aktinolizat can be administered subcutaneously or nutrico-but, as well as intramuscularly. Under the skin and intramuscularly injected with 3 ml of aktinolizat 2 times a week. At the rate of 20-30 injections, the course duration is 3 months. Abscess, empyema, surgical treatment of (opening and drainage). If extensive damage lung tissue sometimes resorted to lobectomy. One of the most effective antibiotics are tetracycline, followed by dentists and less effective erythromycin. Resistant to these antibiotics of strains of actinomycetes are not met.
Forecast. Without etiotropic treatment the prognosis is serious. When abdominal actinomycosis died 50 patients with thoracic died all patients. It is relatively easier proceeded cervico-maxillo-facial actinomycosis. This leads to the need for early diagnosis and initiation of therapy before the development of severe anatomical damage. Given the possibility of recurrence, patients should be under long-term follow-up (6-12 months).

Prevention of Abdominal actinomycosis:

The oral hygiene, prompt treatment of the teeth, inflammations of the tonsils and mucous membrane of the oral cavity. Specific prevention has not been developed. Activities in the center does not hold.

Which doctors should be consulted if You have Abdominal actinomycosis:

Mandatory doctor:
- Dermatologist in order to rule out pathology of the skin.
- The dentist in order to rule out pathology of the oral mucosa.
- Otolaryngologist in order to rule out pathology of the tonsils.

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