Actinomycosis — the disease, caused by actinomycetales
Actinomycosis possesses the properties of bacteria due to the presence of a nucleoid. Their filamentous structure, forming a mycelium, resembles fungi, they multiply by spores.
Actinomyces are peculiar to special resistance, they are widely distributed in soil, dust, damp walls, on the ears of grain crops. In humans, they are considered to be part of the opportunistic intestinal flora. They also inhabit the tonsils, carious cavities, a plaque on the teeth.
The causes of fungal activity are divided into endogenous and exogenous types.
Endogenous (internal) is characterized by a lack of immunity, vitamin deficiency after serious diseases and surgical operations.
The exogenous (external) type is possible when the pathogenic fungus is introduced into the organism from the external environment: with dust, during agricultural work on the harvest of grain crops.
As soon as actinomyces enter the body, for example, with dust, granulomas (seals) occur in the lungs, followed by a process of tissue necrosis. The pathological agent is actively developing in the center of the granuloma, which is accompanied by a sharp inflammation. The process of skin dying causes fistulas. Cases, when suppuration gets to bronchial tubes after an opening of a granuloma, are not excluded. Sputum can go out when coughing. There, the fungus can be found.
When actinomyces are wound up through a scratch or puncture with sharp parts of the spikelet, an inflammatory process may occur on the skin.
If the fungus got through the wound on the skin, an infiltrate develops in its tissue, which has a plank-form density. The initial bluish tint is replaced by bright red. The patient has a symptom of fluctuation: in the center of the affected area is softened tissue, the process of necrosis is directed to the edges. A granuloma is a collection of fungal colonies.
Infiltration can grow in the form of fistulas through the subcutaneous fatty tissue. Blood vessels undergo tremendous stress at the time when granulomas melt. The disease is able to transform into a generalized form when the walls of blood vessels are destroyed, and the contents of the fistula enter the blood.
A bacterial infection can join the fungal infection, which is fraught with the formation of abscesses and/or phlegmon.
The patient has the next symptoms:
- High body temperature.
- Excessive sweating at night.
- Skin surface pales. Abscesses and pleurisy are gray.
- Acrocyanosis caused by tissue hypoxia due to the restriction of the respiratory surface of the lungs.
- The nail plate becomes convex (Nail clubbing).
- The fingertips thicken.
- The appearance of fistulous passages.
- Depletion of the body.
If there is an excessive weakness, the foci of the disease come out in the form of fistulas, and other organs become affected. These signs indicate the transition of the disease into a chronic form.
Severe actinomycosis is accompanied by metastases that spread to other organs. Sometimes the patient is left to live only 1-2 years and the case is fatal. Some patients live up to 5 years.
Complete cure is possible only with mild severity.
The considered type of ailment in children most often manifests itself in the tonsils at the age when the permanent teeth have already grown. That dental plaque contains fungus.
Actinomycosis of the bones also occurs, but only adult patients are affected.
Fungal pathology can take various forms of the clinical picture, depending on the location:
- Genitourinary system.
- Bones and joints.
- Pathological effects of actinomycosis on the skin.
If there are injuries on the oral mucosa, this serves as an active migration factor of fungi and a maxillofacial lesion develops. The development of infection occurs on the same principle as in other places: the red-bluish granuloma in the form of a flat disc is reborn into a fistula. Usually, the granuloma is located in the corner of the lower jaw. The inflammatory process is gaining activity gradually. The patient feels discomfort, pain in the mouth and the presence of something heterogenous. Body temperature almost does not change, sometimes increases slightly. Actinomyces can affect the jaw periosteum, the space between the muscles. The lesion process can penetrate the skin of the neck and face. Often there is a spasm of chewing muscles if they are affected by a lesion.
На фото челюстно-лицевой актиномикоз:
With the intensification of infection in the tonsils, tonsillitis occurs, which takes a chronic form.
When a patient’s chest suffers, a wet cough appears. If blood is observed in the composition of sputum, it means that the melting of lung tissue has reached the stage of vascular damage. This condition of the patient is accompanied by moist wheezing. When the breathing is amphoric, it indicates the appearance of a cavity in the lungs.
The sounds of breathing at the very beginning of the lesion are somewhat blunted. Tympanic tone signals about the formation of cavities. When the doctor palpates the chest and hears an increase in voice tremor, it means that infiltrates have arisen in the lungs.
The result of the granulomas growth, which is directed from the middle of the lung to the brim, is the formation of adhesions between the pleura.
Pain syndrome occurs at a time when inflammation affects the pleura. If the patient lies, turning on the painful side, he thereby fixes the body and the pain subsides a bit.
Death is not excluded if the treatment wasn’t conducted on time.
The abdominal form displays with the lesion of the appendix. Not only the appendix but also the ileocecal area often undergoes pathology. A person is given a preliminary diagnosis: appendicitis or intestinal obstruction. Actinomyces enter the blood through the colon, stomach, or through an overgrown granuloma. Sometimes the peritoneal wall is involved. Metastases germinate in the spine, liver, kidneys. Paraproctitis occurs if the fistulous passages reach the perianal area and open into the intestinal lumen. This form of the disease is also considered fatal in the absence of medical care.
Actinomycosis of the urogenital system acts as a secondary infection, provoked by the activity of the primary focus.
Bones and joints are exposed to the activity of a fungus when a granuloma from adjacent organs grows or is carried with blood into the bone tissue. The patient is diagnosed with osteomyelitis, accompanied by the occurrence of bone sequesters. For quite a long period of time, the patient does not lose the mobility of the joints. A distinctive feature is the bluish tinge of the fistula edging.
Skin damage by actinomyces occurs as a result of the inflammatory process’ generalization. Symptoms become apparent when the granuloma penetrates the subcutaneous fat.
Madura’s foot is a type of skin pathology, most often found in the tropics. Pea-sized nodules appear on the foot, the skin becomes purple. New nodes join to the primary, the foot swells, its shape is distorted. The next stage is characterized by the formation of fistulous passages filled with ichor and pus. Fistulas open on all sides of the foot, which leads to the deformation of the fingers, which are directed upwards. At the most severe stage, even the calf and tendon muscles are involved in the inflammatory process.
На фото мадурская стопа:
Diagnostics are carried out to determine the type of disease. It is very important to differentiate changes similar to tuberculosis by X-rays.
A blood test provides valuable information on the presence of the inflammatory process, on the body’s sensitization. Against the background of weakened immunity, leukopenia can develop, which is expressed by toxic granularity in the red blood cells.
Microabscesses are characteristic of the disease, as a result of which the skin becomes cellular in structure. Compacted subcutaneous metastases, fistulous passages through which pus is secreted, draw a clear clinical picture of actinomycosis.
Conducting a puncture procedure allows you to study the composition of the fistula contents. A sputum culture is performed to determine the type of fungus. For better visual consideration, the lab technician takes a clean environment. After an incubation period of 2-4 days, spider-like colonies are formed. At 10-14 days typical colonies appear (striated, smooth, rough, curved), with filamentous mycelium visible on them. Actinomyces can create pigmentation, so the colonies can be greenish, gray and crimson.
When clusters of colonies are found, the intended diagnosis is made. Next, the type of fungus is determined. By the way, for a more accurate diagnosis, smears from the fistulous passages are taken.
A sample taken from the subcutaneous tissue with the help of an actinolysis can also be used to establish the correct diagnosis. A negative result means that the patient has an advanced stage of the disease.
For diagnostic purposes, the following procedure is carried out: 0.3 ml of antigen is injected subcutaneously into the forearm. If after one-day erythema occurred in that place, it means that the presence of actinomycosis can be noted.
This diagnosis is also confirmed if microscopic examination of sputum secreted by a fistula shows actinomyces, similar to granules.
Computed tomography is not required to establish the diagnosis, this type of examination is necessary to monitor changes in the affected areas during the period of therapy.
Also, signs of an inhomogeneous structure can be identified with the help of ultrasound. It may cause suspicion for actinomycosis.
The treatment course involves etiotropic drugs and surgery.
When prescribing antibiotics, the doctor necessarily takes into account the range of their effects in order to destroy not only actinomyces but also other bacteria that could penetrate and settle in the pathogenic flora. Often this moment is very difficult, especially when the microflora becomes antibiotic-resistant.
Depending on the localization of the colonies, a special treatment program is being developed.
Maxillofacial pathology is treated with penicillin group antibiotics with clavulanic acid. The first cycle lasts one week, the dose contains 2.4 mg three times a day. Gradually, the dosage is reduced, and the second cycle extends the treatment for another 1 week. The same method is used for the treatment of neck disease.
The affection on the lungs by an actinomyces takes more time: from 3 weeks to 1 month. Parenteral medication is used. If the stage is started, combinations of different antibacterial agents are prescribed.
If there are concomitant anaerobic bacteria, antibiotic carbapenems will be needed. Antifungal medications are shown in combination with other medicines: Fluconazole, Lamisil, Itraconazole, Ketoconazole.
When a patient takes such radical drugs as antibiotics, therapy is needed to strengthen the immune system. Actinolysate is one of the most effective, which improves the quality of phagocytosis (cellular immunity). This drug is prescribed for any form and stage of the disease. Introduced intramuscularly in 3 ml three times a week with equal intervals.
Antihistamines: Chloropyramine, Clemastine, and Mebhydrolin carry out desensitization therapy.
Sometimes additional medications are prescribed, for example, potassium iodide, which increases the etiotropic effect.
Autohemotherapy is used as an immune stimulant. For the relief of inflammation Aloe extract intramuscularly can be used.
Ointments with antifungal and antibiotic components promote wound healing, especially after removing fistulas with surgical operations.
Electrophoresis fixes the resulting effect of drug treatment. Ultrasound is also recommended: daily, from 12 to 25 sessions.
Surgical treatment is carried out in some cases, which are considered individually for each patient. If the operation leaves noticeable effects, dermoplasty is performed.
In the case of actinomycosis of the lung, resection of the affected part of the respiratory organ is performed, and adhesions are also removed.
Special preventive methods do not exist. To prevent the disease or at least reduce the frequency of cases to a minimum, only non-specific measures are recommended. The first step is to sanitate chronic foci. The patient has to treat tonsillitis timely to prevent chronic forms, to prevent open carries, to complete the treatment of bronchitis and the digestive tract.
An important preventive measure is to strengthen the immune system. A person needs good nutrition, physical activity. It is important to introduce a rule for the prevention of seasonal diseases.
Personal hygiene, especially of the oral cavity, is a recommendation that should never be neglected.
Farmers must comply with the rules of conduct at the harvest.
It is very important to remain under doctor’s control for a year after the course of treatment. Also, the patient has to undergo regular examinations to ensure that the disease is beaten.