Actinomycosis is an infectious disease caused by radiant fungi (actinomycetes) and has a primary chronic course with the formation of dense granulomas, fistulas and abscesses. Disease can affect not only the skin, but also internal organs. The diagnosis of the disease is based on the detection of a characteristic mycelium of fungi in the separated and the detection of the growth of specific colonies when sowing on nutrient media. In the treatment of actinomycosis, the administration of actinolysate is used in combination with antibiotic therapy, skin UV, iodine electrophoresis. According to the indications, abscesses are opened, surgical treatment of fistulas, drainage of the abdominal and pleural cavities is performed.
Actinomycosis is an infectious disease caused by radiant fungi (actinomycetes) and has a primary chronic course with the formation of dense granulomas, fistulas and abscesses. Actinomycosis can affect not only the skin, but also internal organs. The diagnosis of the disease is based on the detection of a characteristic mycelium of fungi in the separated and the detection of the growth of specific colonies when sowing on nutrient media.
Pathogens of this disease — fungi of the genus Actinomyces are often found in nature. They can be on soil, plants, hay or straw. Actinomycetes enter the human body through damaged skin, by inhalation or with food. In most cases, they do not cause disease, but live on the mucous membranes of the eyes or oral cavity as saprophytic flora. Inflammatory processes in the mouth, gastrointestinal tract or respiratory organs can lead to the transition of actinomycetes into a parasitic state with the development of actinomycosis. Disease also occurs in farm animals. However, human infection from animals or people with actinomycosis does not occur.
Actinomycosis of the skin can occur primarily when actinomycetes penetrate through wounds and other lesions on the skin. Secondary skin lesion develops from the inside, during the transition of infection from the underlying tissues (tonsils, teeth, lymph nodes, muscles, mammary gland) and internal organs.
Depending on the localization of the pathological process in actinomycosis , the following forms are distinguished:
- actinomycosis of joints and bones;
- actinomycosis of the central nervous system;
- actinomycosis of the foot (mycetoma, Madura foot)
The duration of the incubation period in actinomycosis is not exactly known. The disease is characterized by a long and progressive course and can last 10-20 years. In the initial period, the patient retains normal well-being, but when the internal organs are affected, the condition becomes severe, cachexia occurs.
Actinomycosis of the skin most often affects the submandibular, sacral region and buttocks. It is characterized by the appearance of seals in the subcutaneous tissue and a bluish-purple coloration of the skin above them. The seals have a spherical shape and practically do not cause painful sensations. At first they are very dense, then they soften and open with the formation of poorly healing fistulas. There may be an admixture of blood in the purulent discharge of the fistula. Sometimes it contains yellow grains — druses of actinomycetes.
Actinomycosis of the skin can be of 4 types. With the atheromatous variant, which occurs mainly in children, infiltrates resemble atheromas. Tubercular-pustular actinomycosis begins with the formation of tubercles in the skin, turning into deep pustules, and then fistulas. The gum-nodular variant is characterized by the formation of cartilaginous density nodes. Ulcerative actinomycosis, as a rule, develops in weakened patients. With it, the stage of suppuration of the infiltrate ends with tissue necrosis and the formation of ulcers.
Cervical-maxillofacial actinomycosis is more common than others and occurs in several forms: with damage to the intermuscular tissue (muscle form), subcutaneous tissue or skin. The process can spread across the face and neck, capturing the lips, tongue, penetrating the larynx, trachea and eye socket. With a muscular form, a characteristic infiltrate is most often formed in the area of the masticatory muscles, causing a trism and leading to facial asymmetry.
Thoracic actinomycosis begins with the symptoms of a cold: general weakness, subfebrility, dry cough. Then the cough becomes moist, mucopurulent sputum is released, which tastes of copper and smells of earth. Gradually, the actinomycotic infiltrate spreads from the center to the chest wall and exits onto the skin, forming fistulas coming from the bronchi. Such fistulas can open not only on the surface of the chest, but also in the lumbar region and even the hip.
Abdominal actinomycosis often mimics acute surgical pathology (intestinal obstruction, appendicitis, etc.). It spreads to the intestines, liver, kidneys, spine and can reach the anterior wall of the abdomen with the formation of intestinal fistulas opening on the skin. Actinomycosis of the rectum proceeds with a clinical picture of paraproctitis. Actinomycosis of the genitourinary organs is a rare disease that often occurs a second time when an infection passes from the abdominal cavity.
Actinomycosis of joints and bones usually occurs when the process spreads from other organs. Joint damage is not accompanied by a significant violation of their function, and actinomycosis of bones proceeds according to the type of osteomyelitis. The spread of infiltrate to the surface of the skin leads to the formation of fistulas. Mycetoma begins with the appearance of several dense “peas” on the sole, the skin over which gradually acquires a brownish-purple color. The number of seals increases, swelling occurs, the shape of the foot changes and purulent fistulas form. The tendons, muscles and bones of the foot may be involved in the process.
With the development of a characteristic clinical picture of actinomycosis, diagnosis does not cause difficulties. However, it is important to make the correct diagnosis even in the initial period of actinomycosis. The detection of actinomycetes in sputum, smears from the pharynx or nose has no diagnostic value, since it is also observed in healthy people. Therefore, a fistula is taken for examination or a percutaneous puncture of the affected organ is performed. Conventional microscopy of the test material can reveal actinomycete druses, which allows you to quickly make a preliminary diagnosis of actinomycosis. Subsequent immunofluorescence reaction (RIF) with specific antigens is aimed at determining the type of actinomycetes.
The difficulties are those cases of actinomycosis in which there are no druses in the studied material, which is observed in 75% of the disease. In such cases, the only reliable way to diagnose is by sowing pus or biopsy material on the Sabur medium. A complete and reliable study of sowing for actinomycosis may take more than 2 weeks. But after 2-3 days, microscopy can detect colonies characteristic of actinomycosis. In the study of sowing, the growth of the accompanying microflora and its sensitivity to antibiotics are necessarily taken into account.
Serological diagnosis of actinomycosis, unfortunately, is not specific enough. And the methods of PCR studies in relation to this disease are still under development.
Treatment of actinomycosis is carried out by intramuscular and subcutaneous administration of actinolysate. Together with this, antibiotic therapy is carried out, aimed at suppressing the concomitant flora and preventing secondary infection. Like any chronic infection, actinomycosis requires additional detoxification and restorative therapy.
The physiotherapeutic treatment used for actinomycosis includes UV of the skin in the affected area, local electrophoresis of actinolysate and iodine. When abscesses form, their autopsy is necessary. Surgical treatment of fistulas, drainage of the pleural cavity or abdominal cavity may also be required. In some cases, with large lung lesions, a lobectomy is performed.
Prognosis and prevention
In the absence of specific treatment, actinomycosis of internal organs can lead to death. The most mild form is considered to be cervical-maxillofacial actinomycosis. After the recovery of patients, relapses may develop.
There is no specific prevention of actinomycosis. Non-specific prevention includes hygiene, prevention of skin injury, timely treatment of teeth, inflammatory diseases of the oral cavity, tonsils, respiratory organs and gastrointestinal tract.