Pulmonary actinomycosis
Introduction
Introduction to pulmonary actinomycosis Pulmonary actinomycosis is a chronic suppurative granulomatous disease caused by anaerobic Israeli actinomycetes infecting the lungs. The lesions are formed by multiple abscesses and sinuses, and the secretions are characterized by sulfur yellow pus. It is easy to form fibrosis. The neck, face and chest and abdomen lesions accounted for about 1/3. The lung is suffering from actinomycete infection, called lung actinomycosis. The bacteria are normal bacteria in the oral cavity, dental caries, and tonsil crypts. Most of them are caused by poor oral hygiene, inhalation of secretions containing actinomycetes, and can also be caused by direct spread of blood circulation or abdominal lesions. basic knowledge The proportion of illness: 0.002% - 0.004% Susceptible people: no special people Mode of infection: non-infectious Complications: underarm abscess
Cause
Causes of pulmonary actinomycosis
Reduced immunity (30%):
Actinomycetes often parasitize the human oral mucosa, gums, tonsils, colons, etc. When the body's resistance is reduced, it can invade the respiratory tract due to inhalation of oral secretions, first causing lesions in the bronchi, then invading the lung parenchyma, or due to the esophagus The lesion spreads to the mediastinum, or the abdominal infection passes through the diaphragm and the pleura and lungs, causing suppurative pneumonia in the lungs, and through the interlobular space, the pleura invades the chest wall, the ribs, and forms the sinus, which can also invade the blood circulation and cause systemic dissemination.
Causes
Actinomycetes are prokaryotes with bacterial characteristics. Their proliferation is not sporulation or filamentous buds, but is replicated by bacterial division. Most of them are anaerobic or facultative anaerobic bacteria, so they grow in an anaerobic environment. Preferably, the growth in the tissue is closely clustered together, visible to the naked eye, called granules. Actinomycetes are the most common pathogens, and other actinomycetes such as actinomycetes and actinomycetes can also cause disease.
Pathogenesis
The pathological features of this disease are multiple abscesses, fistulas, granulation and fibrosis. After the invasion of pathogenic bacteria, leukocyte infiltration is first caused in the tissues to form multiple small abscesses. The abscess is pierced to form multiple sinuses, in the pus Sulfur granules can be seen in the sinus secretions, advanced lesions, chronic granulation tissue hyperplasia, fibrous changes in adjacent lesions, lesions involving the pleura, causing pleurisy or empyema, and piercing the chest wall to form fistulas, the disease is characterized by destruction Simultaneously with hyperplasia, it can still spread to surrounding tissues while the lesion is healed.
Prevention
Lung actinomycosis prevention
1, pay attention to food hygiene, do not eat spoiled food.
2, pay attention to oral hygiene, to prevent infection, such as antibiotics should be used in time after tooth extraction.
3. Early treatment of lesions such as sick teeth and tonsils should be carried out to remove the origin of actinomycetes.
Complication
Lung actinomycosis complications Complications underarm abscess
Often combined with empyema or subphrenic abscess, gradually spread to form a pulmonary pleural fistula or empyema.
Symptom
Symptoms of pulmonary actinomycosis Common symptoms Low fever, high fever, hemoptysis, fatigue, night sweats, weight loss, periostitis
Mostly slow onset, start with low fever or irregular fever, cough, cough up a small amount of mucus sputum, as the lesion progresses, the lungs form multiple abscesses, the symptoms worsen, can appear high fever, cough, a lot of mucus pus Sexual paralysis, and bloody or massive hemoptysis in the sputum, accompanied by fatigue, night sweats, anemia and weight loss, the lesion extended to the pleura can cause severe chest pain, invading the chest wall with subcutaneous abscess and fistula formation, often excreted pus, mixed with bacteria, There is pigmentation in the surrounding tissue of the fistula. After the fistula is healed, the fistula can appear in the vicinity. If the mediastinum is involved, it may cause difficulty in breathing or swallowing. In severe cases, it may lead to death, and there may be pulmonary abscess and pleural fluid.
Examine
Examination of pulmonary actinomycosis
1. Blood test : blood leukocytes rise and erythrocyte sedimentation rate increases.
2. Pathogen examination : yellow granules with a diameter of 0.25~3mm can be seen from the secretions of sputum, pus or sinus. It is round under low magnification, the central color is light, arranged in a radial shape, similar to spores, will be granules. Crushed for Gram staining, Gram-positive Y-branched bacterial filaments can be seen under oil microscope. Specimens containing sulfur particles can be placed on antibiotic-free medium under anaerobic conditions, and pathogen growth can be seen, combined with biochemical reactions and strains. Identification, the cultured strain was injected into the abdominal cavity of mice. After 4 to 6 weeks, there were many small abscesses in the abdominal cavity. The slices showed "sulphur granules", and the Gram-positive mycelium was observed by microscopy.
3. X-ray : manifested as bronchial pneumonia, lung consolidation, there are a number of small light-transmissive areas, which can also be expressed as a mass-like shadow. If the blood is spread, it is characterized by miliary lesions in the lungs and lungs in the late stage. Fibrosis, pleural thickening, lesions spread to the ribs and spine, signs of periostitis, ribs or spine destruction.
Diagnosis
Diagnosis and identification of pulmonary actinomycosis
diagnosis
Early in the clinical and X-ray no characteristic changes, it is more difficult to diagnose, the diagnosis depends mainly on microbiology and histological examination, find sulfur particles from the tissues of the pus, sputum or fistula wall, or anaerobic culture to cause disease The bacteria can be diagnosed.
Differential diagnosis
The disease is more easily confused with tuberculosis, bronchial cancer and lung abscess; it is similar to the clinical manifestations of X-ray disease and X-ray manifestations and pathogenic bacteria. It should be noted that Nocardia often invades the central nervous system. The chest wall fistula is rarely formed, and there is no sulfur particle in the sputum, which belongs to aerobic bacteria.
Unilateral or bilateral lungs scattered in irregular patchy infiltration shadows, can be fused into consolidation, which has irregular translucent areas, may also be accompanied by pleural effusion, lesions spread to the ribs and spine, visible signs of periostitis, The ribs or spine are destroyed.
The disease should be differentiated from tuberculosis, bronchial cancer, lung abscess, slave disease, lung cancer.
