actinomycosis of bone
Introduction
Introduction to osteomyelitis Actinomycosis of bone is a deep mycosis, rare, and the disease is occasionally seen in the northwest of China. Most of the rural patients, the age of onset is at most 11 to 30 years old, the disease produces multiple sinus granulomatous diseases. It is characterized by the discharge of purulent fluid with "sulphur-colored particles" from the sinus. Cows and horses can also suffer from this disease. basic knowledge The proportion of sickness: 0.01%-0.05% Susceptible people: people who are 11 to 30 years old Mode of infection: non-infectious Complications: maxillofacial actinomycosis Actinomycosis
Cause
Cause of osteomyelitis
Cause:
Actinomycetes are filamentous molds, often arranged in a radial arrangement. They are present in the soil and are of various types. The pathogenic bacteria are bovine-type actinomycetes. The bacteria are positive for Gram stain and have anaerobic properties. In the oral cavity, actinomycetes can be found in the crypts of the caries and tonsils. The morphology is the same as that of the pathogenic bacteria. Five types have been found in addition to the bovine type, and the pathogenic bacteria are mostly in the tissue mucosal hypoxia and the resistance is reduced. Under the condition (common tooth extraction or inflammation), growth and spread, from the oral mucosa into the mandibular angle and neck, can also be invaded into the lungs by the respiratory tract to cause lung lesions, invading the ileocecal zone from the digestive tract, actinomycetes Connective tissue directly invades surrounding tissues, rarely spreads through blood circulation, and never spreads through the lymphatic system. The expansion of lesions can involve bones, and bone lesions are mostly secondary.
Prevention
Osteomycete prevention
Early treatment is a key to this disease, so early detection and diagnosis should be paid attention to. Secondly, oral hygiene should be paid attention to, and infection should be prevented. If antibiotics should be used promptly after tooth extraction, it is also of positive significance to prevent the occurrence of actinomycetes.
Complication
Osteomyelitis complications Complications, maxillofacial actinomycosis, actinomycosis
In some patients with this disease, the damage of the maxilla can be extended to the intracranial, meninges and brain. The lesions below the jaw can be extended to the neck and chest, extending back to the cervical vertebrae, and the chest lesions can invade the ribs and thoracic vertebrae. The lesion can invade the pelvis and lumbar vertebrae. If the vertebral body is involved, the lesion can extend up and down along the anterior longitudinal ligament to the multiple vertebral bodies. The destruction process can be performed to the lateral vertebral arch, transverse process, rib neck and head, and then to the spinous process. All were destroyed, but the intervertebral disc remained intact. At this time, the patient's clinical symptoms and signs were not heavy, only mild pain and tenderness, and spinal activity was slightly restricted.
Symptom
Bone actinomycosis symptoms common symptoms toothache fever granuloma soft tissue swelling
Patients may have systemic infectious symptoms such as fever, discomfort, anemia, etc., but mainly local inflammation. When the mandible is involved, there are many toothaches at the beginning, followed by swelling of the alveolar, loose teeth, and mild pain. The soft tissue of the cheeks is swollen and the mandible is thickened. The inflammatory granuloma mass can soften and break out the yellow "sulphur particles" pus composed of colonies, forming most fistulas, forming irregular tough scars after healing, and the damage of the maxilla can be expanded. To the intracranial, meninges and brain, the lesions below the jaw can be extended to the neck and chest, extending back to the cervical vertebrae, while the chest lesions can invade the ribs and thoracic vertebrae, and ileocecal lesions can invade the pelvis and lumbar vertebrae.
Examine
Examination of osteomyelitis
There are two main methods for examining this disease:
1. The X-ray films are mainly irregular, the osteoids with irregular edges and compacted bones. The mandibular enlargement and thickening may be accompanied by the appearance of the fistula. The vertebral body is visible and the vertebral body has a honeycomb transparent area. The osteoporotic destruction zone is surrounded by bone hyperplasia and hardening, and the vertebral body rarely collapses.
2, laboratory inspection: mainly mold inspection, from the sulfur particles in the pus can be found in the radiation bacteria, the sulfur particles are crushed between two pieces of glass, under the microscope can see the mycelium radially arranged around, An anaerobic medium can also be used for the cultivation of actinomycetes.
Diagnosis
Diagnosis and identification of osteomyelitis
diagnosis
The disease is not difficult to diagnose. The lesions of the mandibular surface of the face and neck are special. The clinically purulent chronic granuloma mass is followed by ulceration, and the pus with yellow "sulphur particles" flows out and forms the characteristics of most fistulas. It is helpful for diagnosis, and the clinical manifestations of vertebral body invasion and X-ray changes of vertebral bodies and attachments also have its characteristics.
Differential diagnosis
In the differential diagnosis, this disease should pay special attention to the difference between chronic inflammation of bone and bone tuberculosis.
1, chronic inflammation often has a history of acute inflammation, ulceration and pus, dead bone formation, no yellow particles in the pus.
2, spinal tuberculosis has multiple intervertebral disc destruction, less affected vertebral body, transverse process and rib head are often not damaged, no yellow particles in cold abscess, spine often accompanied by kyphosis, of course, the diagnosis of this disease is in sulfur Finding the arrangement of radial hyphae in the granules is the most convincing.
In addition, the disease needs to be differentiated from systemic infectious diseases, X-ray and pathogen examination can be identified.
