Chlamydial lymphogranuloma
Introduction
Introduction to chlamydial lymphogranuloma The disease is one of the sexually transmitted diseases caused by Chlamydia trachomatis, manifested as a variety of acute to chronic genital damage with local lymphadenopathy. Synonyms of the disease are: tropical diaphragm, althaun, adenosis, diarrhea, benign purulent periorbital lymphadenitis, inguinal lymphadenopathy, inguinal lymphogranuloma lymphagranulomainguinale, Durand-Nicolas- Favre disease and fourth sexually transmitted disease forthvenerealdisease. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of transmission: sexual intercourse. Complications: Epididymitis Peritonitis Ulcerative colitis Periostitis Arthritis Meningitis
Cause
Chlamydia lymphogranuloma cause
Infection (36%):
The pathogens are L1, L2, L3 serotypes among the 15 serotypes of Chlamydia trachomatis, of which L2 serotype is the most common, and L-type has stronger invasiveness than other serotypes.
Route of infection (26%):
Human is the only natural host of L-type Chlamydia trachomatis. The damage on the skin and mucous membrane is the precondition for the invasion of Chlamydia. When the pathogen infects the human body, it mainly invades the skin and lymphoid tissues. It has strong invasiveness and involves deeper body tissues, causing serious damage. Systemic lesions, unlike other serotypes of Chlamydia trachomatis, are mainly confined to the mucosa. The pathological basis of LGV is thrombophlitis and perilymphitis. Due to inflammation, the proximal lymph nodes of the primary site are enlarged and stars appear. Necrosis, the latter develops into an abscess, the abscess can be fused, and then ulcerated, eventually forming the fistula and sinus. After several weeks or months of inflammation, the inflammation begins to subside. The repair process is characterized by fibrosis of the tissue and fibrosis on the one hand. The normal structure of the lymph nodes is destroyed, the lymphatic drainage is not smooth, and the local blood supply is affected. The final result is the edema, hardening and ulceration of the diseased tissue, and the cell-mediated hypersensitivity reaction exacerbates the tissue damage. This inflammation and repair process directly leads to extensive adhesion of the tissue.
Immunity (20%):
The presence of complement-binding antibodies in the serum of humans infected with LGB, the emergence of this antibody contributes to the diagnosis of this disease, the cellular and humoral immunity produced by the body can limit but not completely eliminate the spread of local and systemic infections, even in the late stage, Pathogens can be isolated from infected tissues.
Pathogenesis
Chlamydia usually enters the skin and mucous membranes through tiny wounds. Local infections are drained to the lymph nodes. Early LGV lesions are limited to 1 to 2 lymph nodes. The infected lymph nodes cause inflammation of the surrounding tissues. The basic pathological changes are thrombotic lymphoids. Tube inflammation and lymphatic inflammation, lymphangiitis is characterized by lymphatic LU in the lymph nodes and interstitial cell proliferation in the lymph nodes, lymph nodes are enlarged, forming small and scattered, necrotic foci tightly wrapped by endothelial cells, attracting more necrotic foci The nucleated white blood cells accumulate and become larger to form a characteristic triangle or quadrilateral "satellite abscess", which causes adjacent lymph nodes to entangle.
As the inflammation worsens, the abscess melts and ruptures, forming a small cavity abscess, fistula, sinus, and the inflammatory process lasts for weeks to months, and heals due to fibrosis. At this time, the normal structure of the lymph nodes disappears and the lymphatic vessels are blocked. The chronic edema and fibrosis formed cause the lesion to be swollen and hardened. Fibrosis affects the blood supply to the surface mucous membrane, produces ulcers, occurs in the destruction of the rectal mucosa and causes inflammation of the intestinal wall, and lymphatic drainage is blocked. Fibrous formation, inflammatory stenosis, a large number of adherents in the lower part of the sigmoid colon and rectum, affecting the pelvic and surrounding organs. With the dissemination of chlamydial blood, LGV can affect the central nervous system. The limitation or spread of the disease depends on the host's immunity. 1 to 2 weeks after infection, a delayed hypersensitivity immune response is produced, and LGV-specific chlamydial antibodies can also be detected, and the infection can be early.
Prevention
Chlamydia lymphogranuloma prevention
Patients should be followed up after treatment until clinical symptoms and signs are alleviated. This process takes 3 to 6 weeks, but there are also reports of self-healing for 8 weeks.
Complication
Chlamydia lymphogranuloma complications Complications epididymitis peritonitis ulcerative colitis periostitis arthritis meningitis
Epididymitis, peritonitis, ulcerative colitis, periostitis, arthritis, meningitis, etc.
Symptom
Chlamydia lymphogranuloma symptoms Common symptoms Progressive granuloma ulcer necrosis Low fever abdominal pain Pain defecation difficulty Red granulomatous periostitis Peritonitis Meningitis
The incubation period is 5 to 21 days, with an average of 1 week. The clinical course can be divided into 3 phases:
1. The first stage of the early genital damage period, roughly 3 days to 3 weeks, or even 3 months after sexual intercourse, on the external genitalia, such as the male coronary sulcus, the inside of the foreskin, the glans or urethra, the female labia, Vagina or cervix, needle-sized papules, pustules, and ulceration quickly form ulcers, often single, sometimes 2 to 3, diameter 1 to 4 mm, round, clear edges, rounded with blush, not touching Hard, no pain, so easy to be ignored by patients, after about 10 days to heal, leaving no scars.
2. The second phase, the groin of the inguinal hernia, after 1 to 4 weeks of the first stage of injury, the groin is sore and stiff, and immediately the lymph nodes begin to enlarge, merge into a less regular, slightly fusiform along the groin. The center is high and the outer part is flat. The size is like egg or larger. The surface is purple and cyan. Because the inguinal ligament separates the lymph nodes, the skin is grooved. Each lymph node inflammation is purulent and perforated, forming a majority of fistulas. Like "spraying bottle", discharges purulent or blood serum, the main pain, is lighter than the lower jaw, but affects the action, may have low fever, loss of appetite or general malaise, the distribution is often unilateral, sometimes symmetrical, after The side of the hair, because of a certain immunity, is often smaller, lighter, and does not necessarily pus perforation, called the inguinal lymphogranuloma, and infrequent inguinal lymphadenitis in women, because of its initial sores Occurred in the lower part of the vagina, spreading to the ankle and anorectal lymph nodes, causing paralysis and rectal inflammation around the rectum, causing abdominal pain and low back pain.
3. The third stage is the external genital elephantiasis and rectal stenosis, 1 to 2 years from the first phase, male elephantiasis can involve the penis (thick and solid), scrotum and lower limbs, homosexuals can occur anorectal stenosis This has not been seen in China, the female elephant skin swelling can be very prominent, the author has seen a case of a round labia elephanta skin swelling larger than the egg, the two sides of the labia elephant finger extension down 7 ~ 8cm, bilaterally symmetrical, Hard as elephant skin, slightly brown, slightly pointed at the end, with pus in the stool at the beginning, gradually difficulty in defecation, fecal shape like pencil, rectal examination revealed thickening of the intestinal wall, there is a fairly solid mass 5~6cm above the anus This change may be ring-shaped, cylindrical or funnel-shaped. The latter is more common. X-ray film can confirm that the author has seen an extra-anal mass such as a baby's head, the rectum and the bladder are connected, and the damage is often for many years. Not healed.
In addition to the lesions around the genitals, groin and anus seen in the above three phases, there are other rare lesions in this disease, suggesting that the disease may be a systemic multi-system disease. Rare lesions include: erythema of the skin, nodular erythema , erythema, nodules, abscesses or ulcers occurring near the groin of the groin, photosensitive skin reactions are common: the eye has edema around the optic disc, the fundus veins expand and bend (disappear after healing, this lesion is not uncommon) and conjunctivitis.
Others have epididymitis, peritonitis, ulcerative colitis, periostitis, arthritis, meningitis, etc. Shanghai Huashan Hospital has seen a case of meningitis caused by this disease, died of persistent epilepsy.
Examine
Chlamydia lymphogranuloma examination
1. Direct microscopic examination of chlamydia and culture of acupuncture with fluctuating lymph nodes to obtain specimens, smear stained with Giemsa, iodine or fluorescein-labeled antibody, microscopically looking for chlamydia and inclusion bodies, but the diagnostic success rate is low; inoculation in development The chicken embryo yolk sac or the monolayer of McCoy cells (Hela-229 cells, L929 cells, BHK-21 cells) are centrifuged at constant temperature, and the inclusion bodies are found after culture. The cell culture and nucleic acid amplification techniques are the gold standard for chlamydia detection.
2. Frei test used lymph node pus or monkey body isolated and cultured antigen, intradermal injection, 48h observation, the history of this test has a value for the diagnosis of LGV.
3. Serological examination The complement fixation test (CF) sensitivity is higher than the Frei test, but the chlamydia of various serotypes have cross-reactivity, the active LGV infection CF titer can reach 1:64 or higher, serum antibodies can last for many years. The test results combined with clinical manifestations are helpful for diagnosis. The sensitivity and specificity of the micro-immunofluorescence test (MIF) are higher. It can also be used to determine the serotype of infected strains. High titer of Chlamydia L1-3 antibody is useful for the diagnosis of acute LGV is valuable.
4. Polymerase chain reaction (PCR) PCR mainly detects the chlamydial infection of various serotypes by detecting the Chlamydia trachomatis plasmid or outer membrane protein (MOMP) DNA sequence, which has high sensitivity. In LGV, studies have shown that Genital ulcers and lymph node lesions are often caused by a variety of pathogens (including HIV), and PCR has advantages for diagnosing LGV.
Histopathology: Lymph node pathology is non-specific for LGV, but it helps to rule out other diseases. LGV lymph nodes are typically characterized by infectious granulomas with stellate abscess: central necrosis consists of lymphocytes, endothelial cells and white blood cell debris. It is surrounded by epithelioid cell bands.
Diagnosis
Diagnosis and diagnosis of chlamydial lymphogranuloma
Detailed medical history is required, careful clinical examinations are performed, combined with appropriate laboratory tests, diagnostics are carefully analyzed, and complications are determined.
Including: reactive lymphadenopathy, soft chancre, syphilis, spastic skin tuberculosis, cat scratching, Hodgkin's disease, syphilis, soft chancre, ulcers and lymphadenopathy have their characteristics, laboratory tests are helpful. Inguinal hernia or inguinal lymph node tuberculosis is also an important differential diagnosis, the course of which is slow and painless, and the laboratory test for tuberculosis is positive. Cat scratching is an acute disease. Hodgkin's disease is a systemic disease, and the late stage of LGV should be differentiated from skin tumors, filariasis, rectal cancer, enteritis and suppurative sweat gland inflammation.
