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Actinomycosis

Actinomycosis — the chronic suppurative process at the person and animals which is characterized by formation of hypodermic abscesses and fistulas, usually multiple. Is caused by an anaerobic radiant mushroom from the sort Actinomyces and it is localized in a face and a neck, a breast, a stomach or in the field of a basin.
Etiology. Actinomyces — a microorganism, gram-positive with the branching mycelium threads. In laboratory it is isolated infrequently as demands strictly anaerobic conditions for growth. The disease causes in the person mainly to A. israelii, however as its reason can serve also A. naeslimdii, A. viscosus and A. odontolyticus.
Epidemiology. The actinomycosis — an eurysynusic disease, in recent years its frequency decreases. It seldom occurs at children, tsrichy boys get sick 4 times more often than girls. Actinomycetes at the person saprofitirut in a stomatopharynx and a digestive tract. Their pathogenic properties are shown at damage of fabrics as a result of an injury, surgical intervention or after the postponed intercurrent infection.
Pathology. The disease is characterized by the suppurations surrounded with the expressed fibrozirovanny fabrics. The fistulas extending on a surface of skin of a pla deeply in internals are usually formed. The "Sulfuric granules" found in the field of suppurations are surrounded with basphilic cells and represent accumulations of a mycelium with calcium phosphate. These granules of yellow-white color with a diameter up to 2 mm are most often caused by A. israelii infection, but can be found at other types of an actinomycosis, a nocardiosis, a stafilokokkoza and other fungus diseases.
Clinical manifestations. A cervical and front actinomycosis — the most frequent form of a disease of children. The microorganism gets into hypodermic cellulose on a neck from the injured teeth. Along edge of a mandible there is all the increasing painless tumor with gradual distribution of fluctuation on area of a neck. Skin over a tumor becomes intense, gains red or dark red color, education is condensed. Eventually it gradually decreases in the amount of as in skin fistulas are formed. Lymph nodes, a thyroid gland and the subject bone sharply are involved in process. Pains are very insignificant, and the child has no signs of a general disease. On the roentgenogram of changes do not find, but at it is long the ill children on it signs of periosteal reaction and destruction of a bone appear.
The actinomycosis of abdominal organs most often develops after operation of appendectomy or the getting wounds of a stomach. There are abdominal pains, body temperature increases, the child grows thin, in ileocecal area at him consolidation begins to be palpated. Are involved in process skin and the fistular courses can be formed. The diagnosis is usually made out of time. Quite often the liver, the next abdominal organs, a diaphragm and bodies of a thorax are surprised. Sometimes process extends to bodies of a small pelvis at the women who are especially applying intrauterine contraceptives.
The actinomycosis of bodies of a thorax seldom occurs at children and develops after aspiration of the infected contents from an oral cavity or, more rare, as a result of distribution of process from a gullet on area of a mediastinum. Clinical manifestations do not differ from manifestations at other forms of a persistent pulmonary infection: fervescence, perspiration at night, a degrowth of a body, pain in a breast, cough, a phlegm, a pneumorrhagia. Process can extend to a pleura, however the empyema develops seldom. Heart and other bodies of a mediastinum are also surprised infrequently. On the roentgenogram usually find massive changes in lungs, a chest wall, destruction of edges, breasts in bones of a shoulder girdle.
Diagnosis. The disease is diagnosed on the basis of data of histologic research of the bioptat received from area of suppuration in which find "gray granules" and gram-positive bacilli with the branching mycelium. As confirmation of the diagnosis serves allocation in anaerobic conditions of the infecting beginning.

Treatment. A long antibioticotherapia, drainage of abscesses and removal of the infected fabrics are shown. At deep abscesses appoint massive doses (400 000 PIECES/kg a day) penicillin intravenously during 6 — 8 weeks, and then in (2 — 4 g in days of phenoxymethylpenicillin) within 6 — 12 months. Believe that actinomycetes are sensitive to levomycetinum, erythromycin, tetracyclines and clindamycin. At intolerance of penicillin effectively each of these means used separately or in combinations.

 
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