penile scrotal elephantiasis
Introduction
Introduction to penile scrotum elephantiasis Penile scrotum elephantiasis is the most prominent manifestation of advanced filariasis, mostly caused by the filariasis. Due to lymphatic inflammation, obstruction, rupture, skin and subcutaneous tissue hyperplasia and thickening to form elephantiasis, when secondary streptococcal infection, the lesions can be further aggravated. basic knowledge The proportion of illness: 0.001% Susceptible people: seen in men Mode of infection: mosquito bites Complications: testicular hydrocele
Cause
The cause of penile scrotum elephantiasis
Causes:
The two adults of B. elegans and B. malayi have similar morphology, and the internal structure is almost identical. However, the male worm is shorter than the filaria. In the human body, the female uterus is developed into a filamentous activity. Microfilariae, when mosquitoes suck the blood of patients with silkworms, the microfilariae are inhaled into the mosquitoes to develop into infected larvae. When the mosquito sucks blood, the infected larva enters the human body; after the infected larva enters the human body, some of them die, and some larvae enter the lymph. The tube or lymph node develops into an adult. The life span of the adult in the human body can reach more than 10 years. The life span of the microfilaria in the human body is about 2 to 3 months, and it can survive for 6 weeks at 4 ° C in vitro. After entering the blood circulation from the lymphatic system, Malay microfilaria has obvious nighttime periodicity, that is, it is clustered in the pulmonary capillaries during the daytime, and appears in the peripheral blood at night, and the Malay microfilaria is 8:00 pm to the night. At 4:00 in the morning, the Bans Microwires peaked at 10:00 pm to 2:00 in the morning.
The pathogenesis and pathological changes of filariasis are mainly caused by adults. The larvae in the infection stage also play a certain role, but have little relationship with the microfilariae in the blood. From the larvae into the human skin to the stage of adult development, the larvae and adults Metabolites and excretions in the uterus of the worm can cause systemic allergic reactions and tissue reactions of the local lymphatic system. Clinical features are characterized by periodic episodes of lymphangitis, lymphadenitis and filarial fever; Due to pathological changes in lymphoid tissue and secondary bacterial infections.
Pathogenesis:
The elephantiasis of penis and scrotum often occurs in the epidemic area of filariasis. The early stage of the disease is often recurrent scrotal diffuse lymphangitis, and later due to repeated lymphangitis and lymphatic exudation on the skin and subcutaneous The long-term chronic stimulation of the tissue makes the skin and subcutaneous connective tissue thicken and harden, dry, and the appearance of the skin is orange peel-like, granular and sputum-like hyperplasia, and the scrotal skin loses elasticity and contraction, due to connective tissue hyperplasia and lymphatic accumulation. The scrotum is spherical, subject to sagging and pulling by volume and weight. In severe cases, the swollen scrotum can sag to the knee joint level of several kilograms. According to the literature, the largest one can reach 102kg, which affects the patient's action and normal life. The huge scrotum is drooping, the closer the lower part of the skin is, the more serious the damage is. On the upper part of the skin and the pubis, the perineal and femoral healthy skin transition areas gradually become thinner, and the penis often retracts into the swollen scrotum, when the penis skin also has skin like skin. When swollen, the protrusions are like the horns of the flexion, the corpus cavernosum shrinks into the foreskin of the penis or even forms a cave-like tunnel in the scrotum to reach the penis head and urine. Outside the mouth, the overflow of urine during urination cave mouth wet clothes and footwear, to be embedded in testicular swelling scrotal skin, sometimes associated hydrocele.
Prevention
Penile scrotum elephantiasis prevention
Effective ways to prevent filariasis:
1. Actively and effectively treat patients with filariasis and cut off the source of infection.
2. Eliminate mosquitoes and mosquito breeding grounds and cut off their vectors.
3. During the epidemic season in popular areas, 0.3% of the salt of hexamine citrate (sea group salt) is taken for 6 months. The dose is small and the side effects are small, and the masses are easy to accept.
Complication
Penile scrotum elephantiasis complications Complications, testicular hydrocele
The disease can be combined with testicular hydrocele, but the testis, epididymis, spermatic cord are generally not involved.
Symptom
Penile scrotum like cutaneous swelling symptoms Common symptoms Scrotal swelling inguinal lymph nodes swelling chills high fever
The patient has a history of filariasis endemic area or a history of filaria infection, and has a history of recurrent scrotal cellulitis or lymphangitis. Most patients have chills, high fever, scrotal swelling and pain, often accompanied by inguinal lymphadenopathy. Large and tender, inflammation can be resolved after a few days, but it can be attacked for several days every year. The scrotum volume gradually increases over time. The early stage of physical examination is scrotal enlargement, rough skin thickening, soft texture, edema can affect the penis, and the late scrotum is further swollen. Large, sometimes as big as a child, even up to tens of kilograms, becoming a huge deformity, the skin of the scrotum thickens and hardens up to several centimeters, is a dry leather-like, loses elasticity and contraction, and the skin of the penis can also be thickened at the same time. It is prone to cleft palate and secondary infection; it seriously affects the patient's activity and local appearance. Due to the huge volume of the scrotum elephant skin, the penis and foreskin contraction is often subsided, and even buried in the scrotum elephantiasis.
Examine
Examination of penile scrotum elephantiasis
After sputum blood test after falling asleep, microfilaria can be found, which will help diagnose, blood eosinophils increase by more than 5%, and hydrocele can also be found in hydrocele, sheath chyle or urine.
Pathological biopsy revealed extensive infiltration of filarial and eosinophils and formation of eosinophilic granuloma.
Diagnosis
Diagnosis and differentiation of penile scrotum elephantia
Diagnostic criteria
1 popular area;
2 history of recurrent scrotal lymphangitis;
3 blood microfilariae positive and other difficult to diagnose, but sometimes should be distinguished from advanced cancer, tuberculosis, syphilis, streptococcal inflammation caused by lymphatic edema caused by lymphatic occlusion.
Differential diagnosis
1. Acute idiopathic scrotal edema: It is an allergic disease that is not related to trauma or infection. It manifests as swelling of the scrotum and even spread to the foreskin, groin or perineum. At the same time, because most patients test blood eosinophils The number of cells is very similar, so it is very similar to the scrotal elephant skin swelling, but the disease has no history of recurrent scrotal cellulitis or lymphangitis, often suddenly onset, swelling of the scrotum skin temperature is higher, soft, skin color due to high swelling Bright, such as large blisters, no swelling of the inguinal lymph nodes.
2. idiopathic scrotal gangrene: is a very serious and rare scrotal infectious disease, early manifestations of scrotal edema, skin color redness, shiny, may be associated with scrotal swelling, chills, high fever and other symptoms, clinically It resembles the acute manifestation of scrotal elephant skin swelling, but the onset of the disease is sharp, often awakened during sleep due to severe pain in the scrotum. The swollen scrotum skin is moist and gradually turns purple black and necrotic, and even necrotic tissue falls off, making the testicles, The spermatic cord is exposed, so the two are easy to identify, especially in the later stages of the disease.
