Urogenital actinomycosis
Introduction
Introduction to genitourinary actinomycosis The genitourinary actinomycete is a kind of kidney-infected disease caused by the actinomycetes of the bovine-type actinomycetes. The actinomycetes can cause colon or abdominal actinomycosis through the digestive tract and can spread directly to the kidney. , the bladder, sometimes through the blood line to invade the testis, epididymis, penis, prostate and other places. Actinomycetes are generally scattered, belonging to endogenous diseases, not infectious diseases. Actinomycetes are parasitic in the caries, periodontal abscesses and tonsil folds of normal people, livestock or other animals. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: digestive tract spread Complications: abscess brain abscess
Cause
Causes of genitourinary actinomycosis
(1) Causes of the disease
Actinomycetes are generally scattered, belonging to endogenous diseases, not infectious diseases. Actinomycetes are parasitic in normal people, caries or other animal caries, periodontal abscesses and tonsils, and Slack cultures in 100 tons of tonsils. 25% have actinomycetes, and Emmons directly examines tonsils, 47% of which have actinomycetes. When the body's systemic or local resistance is reduced or oral infections, the jaws and neck can be infected from the damaged oral mucosa. It can also be inhaled by the trachea to produce pulmonary and thoracic infections. It can also cause colon and abdomen actinomycosis through the digestive tract, and can spread directly to the kidney and bladder. It has also been reported to cause actinomycetes due to hypospadias surgery. The disease is caused by the infection of the actinomycetes in the abdominal surgery.
(two) pathogenesis
The particularity of actinomycete infection is not restricted by anatomical barriers, such as fascia, pleura, diaphragm, etc., which can not limit the development of lesions. It spreads directly from a lesion to its nearby tissues, spreads and spreads, and invades surrounding tissues. And organs, in extremely rare cases, can also be disseminated by blood, causing infection of the brain and internal organs. Primary skin lesions are rare, mostly spread by deep tissue disease until multiple abscesses or sinuses form on the skin. Road, each sinus can communicate with each other and extend to the nearby deep organs. The characteristics of this disease can be seen in the pus, yellow-white particles, 0.25 ~ 2mm in diameter, called sulfur particles, very few patients with obvious immunodeficiency or When the infected actinomycetes are more pathogenic, they can cause severe hematogenous spread.
Prevention
Urogenital actinomycosis prevention
1. Pay attention to oral hygiene and treat teeth, periodontal and tonsil diseases as soon as possible.
2. Timely treatment of respiratory tract, gastrointestinal inflammation, ulceration, so as not to form a chronic infection.
Complication
Urogenital actinomycosis complications Complications abscess brain abscess
If the actinomycetes are found and left untreated, systemic infections, actinomy abscesses, brain abscesses, etc. may occur, and even death may occur.
Symptom
Symptoms of genitourinary actinomycosis Common symptoms Dull pain, low heat, weight loss, dysuria, urinary frequency, urgency, night sweats
Have a history of contact with cattle, horses or pastures and pastoral work history; have a history of chronic wasting.
Chronic suppuration
It is characterized by frequent urination, urgency, and dysuria; low fever accompanied by anemia, weight loss, night sweats, etc., sometimes forming a sinus at the waist, with pus out.
Proliferative type
It is characterized by persistent dull pain or dull pain in the kidney area, sometimes with enlarged kidneys.
Examine
Examination of genitourinary actinomycosis
Urine check
There are a small number of red blood cells, pus cells, proteins and casts. Gram-positive "Y"-shaped mycobacteria can be seen under high magnification.
2. Pus examination
Gray-yellow colony particles, called "sulphur particles", can be found in the pus from the sinus or the pus in the peri-renal abscess. The particles are round or oval, and the center is light and arranged radially. This is the most characteristic change in actinomycosis.
Other auxiliary inspections:
1. Imaging examination
B-ultrasound or IVU can be seen in renal enlargement, renal pelvis deformation, renal pelvis destruction, and seems to have a space-occupying lesion. Proliferative lesions can be seen as a spider-like deformity of the renal pelvis and renal pelvis.
2. Histological examination
When the lesion is difficult to identify, the living tissue may be taken for pathological examination, and at the same time, it should be differentiated from the tumor of the corresponding organ or other infectious diseases.
3. Cystoscopy
Visible intravesical mucosal redness, hyperemia and other chronic inflammatory changes, biopsy to see typical granular colonies, can be clearly diagnosed.
Diagnosis
Diagnosis and identification of genitourinary actinomycosis
diagnosis
According to the medical history, clinical symptoms and signs, combined with laboratory tests and histological examination can confirm the diagnosis.
Differential diagnosis
Kidney tuberculosis
The course of the disease has been delayed for more than several years. There are low back pain, low fever, pyuria, hematuria and bladder irritation. It is similar to the symptoms of renal actinomycosis, but there is a history of tuberculosis, obvious urinary frequency and terminal hematuria, increased erythrocyte sedimentation rate, continuous urinary sediment application. Tablet acid-fast staining can be found in acid-fast bacilli, "silver particles" formed by colonies without actinomycetes, urinary tract angiography can be seen blurring of the renal pelvis, renal pelvis, dilated or undeveloped renal pelvis, sometimes with typical contracture bladder and contralateral Hydronephrosis, cystoscopy or superficial mucosal ulceration can be seen by cystoscopy, and tubercle bacilli can be found on biopsy.
2. Chronic pyelonephritis
Also manifested as repeated urinary frequency, urgency, pyuria, hematuria, low back pain and fever, urine examination of protein and pus cells, urography can be found in renal pelvis, renal pelvis deformation and renal parenchymal atrophy, and renal actinomycosis symptoms Similarities, but the disease has obvious chronic renal insufficiency. There is no "sulphur granule" in urine test. The middle urinary bacteria culture is positive. X-ray examination shows that the kidney is shrinking, the kidney edge is irregular, and the renal pelvis and renal pelvis are irregularly deformed. ,distortion.
3. Peri-renal inflammation and peri-renal abscess
Sometimes it is also characterized by fever, low back pain, with weight loss, fatigue and chronic suppurative lesions. However, patients with periarteritis and peri-renal abscess have lumbar vertebrae bent to the affected side, limb activity is limited, and renal pain is extremely obvious. CT can show There is a low-density mass in the kidney, the renal pelvis and renal pelvis can be normal, and there is no "sulphur granule" in the pus.
4. Pus kidney
Chronic course type mainly manifested as recurrent low back pain, often accompanied by night sweats, anemia and weight loss, similar to chronic suppurative lesions, but pus kidney patients have a large number of pus cells in urine routine examination, urine culture positive and no "sulfur particles".
5. Kidney tumor
Sometimes it can be characterized by low-heat, wasting, fatigue and other chronic consumptive performance, physical examination can be licking kidney lumps, urinary tract angiography can be seen in the renal pelvis, renal pelvis compression, deformation, and the disease caused by proliferative lesions are very similar, but There were intermittent painless gross hematuria, obvious low back pain, and the kidney area touched the progressively enlarged mass. Renal angiography showed tortuous and irregular tumor blood vessels. B-ultrasound, CT and MRI showed tumor images.
6. Penis syphilis (hard squat)
It is difficult to distinguish the penile head ulcer from this disease, but the disease has a history of contact with sexually transmitted diseases. The ulcer exudate is used for dark field examination, and Treponema pallidum can be found. The dark fluorescent field of the serum fluorescent antibody is positive.
7. Trichomonas cystitis
It is also characterized by repeated frequent urination, urgency, pyuria with hematuria, but trichomoniasis can be found in the urethral secretions and urine of patients, and "sulphur granules" cannot be found.
8. Chronic cystitis
Also manifested as repeated frequent urination, urgency, pyuria with hematuria, but urine routine examination has white blood cells, middle urinary bacteria culture positive, no "sulphur granules" in the urine, cystoscopy, although there is inflammation in the bladder, but biopsy No granular colonies were found.
9. bladder tuberculosis
Also manifested as repeated frequent urination, urgency, pyuria with hematuria, but at the same time a history of tuberculosis and renal tuberculosis, urinary smear smear acid-fast staining can be found acid-fast bacilli, but no "sulphur granules" in the urine, IVU visible kidney Destructive changes in stagnant water and renal parenchyma, tuberculous nodules or superficial mucosal ulcers can be seen by cystoscopy, and tubercle bacilli can be found on biopsy.
