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General principles of treatment of submandibular lymphadenitis. What is tuberculous lymphadenitis? Tuberculous lymphadenitis symptoms in adults

The most common type of inflammation of the lymph nodes is submandibular lymphadenitis. In fact, the disease is not considered serious, but if left unattended, serious complications can occur.

The body's lymphatic system is connected to the cardiovascular system. It is designed to transport tissue fluid from the interstitial space into the blood. This fluid is called lymph.

The main elements of the lymphatic system are the lymph nodes. They are responsible for filtration in the body. It is the lymph nodes that prevent infections from entering the blood and spreading. However, when harmful microorganisms enter the body, causing inflammation, they accumulate in the lymph nodes.

Submandibular lymphadenitis is the result of infection entering the body and its spread. Often the pathology is caused by various inflammatory processes in the oral cavity (chronic tonsillitis, pustular lesions, etc.). When bacteria settle in the lymph nodes, they become inflamed and enlarge. As a rule, several lymph nodes are affected at once.

Characteristic symptoms of submandibular lymphadenitis:

when you feel the area under the jaw, pain occurs;
swelling;
redness of the oral mucosa.

If any symptoms occur, you should immediately consult a doctor. As the disease progresses, pain and swelling will increase, so complications should not be allowed.

Diagnosis of lymphadenitis

To identify submandibular lymphadenitis, you need to undergo a thorough physical examination. The doctor must evaluate the clinical picture and history. The purpose of diagnosis will be to identify the primary source of inflammation and establish the etiology of the disease.

Methods for diagnosing submandibular lymphadenitis:

blood test;
Ultrasound of lymph nodes;
tuberculin tests;
chest x-ray;
puncture;
bacteriological culture;
lymph node biopsy;
cytological and histological examination of tissues.

When identifying lymphadenitis, differential diagnosis is extremely important. Therefore, additional consultation with an infectious disease specialist, otolaryngologist, hematologist, phthisiatrician and surgeon is often required.

Differential diagnosis allows you to exclude:

tumors of the salivary glands;
phlegmon;
metastases of malignant tumors;
systemic diseases (leukemia or sarcoidosis);
diffuse connective tissue pathologies (lupus erythematosus, dermatomyositis, rheumatoid arthritis);
granulating periodontitis;
cysts of the neck and face;
HIV infection.

General principles of treatment of lymphadenitis

You should always remember that only a doctor is able to correctly diagnose and prescribe adequate treatment. In the case of lymphadenitis, the symptoms of which are very vague, wasting time can turn out very badly for the patient.

General therapy for lymphadenitis at home:

Use of anti-inflammatory ointments. To treat inflamed lymph nodes, it is recommended to apply bandages with Heparin ointment, boric vaseline, Vishnevsky ointment and Troxevasin.
Strengthening the immune system with vitamins. For lymphadenitis, vitamin C is prescribed, which helps the body cope with inflammation. You are also allowed to take multivitamins or increase the amount of foods with vitamins you consume (celery, spinach, parsley, onions, sauerkraut, kiwi and oranges).
Drink plenty of fluids. The patient is advised to drink plenty of plain water so that the body is able to fight the infection.
Stay warm.
Avoid hypothermia.
Provide physical therapy. For lymphadenitis, UHF and quartz irradiation are prescribed.
Maintain hygiene. If the disease was caused by inflammation in the oral cavity, you need to thoroughly brush your tongue and teeth to prevent the spread of germs.
Take antibiotics in advanced cases of lymphadenitis.
Surgical procedures are indicated in cases where any therapy is ineffective, and the lymph nodes continue to enlarge.

If lymphadenitis is detected at an early stage, antibiotics and general measures are sufficient for a complete recovery. If the patient has purulent inflammation, surgery may be required to remove pus from the lymph node. Serious surgery is needed if several lymph nodes are affected.

Antibiotics for lymphadenitis

When submandibular lymphadenitis reaches an advanced stage, it can only be overcome by taking antibiotics. However, you need to remember that antibiotics help get rid of the infection, not inflammation in the lymph nodes. Only a doctor who has conducted a thorough examination should choose an antibiotic.

Most often, the following antibiotics are prescribed for lymphadenitis:

Ampicillin;
Flemoxin;
Amoxiclav;
Amoxicillin;
Ceftriaxone;
Ceftazidime.

Traditional medicine against submandibular lymphadenitis

What compresses are allowed for lymphadenitis:

Echinacea. One of the best for lymphadenitis is a compress with echinacea tincture. It is diluted in warm water in a ratio of 1:2. Then moisten the bandage with the solution and apply it to the inflamed area. It is recommended to apply this compress at night, wrapping your neck with a warm scarf or handkerchief.
Onion. The onion head needs to be baked in the oven (15 minutes). After cooking, remove the peel and crush the pulp, adding a tablespoon of pharmaceutical tar to it. The mixture is applied to the inflammation overnight.
Herbal collection. For this compress, take walnut leaves, St. John's wort, yarrow and mistletoe. Add a teaspoon of each product to a glass of water and cook for several minutes. After cooling, you can moisten the bandage with the decoction and apply a compress overnight. The course of treatment should be 14 days.
Mint. Fresh mint leaves are crushed into a paste, which is applied to the area of inflammation and secured with a bandage. A similar compress can be made from dandelion leaves.
Gastrointestinal fat. Melt 200 g of fat in a water bath, add three tablespoons of chopped norichnik herb to it. Simmer the mixture in a water bath for four hours. While hot, the mixture is filtered and poured into a glass container. Keep refrigerated. The product is applied to the inflamed lymph nodes three times a day.
Chicory. Chicory root is crushed and poured with boiled water. After infusing for twenty minutes, the mixture should be crushed and excess water should be poured out. Then the mixture is spread on a gauze pad and applied to the affected area for two hours daily. The compress is secured with film.

Sometimes tincture of pine shoots helps with lymphadenitis. You need to add a glass of sugar and pine shoots (a two-liter jar) to three liters of water. All this needs to be simmered for two hours over low heat, then strained and cooked for another two hours. Drink a tablespoon after meals. The course of treatment is a month.

Don't forget about medicinal herbs. To prepare the product, you need to mix stinging nettle (1 part), hop cones (1), yarrow (1), horsetail (3) and oregano (1). To prepare one dose, you need to mix a tablespoon of the resulting mixture and 0.3 liters of water, then heat in a water bath for 15 minutes. Strain the product and drink three parts per day.

To strengthen your immune system during illness, you can regularly make healthy drinks based on blueberries, currants and cranberries. The berries need to be crushed in a glass and mixed with water. Before drinking, you need to let the drink brew.

Garlic tincture is a natural antiseptic. To prepare it, chop two heads of garlic and add a liter of hot water (not boiling water). The infusion must be infused for three days, stirring regularly. Drink a teaspoon three times a day.

Submandibular lymphadenitis in children

Treatment of submandibular lymphadenitis in children is carried out according to a similar scheme. It is noteworthy that suppuration of the lymph nodes rarely occurs in children. Most often, enlargement of nodes accompanies other infectious diseases. The main goal of treatment is to eliminate the cause of inflammation. Specifically, lymphadenitis is treated only when there is severe discomfort.

Submandibular lymphadenitis in children often becomes chronic. In such a situation, it is important to detect the hidden source of infection and block it. Infectious mononucleosis is a common cause of inflammation of the lymph nodes in children. In this case, special treatment for inflammation is not required.

Children with lymphadenitis need to strengthen their immunity. The child is prescribed multivitamins and undergoes hardening. However, it must be remembered that hardening cannot be carried out during an exacerbation.

Classification of childhood lymphadenitis

Medicine distinguishes between specific and nonspecific lymphadenitis (depending on the cause). The disease can have an acute course (2 weeks), subacute (2-4 weeks) and chronic. Depending on the etiology, odontogenic lymphadenitis (caused by pathology of the dental system) and non-odontogenic lymphadenitis are divided.

Based on the nature of the changes in the lymph nodes, serous, necrotic and purulent lymphadenitis are distinguished. If we talk about the lesion, there are regional and generalized. Submandibular lymphadenitis is regional, as are cervical, axillary, inguinal and others.

Symptoms

Most often in children, it is the submandibular and cervical lymph nodes that become inflamed, less often the axillary and inguinal lymph nodes. Acute nonspecific lymphadenitis causes enlargement of the lymph nodes, they acquire a dense and elastic structure. The child begins to suffer from pain, but the temperature does not rise. The skin over the affected areas does not change. Chronic lymphadenitis in children provokes a constant enlargement of the nodes; they are limited in mobility, have a dense structure, and are painless.

During the transition from the acute stage to the purulent stage, the symptoms become pronounced. The child’s well-being sharply worsens, symptoms of intoxication occur (chills, fever, weakness, headaches, sleep disturbance). Nagging pain, swelling and hyperemia appear in the area of the lymph nodes.

It must be remembered that without treatment, submandibular lymphadenitis is complicated by adenophlegmons. Purulent inflammation spreads beyond the lymph node. Adenophlegmons, in turn, are complicated by thrombosis and sepsis.

Treatment of submandibular lymphadenitis in children

Therapy for lymphadenitis depends on the stage and type of the disease, as well as the degree of intoxication. The doctor must stop inflammation in the lymph nodes, as well as find and eliminate the primary source of infection.

Acute serous or chronic lymphadenitis requires a conservative approach. For these purposes, antibiotics (macrolides, penicillins, cephalosporins) and desensitizing drugs are prescribed. Local effects include compresses and physiotherapy.

Often, children with lymphadenitis are prescribed general strengthening drugs (vitamins, calcium gluconate, immunostimulants). If therapy is ineffective, or the disease progresses to an acute stage, the child should be hospitalized and the purulent focus should be drained.

For necrotizing lymphadenitis in children, it is necessary to perform curettage of the cavity, sometimes even requiring removal of the lymph node. During the rehabilitation period, anti-inflammatory and disinfectant drugs are prescribed. Specific tuberculous lymphadenitis in children is treated in specialized institutions.

Prevention and prognosis

With timely treatment of submandibular lymphadenitis, the prognosis is almost always favorable. When the disease becomes chronic, lymphoid tissue can be replaced by connective tissue, and a violation of lymph outflow in the affected area may develop. To never have problems with lymph nodes, it is enough to follow some simple rules.

Preventive measures against lymphadenitis:

Maintain good hygiene (hands, mouth).
Visit the dentist regularly to rule out caries, gingivitis, and fungal infections.
Avoid damage to the skin (cracks, wounds, scratches).
Treat all injuries with special means.

Prevention of lymphadenitis involves eliminating infections, timely treatment of teeth and injuries (skin and mucous membranes). It is also important to increase the general and local resistance of the body.

The cold weather has arrived, evil infections are circling the streets in search of tired adults and weakened children. In the humid, polluted street air, infectious agents, harmful substances, street dust allergens and gasoline combustion products penetrate every pedestrian almost every second. But there are sentinels in the body - lymph nodes, which are constantly on duty so as not to miss the enemy. The cervical lymph nodes are usually the first to be hit. Developing cervical lymphadenitis.

Characteristics of the disease

Lymphadenitis in general is an inflammation of the lymph nodes at the site of entry of an infectious agent or any pathogen that, upon entering the organ, is then carried into the lymph node by the lymph current. The pathogen may not be foreign; a reaction also occurs to one’s own cells that are mistaken for foreign: in autoimmune reactions, tumor diseases.

Activation occurs of leukocytes that are in a free state in the blood and mature in the lymph node. Due to the increased work of these immune cells, the lymph node enlarges, becomes noticeable, and painful to the touch, which does not happen in the normal state, since its size does not exceed 1-2 cm.

The inflammatory process is essentially a war in which immune cells fight the enemy tooth and nail. Externally noticeable changes in the lymph nodes are only its consequences.

Causes

Cervical lymphadenitis occurs when pathogens enter the body:

through the upper respiratory tract (nose, pharynx, larynx);
upper parts of the digestive tract (oral cavity, esophagus);
for infectious, autoimmune or tumor lesions of organs located in the neck, for example, the thyroid gland;
for lesions of the scalp and neck, including wound infections of these areas.

Classification of pathology

The classifications are arbitrary and are used for convenience. Cervical lymphadenitis (ICD-10 code: L04.0) is characterized by the localization of specific lymph nodes, which are located, like clusters, several pieces in areas between the muscles and organs, also located on the neck.

There are deep and superficial lymphadenitis of the neck.

External changes can be seen in the superficial lymph nodes. The deep ones are inaccessible for routine inspection and palpation.

Superficial lymph nodes include:

anterior cervical, responsible for the throat and thyroid gland; located along the front surface of the neck from the chin to the jugular fossa;
posterior cervical, located on the back of the head, along the back of the neck; their inflammation may indicate damage to the bronchi;
almond, located under the lower jaw, responsible for the tonsils and the back wall of the laryngopharynx;
submandibular, the most often detected, since they become inflamed in common diseases of the ENT organs (rhinitis, sinusitis, pharyngitis, otitis), tongue, salivary glands, dental infections (stomatitis, periodontitis); located along the lower jaw;
behind the ear, they are sometimes classified as a separate group, and sometimes as cervical nodes; become inflamed due to skin lesions in the area of the back of the head and crown;
chin, responsible for the condition of the cheeks, lower lip, teeth in this area;
supraclavicular, collect lymph from the lungs, esophagus, heart, and therefore their inflammation usually indicates a serious disease of these organs.

There is a classification of cervical lymph nodes according to the levels of their location, distinguishing 6 groups:

Level 1 – chin and submandibular;
Level 2 – upper jugular;
Level 3 – middle jugular;
Level 4 – lower jugular;
Level 5 – back group;
Level 6 – front group.

Such anatomical classifications are convenient for determining the location of the organ from which the pathogen entered the lymph node.
There is a division into non-odontogenic and odontogenic lymphadenitis of the neck, associated with their common cause in the form of dental damage in children, both primary and permanent.

Symptoms and signs

Symptoms of infectious lymphadenitis in children are usually nonspecific. The lymph node or nodes increase in size (to the size of a bean or more), become visible on the neck, sometimes with redness of the skin in the area of their round protrusion. To the touch, the skin here is hotter than usual, and the protruding lump itself is dense compared to neighboring tissues (infiltrate). Pain can be observed both at rest and when palpating an enlarged node or when moving the head, if the node is adjacent to the corresponding muscle. For example, when the submandibular nodes are affected due to pain, children may limit turning and tilting their head.

With purulent lymphadenitis in the neck, all the symptoms are more pronounced, the body temperature rises to feverish levels, the child’s condition suffers - he is apathetic or capricious, appetite is reduced.

On the contrary, inflammation of the lymph nodes of the neck is sluggish and long-lasting. The child is losing weight, has a cough, and the nodes are welded together.

With chronic inflammation of the cervical lymph nodes, they remain enlarged for a long time, but are not painful, are not welded together, and are mobile upon palpation.

Diagnostics

An experienced doctor can suggest the correct cause of inflammation of the cervical lymph nodes even by questioning the child’s parents and thoroughly examining him.

This will indicate to the doctor the following information:

what the child had been ill with shortly before the development of symptoms of lymphadenitis or continues to be ill at the present time, whether he traveled to countries where unusual infections occur;
what illnesses the child’s immediate environment suffers from;
how the child’s weight, appetite, and mood have changed recently;
what is his temperature?
what is the projection zone of the lymph nodes - the condition of the skin, its density, pain or painlessness, redness (hyperemia), mobility, adhesion to surrounding tissues;
is there any damage to other lymph nodes (, ulnar,);
are there any disturbances in swallowing and breathing, or voice timbre, which may indicate compression of the upper respiratory tract.

All this will help to suggest the localization, specific or nonspecific nature of the inflammation, its etiology - viral, bacterial, autoimmune, endocrine or tumor.

A clinical blood test is required, which, based on the number and ratio of leukocyte fractions, will tell whether the current inflammation is acute or chronic, viral or bacterial.

If a pathology of the thyroid gland is suspected, a blood test is prescribed to determine the level of hormones and antibodies to the gland tissue in order to confirm the autoimmune nature of the inflammation.

If the doctor assumes a tuberculous etiology of lymphadenitis, we need data on the Mantoux tests, Diaskintest, BCG vaccination, and radiography performed on the child.

If tumor lymphadenitis is suspected, an ultrasound examination of the lymph nodes of the neck and the organ suspected as the cause of inflammation, magnetic resonance imaging (MRI) of the lymph nodes and relevant organs can be performed. These two methods are not accompanied by radioactive radiation, therefore they are safe for the child.

If a malignant neoplasm is suspected, a lymph node biopsy is prescribed. This is an invasive method in which a small part of the node tissue is removed surgically or with a needle for microscopic and histological examination.

Possible complications and consequences

Acute infectious non-purulent lymphadenitis, which itself developed as a complication of a common respiratory viral infection, will usually go away once the underlying disease is cured.

One of the forms of tuberculosis (previously included in the concept of “scrofulosis”). The tuberculosis process most often affects the submandibular and cervical lymph nodes, located along the anterior edge of the sternocleidomastoid muscle and under it, which is associated with the penetration of tubercle bacilli through the mucous membrane of the mouth and nasopharynx.

Symptoms. Tuberculous cervical lymphadenitis occurs with mild general symptoms. Lymph nodes are usually affected on both sides. In the initial stages of the disease, dense, mobile, painless lymph nodes are detected in the submandibular region and along the sternocleidomastoid muscle. Subsequently, as a result of the transfer of inflammation to the membrane of the lymph nodes (periadenitis), the nodes are soldered into bags. In the center of the node, cheesy necrosis begins to form with the transition of inflammation to the surrounding tissue. Lymph nodes are fused to the skin located above them. A fluctuation may appear above this location. When the abscess is opened, a long-term non-healing fistula with characteristic crumbly pus is formed.

Diagnostics tuberculous lymphadenitis is based on the general principles of diagnosing tuberculosis, as well as data from microscopic examination of pus.

Differential diagnosis carried out with lymphosarcoma, lymphogranulomatosis, nonspecific lymphadenitis, lateral fistulas of the neck, metastases to the lymph nodes in malignant neoplasms. Nonspecific lymphadenitis is characterized by the presence of a specific source of the disease, an acute onset, and a pronounced temperature reaction. Lateral cysts and fistulas of the neck are characterized by the presence of an elastic formation without involvement of the lymph nodes in the process.

Treatment of tuberculous lymphadenitis. Local treatment of fistulas - according to the general principles of treatment of purulent wounds. Specific treatment of lymph node tuberculosis begins with the appointment of streptomycin, kanamycin or cycloserine.

Streptomycin sulfate is prescribed 0.5 ml 2 times a day intramuscularly for 2-3 days. In the future, the entire daily dose (1 g) can be administered once a day. Streptomycin is used in complex treatment with PAS and ftivazid. Streptomycin should not be used together with kanamycin due to the risk of enhancing their neurotoxic effect.

A specific drug for the treatment of tuberculous lymphadenitis is cycloserine. It can also be used with other anti-tuberculosis drugs - PASK, ftivazide, kanamycin. Cycloserine is used only internally. The initial dose is one tablet of 0.25 g. Every 2 days the dose is increased by 0.25 g. The full daily dose is 1 g. The drug is taken with food. The course of treatment is 1-2 months. You can take it for up to 8 months, as well as repeat the course. Cycloserine has a neurotoxic effect. To reduce side effects, the daily dose should not exceed 1 g. To prevent side effects of the drug, patients are prescribed glutamic acid 0.5 s 3-4 times a day, vitamin B6 0.02-0.05 g per day.

When caseous decay develops in the lymph nodes with pus breaking out and when fistulas do not heal for a long time, surgical treatment is indicated.

Clinic surgeon's directory. Kutushev F. Kh., Libov A. S. Michurin N. V., 1982

Tuberculous lymphadenitis is inflammation of the lymph nodes of a tuberculous nature - a manifestation of tuberculosis as a general disease of the body. More often, especially in childhood, the period of primary tuberculosis is combined with damage to the intrathoracic lymph nodes. Relatively isolated damage to certain groups of lymph nodes is possible (more often in adults) against the background of old inactive tuberculous changes in other organs, when tuberculous lymphadenitis manifests itself as secondary tuberculosis. The incidence of tuberculous lymphadenitis depends on the severity and prevalence of tuberculosis and social conditions. In children, tuberculous lesions of peripheral lymph nodes are detected in the presence of active forms of extrapulmonary tuberculosis.

The entry point for infection can be the tonsils, when they are damaged, the cervical or submandibular lymph nodes are involved in the process. Most often, the infection spreads through the lymphohematogenous route from affected intrathoracic lymph nodes, lungs or other organs.

There are three forms of tuberculous lymphadenitis: infiltrative, caseous (with and without fistulas) and indurative.

Clinical manifestations. With the acute onset of the disease, high body temperature, symptoms of tuberculosis intoxication, enlarged lymph nodes, often with pronounced inflammatory-necrotic changes and perifocal infiltration, are noted. A characteristic sign of tuberculous lymphadenitis, which distinguishes it from other lesions of the lymph nodes, is the presence of periadenitis: the affected lymph nodes are defined as a conglomerate of formations of various sizes welded together. In adults, more often than in children, the onset of the disease is gradual, with less enlargement of the lymph nodes and less frequent formation of fistulas due to the predominantly productive nature of the inflammation.

The most common lesions are the cervical, submandibular and axillary lymph nodes. Several groups of lymph nodes on one or both sides may be involved.

For diagnosis, in addition to clinical signs, a comprehensive examination of the patient taking into account anamnestic data is of great importance: the presence of contact with tuberculosis patients, the results of the reaction to tuberculin (the Mantoux reaction - in most cases it is pronounced), the presence of tuberculosis damage to the lungs and other organs. An important role in making a diagnosis is played by the data of a puncture biopsy of the affected lymph node. Calcium deposits can form in the nodes, which are detected radiographically in the form of dense shadows in the soft tissues of the neck, submandibular region, axillary and groin areas. Tuberculous lymphadenitis is differentiated from nonspecific purulent lymphadenitis, lymphogranulomatosis, metastases of malignant tumors, etc.

Treatment tuberculous lymphadenitis depends on the nature of the damage to the lymph nodes and the severity of changes in other organs. With an active process, first-line drugs are prescribed: antibiotics in combination with aminosalicylic acid or ethionamide, prothionamide, pyrazinamide, ethambutol. Treatment should be long-term - 8, 12 or 15 months. When a purulent process occurs, broad-spectrum antibiotics are prescribed. In case of caseous lesions of the lymph nodes, surgical intervention (lymphadenectomy, excision of fistulas) is indicated against the background of a general course of anti-tuberculosis therapy.

Actinomycosis

Actinomycosis (actinomycosis)- a specific infectious disease caused by actinomycetes (radiant fungus), characterized by the formation of drusen and dense infiltrates with progressive growth and chronic course.

Pathogenesis. Human infection occurs when the radiant fungus gets on the mucous membrane of the mouth, pharynx, intestines, bronchi when chewing or swallowing cereal grains, inhaling particles of cereals, hay, straw on which the fungus is located. Depending on the site of penetration, cervicofacial, intestinal or pulmonary forms of actinomycosis develop.

In response to the introduction of the fungus into the tissues, productive chronic inflammation occurs with the formation of a granuloma, characterized by woody density and progressive growth with the involvement of new tissues in the process. In the depths of the resulting infiltrate, foci of softening are determined, containing liquid pus and drusen of the fungus, which open to form tortuous fistulas or ulcers. Regional lymph nodes do not enlarge; only with the addition of a secondary purulent infection with the development of phlegmon and abscesses does regional lymphadenitis form. Germination of vascular infiltrates can lead to generalization of infection - specific actinomycotic sepsis.

Clinical manifestations. The most common (50%) localization of actinomycosis is the face and neck. Infiltrates are located in the area of the lower jaw and neck. The disease begins gradually, gradually, without acute phenomena. The earliest symptom is the reduction of the jaws, then compaction and swelling of the masticatory muscles appear; the subcutaneous tissue, skin, and sometimes bone are involved in the process. A very dense, immobile infiltrate is determined. During this period, it should be differentiated from tuberculous lymphadenitis and tumor. Gradually, the skin in the area of the angle of the lower jaw and neck is involved in the process. It acquires a blue-purple color; in this place, a woody-density infiltrate is palpated, fused with the skin and underlying tissues. Subsequently, multiple convoluted fistulas with purulent discharge appear in the area of infiltration. The pus is liquid, odorless, and contains small grains (fungal druses).

To clarify the diagnosis, pus is examined under a microscope or biopsies are taken from the skin, infiltrate, or lymph node. The detection of fungal drusen in pus or tissues clarifies the diagnosis of actinomycosis.

The most common localization of intestinal actinomycosis is the cecum and appendix; other parts of the large and small intestine are less commonly affected. The infiltrate covers the entire thickness of the intestine, grows into the peritoneum and abdominal wall. When the infiltrate disintegrates, ulcers form on the mucous membrane; the disintegrating infiltrate can open through the abdominal wall to the outside (with the formation of multiple purulent and sometimes fecal fistulas) or into neighboring organs: the bladder, kidney, retroperitoneal space. On palpation of the abdomen, the infiltrate is determined in the form of a very dense tumor-like formation, motionless as it grows into the abdominal wall or neighboring organs. The emerging tumor should be differentiated from the appendiceal infiltrate: the latter develops immediately after an attack of acute appendicitis and, under the influence of anti-inflammatory treatment, quickly undergoes regression.

Actinomycosis of the lung is characterized by the formation of a specific granuloma in the lung tissue. The dense infiltrate, growing, involves the parenchyma, pleura, bronchi, and pulmonary vessels in the process. It can grow into the pleura, chest wall, and spread to the diaphragm and mediastinum. The disintegration of the infiltrate leads to the formation of abscesses, cavities, and fistulas. Pus containing fungal drusen may be discharged with sputum when the infiltrate opens into the bronchus or outward (when the chest wall grows). The process lasts for months and even years and leads to severe pneumosclerosis.

According to the clinical course, actinomycosis of the lungs in the initial period resembles chronic bronchopneumonia, which is not amenable to antibacterial therapy. Differential diagnosis is carried out with a tumor, pulmonary tuberculosis. The presence of infiltrate in the lung is easily determined by X-ray examination. The use of X-ray methods, computed tomography, bronchoscopy, and clinical features (growth of infiltrate, its disintegration, lack of effect from antibacterial therapy) make it possible to exclude tuberculosis, lung cancer and make a diagnosis of actinomycosis. In advanced cases, when the process spreads to the chest wall with a clinical picture of skin lesions characteristic of actinomycosis, the diagnosis is beyond doubt. The detection of drusen in sputum, pus, and biopsy specimens obtained during broncho or thoracoscopy in case of involvement of the bronchi or pleura is extremely important.

For treatment For actinomycosis, iodine preparations (potassium iodide) are used in combination with radiotherapy. Actinomycosis of the face and neck is easy to treat, and the prognosis is favorable even in advanced forms. For actinomycosis of the intestines and lungs, similar conservative therapy is carried out. In the initial stages, the prognosis is favorable. If conservative therapy is unsuccessful, surgical treatment is indicated - resection of part of the intestine or lung in combination with conservative therapy. In advanced cases, with germination into other organs, development of severe purulent complications (purulent pleurisy, mediastinitis, retroperitoneal phlegmon), emergency palliative operations are performed - opening of the phlegmon, drainage of the mediastinum, pleural cavity.

The prognosis for advanced forms of actinomycosis of the lungs and intestines is unfavorable.

Anthrax

Anthrax (anthrax) Causes sporogenous anthrax (B. anthracis). The source of infection is animals infected with anthrax, usually sheep and cattle. Penetration of pathogens into the human body occurs when a person comes into contact with an animal that is sick or has died from anthrax, when cutting carcasses, processing leather, fur, or eating the meat of sick animals. Depending on the place of introduction of microorganisms, it develops intestinal(when eating contaminated meat) or pulmonary(due to inhalation of anthrax spores when working with fur or skin of a sick animal) form of the disease. Skin a form of anthrax occurs when microbial spores enter the skin in the presence of abrasions, abrasions, injections, or scratches. The transfer of microorganisms or their spores by flies cannot be ruled out.

The cutaneous form of the disease is important for surgical practice. It is manifested by the development of an anthrax carbuncle at the site of introduction of the pathogen. Most often, the carbuncle is localized on open parts of the body: face, head, neck (60%), hands (25%).

Clinical manifestations. After an incubation period (2-7 days), a small red nodule appears; after 1-2 days it turns into a vesicle with bluish-pinkish contents; swelling of the surrounding tissues is pronounced. After opening the vesicle, a thick, hard, black scab forms, and new bubbles appear around it. The swelling quickly increases, regional lymphadenitis, severe intoxication, high body temperature are added, and a copious amount of serous or bloody fluid is released from under the scab. After the scab is rejected, ulcers (one or more) are formed with a slight purulent discharge. Sometimes the patient’s general condition suffers little (in a localized form), but when the infection generalizes and sepsis develops, it becomes extremely severe.

Diagnosis established on the basis of the clinical picture of the disease and the results of bacteriological examination of the discharged bladder, scab, ulcer.

The cutaneous form of anthrax should be distinguished from the boil, carbuncle, and bubonic form of plague.

Treatment Patients with intestinal and pulmonary forms of anthrax are treated in the infectious diseases departments of the hospital. The prognosis is usually unfavorable. With the cutaneous form of anthrax, the mortality rate is 2-20%; the prognosis is especially unfavorable when the anthrax carbuncle is localized on the face and neck.

The patient should be provided with complete rest. An aseptic bandage is applied to the carbuncle. No active interventions (opening, excision of the carbuncle, removal of the scab) are unacceptable due to the risk of generalization of the infection.

Specific treatment includes the use of anti-anthrax serum in a dose of 50-150 ml with an interval of 2-3 days, broad-spectrum antibiotics (ciprofloxacin, benzylpenicillin, erythromycin), and chemotherapeutic agents.