泌尿生殖系放线菌病

　　1、发病原因

　　放线菌一般为散在发生，属于内源性疾病，并非传染病。放线菌寄生在正常人、牲畜或其他动物的龋齿、牙周脓肿内和扁桃体皱襞内。Slack培养100例切除的扁桃体中，25％有放线菌生长。Emmons直接检查扁桃体，其中47％有放线菌。当机体全身或局部抵抗力降低或口腔感染时，可由破损的口腔黏膜处感染到颌面部及颈部。也可由气管吸入而产生肺部及胸腔感染。也可经消化道导致结肠、腹部放线菌病，并可直接蔓延到肾、膀胱。也曾有报告由于尿道下裂手术而引发尿道放线菌病。由于腹部手术感染放线菌而侵犯到前列腺。

　　2、发病机制

　　放线菌感染的特殊性，是不受解剖学屏障的限制。如筋膜、胸膜、膈肌等均不能限制病变的发展。由一处病灶直接向其附近组织传播、蔓延与扩散，侵犯周围组织及器官。在极罕见的情况下，也可经血行播散，引起脑、内脏器官的感染。原发皮肤病变少见，多是由深部组织发病向外蔓延。直到皮肤上形成多发性脓肿或窦道。各窦道可以相通，并伸向附近深部器官。本病的特点，在脓液中可以见到黄白色颗粒，直径0.25～2mm，称为硫黄颗粒。极少数患者如有明显免疫缺陷或被感染的放线菌致病力较强时，则可引起严重的血行播散。

　　如发现放线菌而未予治疗，可发生全身性感染、放线菌脓肿、脑脓肿等，甚至因此而死亡。放线菌感染后期可致其下方骨膜炎及骨髓炎。腹部放线菌病，也可波及腹部其他脏器如胃、肝、肾等，或波及椎骨、卵巢及膀胱、胸腔或血行播散侵及中枢神经系统。胸部放线菌病，可伴胸膜黏连和胸腔积液亦可波及心包致心包炎。脑型放线菌病，局限型，尚可见压迫颈内动脉大脑中、前动脉近端变窄。弥漫型，也可呈硬膜外脓肿、颅骨骨髓炎等。皮肤型放线菌病，亦可侵入深部组织，局部因纤维化瘢痕形成而很硬。

　　有与牛，马或牧草接触史以及牧区工作史；有慢性消耗病史。

　　1、慢性化脓型

　　表现为尿频，尿急，尿痛；低热伴有贫血，消瘦，盗汗等，有时可在腰部形成窦道，有脓液流出。

　　2、增殖型

　　表现为肾区持续性钝痛或隐痛，有时可扪及肿大的肾脏。

　　由于本病是由于放线菌直接感染导致的，在身体抵抗力低下以及长期使用免疫抑制剂患者容易感染，故注意增加体育运动、注意个人卫生可减少放线菌的感染几率。

　　1、注意口腔卫生，尽早治疗牙齿、牙周、扁桃体疾病，避免由于局部感染后造成抵抗力下降，容易合并放线菌感染。

　　2、及时治疗呼吸道、消化道炎症、溃疡灶，以免形成慢性感染灶。

　　1、尿液检查

　　有少量红细胞，脓细胞，蛋白及管型，高倍镜下可见到革兰阳性“Y”形分枝菌。

　　2. Pus examination

　　Yellowish colony particles called 'sulfur particles' can be found in the pus drained from the sinus tract or the pus aspirated from the perinephric abscess, which are round or elliptical, with light color in the center, arranged in a radiating pattern. This is the most characteristic change of actinomycosis.

　　3. Imaging examination

　　Ultrasound or IVU shows kidney enlargement, pelvis deformation, pelvis destruction, similar to space-occupying lesions, and proliferative lesions show pelvis and calyces deformed like spider legs.

　　4. Histological examination

　　When it is difficult to differentiate the lesions, take living tissue for pathological examination, and at the same time, it should be differentiated from tumors or other infectious diseases of corresponding organs.

　　5. Cystoscopy

　　The mucosa inside the bladder is red and swollen, and there are chronic inflammatory changes such as congestion. The biopsy shows typical granular colonies, which can be diagnosed definitively.

　　1. What foods are good for the body in urinary and reproductive system actinomycosis

　　Pay attention to nutrition in diet, eat more light foods such as vegetables and fruits, and supplement necessary vitamins and trace elements, such as eating more cucumbers, bitter melon, and portulaca.

　　2. What foods should not be eaten for urinary and reproductive system actinomycosis

　　Try not to drink strong alcohol, eat刺激性 food, and avoid greasy, fried, moldy, and preserved foods.

　　Comprehensive treatment measures such as medication, surgery, and supportive therapy are often required. Especially for severe disseminated patients.

　　Firstly, Drug Treatment

　　1. Penicillin 2.4 million to 9.6 million U per day, intravenous infusion, for 2 consecutive months. It can also be intravenously injected with 1.6 million U every 3 hours, for a total of 30 days.

　　2. Clindamycin 0.6-1.2g per day, intravenous infusion or intramuscular injection, not more than 0.6g per intramuscular injection, and continuous medication for more than 2 months is required.

　　3. Oral doxycycline, 0.2g per day.

　　Secondly, Surgical Treatment

　　Firstly, incision and drainage of the abscess can be performed. If the contralateral renal function is good while the ipsilateral renal function is deteriorated, nephrectomy of the affected side can be performed. If sinus tracts form, they should be excised as well. Antibiotics should be used before and after surgery. When there is a mycetoma bladder fistula in the abdominal or pelvic cavity, surgical drainage of the abscess, removal of the focus, and closure of the bladder are required. Antibiotics should be used before and after surgery.