Inguinal lymphogranulomatosis (synonym: fourth venereal disease, Nicola-Favra disease) is a chronic infectious disease caused by a filtering virus. Transmitted mainly through sexual contact. In Russia, currently not found. The incubation period is from 10 to 25 days. The primary lesion is usually localized in the genital area, has the appearance of a papule, a bubble, erosion, and after a few days he heals independently, often unnoticed. After a few weeks or months, an inguinal lesion develops, later - femoral, pelvic lymph nodes (adenitis and periadenitis), accompanied by fever, enlargement of the spleen , leukocytosis. At the height of the development of the disease in the groin area , a lumpy, soldered to the skin, is formed, an extensive painful infiltration, in the thickness of which condensed nodes are felt, interspersed with areas of softening. Fistula openings and fistulous passages with purulent discharge, which heal in a few months or years, are visible at the site of the decayed and opened lymph nodes. As a result, a disorder of lymphatic circulation — lymphostasis — and elephantiasis associated with lymph stagnation, may gradually develop in the relevant areas.
Foci of tissue consolidation, ulceration and fistula, arising in the rectum and anus, lead to a narrowing of the intestine and cause intestinal obstruction (the so-called anorectal syndrome). In women, the vagina and external genital organs are more often affected, where progressive ulcerations and cicatricial changes develop, leading to the deformation of the clitoris , the labia majora and labia (esteemen). For the diagnosis of inguinal lymphogranulomatosis, Frey's positive reaction is important (intradermal administration of a vaccine prepared from the pus of unopened patient's bubo).
Lymphogranulomatosis inguinal [lymphogranulomatosis inguinalis; synonym: microadenitis inguinalis suppurativa (L.A. Sobolev), Nicola — Favra disease, fourth venereal disease] is a disease characterized by a peculiar lesion of the lymph nodes and transmitted mainly through sexual contact. In the USSR, inguinal lymphogranulomatosis is currently not registered.
Inguinal lymphogranulomatosis is caused by a filtering virus that forms elementary bodies and intracellular inclusions — Miyagawanella lymphogranuloma bodies. Tauruses are 1-4 microns in diameter and are usually arranged in groups. The virus is thermolabile, at 60 ° it dies within 30 minutes, without losing its antigenic properties.
Histologically in the affected lymph nodes diffuse inflammation is observed. Small irregular abscesses are found everywhere, surrounded by a belt of epithelioid cells. Sometimes there are giant Langhans cells, less often - cells that look like Sternberg cells. Plasma cells are abundant. For late lesions of inguinal lymphogranulomatosis (uro-genito-anorectal syndrome) is characterized by the presence of chronic inflammation. In the central part of the granuloma, necrosis can sometimes be detected.
Reinfection with inguinal lymphogranulomatosis is not observed. In the body of persons who have undergone inguinal lymphogranulomatosis, allergic alteration occurs, which persists for many years. This is evidenced by Frey's positive intradermal reaction with vaccination, for which pus collected during the puncture of a bubo of a patient with inguinal lymphogranulomatosis is diluted 3–5 times with saline and warmed 3 days for 1 hour at t ° 60 °. In positive cases, an inflammatory papule develops at the injection site of the vaccine. You can use a vaccine made from the brain tissue of mice infected with a virus, this reaction is very important to clarify the diagnosis.Go
From the moment of infection to the first manifestations of the disease it takes from 10 to 25 days, sometimes more. The primary lesion is in the form of papules, vesicles or erosion, which are more often localized to the genitals. The most characteristic of inguinal Hodgkin's disease is a lesion of the lymph nodes that occurs several weeks after the initial lesion (the second period of the disease). Initially, the patient has pain, fatigue, loss of appetite, fatigue, fever; temperature rises to 38–39 °; the spleen increases, leukocytosis increases to 10,000. Then the regional lymph nodes increase. Due to the fact that the disease is usually transmitted sexually, the inguinal, femoral, and then the iliac and pelvic lymph nodes are usually enlarged. The skin over the affected nodes acquires a bluish color. Soon, in the enlarged lymph nodes, foci of fluctuation appear, the skin over which becomes thinner and perforated with the release of viscous yellowish-green pus. The resulting fistulous passages are not prone to spontaneous healing. The remaining cicatricial changes, as well as changes in the affected lymph nodes, are often accompanied by a persistent violation of lymphatic circulation and lymphostasis in the respective areas; consequently, with the gradual progression of the disease, elephantiasis may develop with the appearance of ulcerations and fistulas in the uro-genito-anorectal region - the third period of the disease (E. K .; Alexandrov). Scars can cause stricture of the rectum up to its obstruction.
The forecast should be set carefully. The disease is severe, difficult to treat and can lead to severe complications.
Treatment. Sulfonamides, antibiotics (biomitsin, chloramphenicol, streptomycin, penicillin), use antimony preparations - an infusion of 1% solution of Stibium kalio-tartaricum. Surgical treatment method - excision of the affected lymph nodes, recommended by some authors, threatens with severe violations of lymphatic drainage and the development of elephantiasis of the genitals. Unconditional indication for surgery is stricture of the anus and rectum. In these cases, excision of scars with plastic replacement of the resulting defects of the mucous membrane is necessary.
Prevention . In case of occurrence of the disease, it is necessary to conduct the full range of dispensary measures