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Infectious diseases. Inguinal lymphogranulomatosis (most important)

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49. Inguinal lymphogranulomatosis

Inguinal lymphogranulomatosis is an infectious disease caused by chlamydia, sexually transmitted, manifested by an ulcer at the site of the pathogen, regional lymphadenitis with suppuration and scarring. Children usually get sick after contact with an adult patient.

Epidemiology. The disease occurs mainly in countries with tropical and subtropical climates.

Pathology. The primary lesion is an ulcer localized in the vulva. The most characteristic changes develop in the regional lymph nodes, which increase, solder to each other, and then melt, resulting in the formation of irregularly shaped abscesses.

Clinical manifestations. The incubation period is 3-30 days in cases where the primary ulcer is considered the end of it at the site of penetration of the pathogen.

The primary lesion has the appearance of a small erosion, pustule or papule, but often goes unnoticed due to asymptomatic and small size. Secondary lesions develop 1 week to 1 month after the primary lesion and represent the most characteristic symptom of the disease.

Lymph nodes are initially dense, elastic and mobile, but then solder.

The skin above them turns red, becomes cyanotic, flaky and thinner. Soon, fistulas open in these areas, functioning for many weeks and months.

Inguinal lymphogranulomatosis is accompanied by general malaise, fever, headaches, anorexia, etc. Sometimes meningoencephalitis develops, and the pathogen is determined in the cerebrospinal fluid.

The number of leukocytes and ESR are often elevated, there is a slight anemia, a decrease in albumin, an increase in globulins, and an increase in liver enzymes.

Diagnosis and differential diagnosis. The disease is diagnosed on the basis of the presence of a primary lesion, regional lymphadenitis in the inguinal region, proctitis.

The diagnosis is confirmed by the detection of the pathogen in the contents of the suppurating lymph nodes or the discharge of fistulas, the isolation of the pathogen in the cultures of developing chicken embryos and cultured cells, the identification of group- and species-specific antibodies, etc.

Treatment. Antibiotics of the erythromycin and tetracycline groups, as well as levomycetin, etc. are effective. Sulfanilamide preparations are prescribed for a period of 3-4 weeks. With severe cicatricial changes and strictures, lidase is prescribed by electrophoresis on the affected area, injections of aloe, vitreous body, etc. In severe cases, they resort to surgical treatment.

Prevention. All measures taken to prevent sexually transmitted diseases are also effective against inguinal lymphogranulomatosis. There are no vaccines.

Author: Pavlova N.V.

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