What Is Lymphomatoid Granulomatosis?
The primary lesions of the disease in the genital area are generally difficult to detect due to mild symptoms, and they are not detected until the appearance of lymph nodes in the groin or in women with advanced genital, anal, rectal abscess, ulceration, or stenosis syndrome. Lymphogranuloma occurs in tropical and subtropical regions. In developed countries, it is mostly transmitted by tourists or homosexuals from tropical regions, and no report has been reported in our country. However, with the increase in international exchanges and the increase in the incidence of sexually transmitted diseases, it will inevitably occur in the future and should be vigilant. The pathogen of lymphogranuloma is Chlamydia lymphoma.
Lymphogranuloma
- STD lymphogranuloma is also called inguinal lymphogranuloma or fourth sexually transmitted disease, and syphilis, gonorrhea, and soft chancre are collectively referred to as classic sexually transmitted diseases. Lymphogranuloma is also called inguinal lymphogranuloma or fourth sexually transmitted disease, and syphilis, gonorrhea, and soft chancre are collectively referred to as classical sexually transmitted diseases. Lymphogranuloma is an infectious disease caused by unclean sex. It is mainly transmitted through sexual contact. Occasionally, it is caused by pollutants (such as primary damage such as reproductive organ skin, mucosal pustules, ulcers, ulcerated lymph nodes and Rectal ulcer fluid contamination) and infection.
Overview of lymphogranuloma
- The primary lesions of the disease in the genital area are generally difficult to detect due to mild symptoms, and they are not detected until the appearance of lymph nodes in the groin or in women with advanced genital, anal, rectal abscess, ulceration, or stenosis syndrome. Lymphogranuloma occurs in tropical and subtropical regions. In developed countries, it is mostly transmitted by tourists or homosexuals from tropical regions, and no report has been reported in our country. However, with the increase in international exchanges and the increase in the incidence of sexually transmitted diseases, it will inevitably occur in the future and should be vigilant. The pathogen of lymphogranuloma is Chlamydia lymphoma.
Lymphogranuloma transmission
- STD lymphogranuloma is an infectious disease caused by unclean sex. It is mainly transmitted through sexual contact. Occasionally, it is caused by pollutants (such as primary damage such as reproductive organ skin, mucosal pustules, ulcers, ulcerated lymph nodes And rectal ulcer discharge). The primary lesions of the disease in the genital area are generally difficult to detect due to mild symptoms, and they are not detected until the appearance of lymph nodes in the groin or in women with advanced genital, anal, rectal abscess, ulceration, or stenosis syndrome. STD lymphogranuloma occurs in tropical and subtropical areas. In developed countries, it is mostly transmitted by tourists or homosexuals from tropical regions, and no report has been reported in our country. However, with the increase in international exchanges and the increase in the incidence of sexually transmitted diseases, it will inevitably occur in the future and should be vigilant. The pathogen of STD lymphogranuloma is STD lymphogranuloma Chlamydia.
- In 1935, Miyagawa and others took smears from local lesions, and took liquid smears from monkey brains, spinal cords, testes, and lymph nodes of experimental animals for Giemsa staining. They all found deep sky blue bodies, called Miyagawa. Body. In the 1960s, the pathogen was studied through electron microscope observation and cell culture. The results showed that the body had similar characteristics with the trachoma and parrot fever pathogens. It was different from the typical virus and was named Chlamydia. The Chlamydia spp. Is relatively stable outside human body and can maintain viability for 2-3 days.
- Venereal lymphogranuloma
Main manifestations of lymphogranuloma
- What are the symptoms of venereal lymphogranuloma? After suffering from venereal lymphogranuloma, it is mainly manifested as inguinal lymph node swelling and purulent development, which can lead to many serious complications. Among them, rectal stenosis is most common, especially in women. If the lesion occurs in the urethra, it can be accompanied by urethral stricture; if it occurs in the vagina, it can cause vaginal stricture, and it can also cause severe damage such as the passage formed by the perforation between the vagina and rectum (medically called fistula) and vulvar damage damage. Defective genitals can also become cancerous.
Lymphogranuloma clinical staging
- STD lymphogranuloma does not start with these serious lesions. In clinical terms, according to the development of the disease, it can be divided into early stages (infection, primary damage and skin damage), and second stage (lymphatic dissemination, accompanied by systemic symptoms). ) And Phase III (late).
Early Lymphogranuloma
- The lesions were inguinal lymph nodes and genital and anorectal stages. The incubation period is 1-4 weeks or longer. (1) About 1/3 to 1/2 of male patients with primary damage have primary damage, and most of them do not attract attention. Primary damage is manifested by a single small pimples or small blister on the genitals, followed by erosion and the formation of ulcers. The edges of the damage are neat, there are redness around it, and it is not painful or itchy. Men mostly occur in the coronary sulcus, foreskin, penis, glans, and urethra. Oral sex can also occur in the buccal mucosa. Women occur around the labia, the labia minora, the vagina, or around the urethra. The primary damage is usually painless, which lasts for 1 to 3 weeks and subsides without scarring. (2) 3 to 6 weeks after lymphadenopathy infection, and 1 to 3 weeks after the occurrence of primary damage, local lymphadenopathy occurs. Inguinal lymph nodes are mainly involved. About 2/3 of the cases are unilateral and the other 1/3 are bilateral. The nodules are infiltrating and hard, the skin is red or purplish red, and there are wrinkles, which are arranged like sausages along the groin. With the progress of the disease, the lymph nodes on both sides of the inguinal ligament are enlarged in a "groove" shape, which is called "groove sign". About two-thirds of the nodules can rupture and form multiple fistulas, which look like a "watering can" and have a pale yellow serous or bloody pus overflow. About 1/4 of the nodules are not broken, and can be naturally absorbed within 8-12 weeks. A few nodules become persistent sclerotic masses. Femoral and iliac lymph nodes can also be involved in men, and iliac and perirectal lymph nodes can be involved in women. Clitoral and labial lesions can communicate with inguinal lymph nodes. Patients with abnormal sex may involve lymph nodes in other parts. If there is oral genital sex with the infected person, swollen jaw lymph nodes may occur, which is easy to consider as lymphoma or Hodgkin's disease. (3) Proctitis Homosexuals or people with perverted libido can manifest as hemorrhagic proctitis (purulent discharge and intestinal filling} bleeding). Direct examination reveals inflammation, hyperemia, localized exfoliation, or granulation tissue of the rectal mucosa, which can lead to abscesses, rectal vaginal fistulas, and rectal strictures.
Lymphogranuloma secondary disease
- This disease is a systemic disease. When lymph node disease occurs, systemic symptoms such as fever, night sweats, general discomfort, weight loss, headache, migraine arthritis, polyarthritis, myalgia, liver and splenomegaly, false Meningitis and conjunctivitis. Skin manifestations include erythema polymorpha, nodular erythema, scarlet fever-like rash, pimples, pustular lesions, and photosensitivity. Genital anorectal syndrome can occur in sick women and gay men. The early stage of this syndrome is caused by direct vaccination or ulcerative lymphadenitis around the rectum, anal and rectal mucosa edema, bleeding, and shedding, with diarrhea, acute exacerbation, abdominal pain, and alternating constipation. Tube-like or ring-shaped rectal strictures occur near the anal ring at an advanced stage, rectal vaginal and / or anal fistulas, and perirectal abscesses can also occur. Rubber-like swelling and ulceration can occur in the penis, scrotum, and vulva. Oral genital intercourse can cause ulcerative glossitis and lymphadenopathy. There is also cancer in advanced stages.
() Lymphogranuloma stage III (late stage) lesions
- Mainly manifested as systemic weakness and local destruction, mostly due to rectal stenosis and lymphatic circulation disorders. Men sometimes experience urethral fistulas and genital edema. Labia ulcers can occur in women, and the surrounding edema and fibrotic sclerosis are called vulvar sores, also known as vaginal anorectal syndrome. Women are more frequent because of the anatomy of the lymphatic system of the female pelvis. There are two types of vulvar sores, and in female cases, these two types of disease occur in a mixed manner. (1) Vulvar Syndrome Due to long-term lymphatic reflux disorder and ulcer formation, the skin and mucous membranes of the vulva are enlarged and hardened, like rubber disease, and the labia are swollen. And there are many polyps of different sizes and tumor-like hyperplasia. In addition, there are similar lesions in the vaginal opening, vaginal wall and cervix, and even narrowing of the outer urethra. If an abscess occurs deep, fistulas can form between the urethra, vagina, and rectum. This type is extremely rare in men, but can develop scrotum and penile rubber disease. (2) The primary focus of anorectal syndrome is superficial ulcer of the anorectal mucosa. Lesions in the anus such as hemorrhoid-like bulges or fistulas. Ulceration and sclerosis of the edge of the rectum can occur, and pus, blood, and diarrhea can be seen clinically. Rectal strictures can occur 1-2 years after infection. Rectal strictures are more common in women than in men. Disorders of lymphatic circulation in the lower rectum can lead to perianal lymphangiectasis and are easily misdiagnosed as hemorrhoids. Stenosis can occur above the mouth of the rectum, forming an annular band, or a few centimeters of tubular constriction in the lower rectum, accompanied by marked hypertrophy and fibrosis of the bowel wall. The course of the second and third stages is extremely slow, often unhealed for many years.
Lymphogranuloma diagnosis
- Which diseases are easily confused with the diagnosis of this disease is mainly based on contact history, clinical manifestations and laboratory tests.
Lymphogranulomatous complement binding test
- It is an important serological diagnosis method for this disease. It can detect two kinds of antibodies: Chlamydia trachomatis antibody and Chlamydia psittaci antibody. Because chlamydia infections are common in the population, a positive test can help diagnose, but the results cannot be used to determine the diagnosis. Patients had high serum titers, mostly 1:64 or more, and had low serum titers when infected with C. trachomatis conjunctivitis (1: 16--1: 32). Generally speaking, the serum titer of 1: 8 or 1: 6 in this test is suggestive for the diagnosis of the disease, but 1:64 or more is of diagnostic significance. The serum titer of patients in the recovery period decreased. In addition, the results of serum tests are not completely parallel to the response to antibiotic treatment.
Lymphogranulomatous microimmunofluorescence test
- It can detect different serotypes of chlamydia-specific antibodies, which is more sensitive and specific than the complement binding test. However, due to the limitation of the test conditions, it is currently difficult to be widely used.
Lymphogranuloma pathogen culture
- It is advisable to take a swollen lymph node puncture and inoculate the yolk sac of chicken embryos, or do tissue (cell) culture or intracranial inoculation of mice. Positive people have diagnostic value. Bacterial culture and smear Gram staining are also required to exclude lymph node inflammation caused by staphylococci or other bacteria.
Lymphogranuloma biopsy
- Take the skin, mucosal lesions or lymph nodes to make slices, and observe the pathological changes, which is helpful for diagnosis.
Lymphogranuloma other
- May have hyper-globulinemia, albumin / globulin ratio inversion, increased lgA, lgG, mild anemia, leukocytosis, accelerated erythrocyte sedimentation, false positive for syphilis serum test, positive for cryoglobulin and rheumatoid factor. The disease develops to different stages and should be distinguished from different diseases. Early stage should be distinguished from the following diseases: early syphilis, genital herpes, soft chancre, groin granuloma, and other primary or secondary infections. In the presence of lymphadenopathy, in addition to identifying these diseases, malignant tumors (lymphoma, metastatic cancer) and other infectious diseases such as feline scratch disease, tuberculosis, mononucleosis, and tularemia should be considered. Advanced anorectal lesions should be distinguished from inguinal granulomas, hemorrhoids, genital warts, suppurative sweat glanditis, ulcerative and inflammatory colon diseases, filariasis, and anal and rectal cancer.
Lymphogranuloma Treatment
- The earlier the treatment of venereal lymphogranuloma is, the better the systemic symptoms can disappear quickly after the initial patient's medication, but the healing of local lymphadenopathy is limited. Treatment is difficult after severe complications in the later stages, and often require surgery. Treatment methods include systemic treatment and local treatment. Systemic treatment is mainly the timely application of antibacterial drugs. The commonly used medicine hands are: 0.5 grams of tetracycline, once every 6 hours, and even take 3-4 weeks. Sulfadiazole, the first dose of 4.0 grams, and then 1.0 grams every 6 hours for 3 weeks. Pregnant women and children can choose erythromycin, adults 0.5 grams, every 6 hours, even for 20 days. Advanced patients can use hormonal or antibiotics combined with corticosteroids (prednisone), which can reduce lower abdominal pain, reduce rectal secretions and reduce fibrosis. For local treatment, the vulva can be washed with potassium permanganate water externally, and 10% fishstone fat ointment or erythromycin and sulfonamide ointment can be applied to those who have not purged. Those with softened lymph nodes (abscesses) can pierce the lesion to attract the pus, and inject the sulfa solution into the pus cavity. Do not perform an incision, because it is not easy to heal. For those who have vaginal or rectal stenosis in the late stage, dilation must be performed regularly. Severe rectal stenosis requires a rectal resection. Foreskin and scrotal rubber swelling can also be removed by surgery. Local lesions can also be treated with physical therapy such as ultrasound, ultraviolet, infrared, or X-rays.
Early clinical features of lymphogranuloma
- The clinical manifestations of early STDs are hard chancre and lymphadenopathy of all genera. Hard chancre appears about 3 weeks after infection with Treponema pallidum, and the first invaded sites, such as the glans of the male, foreskin, coronary sulcus, labia, clitoris, The vaginal opening and other places. Appears erythema, gradually becomes induration, and the color changes to purple-red or copper-red, which is as hard as nasal bone, without pain and itching. The indurated surface gradually eroded, and finally formed an ulcer, about 1 cm in size, mostly round in shape, with neat edges, flat sores, and a small amount of serous secretions on the surface, which contained a large number of spirochaetes and was highly infectious.
- In addition to the genital area, individual hard chancres can occur on the lips, fingers, breasts, eyelids, and anus. If they are not cured, they will subside naturally after one month, leaving a shallow scar or pigmentation.
- 1 to 2 weeks after the occurrence of hard chancre, nearby lymph nodes became swollen, mostly bilateral, with a large number, which was hard to touch, but without tenderness, ulcers, or ulceration. The enlarged lymph nodes resolve later than the hard chancre, which takes about a few months.
- If early STDs can be diagnosed and treated in a timely manner, the disease can be quickly and completely cured, otherwise the harm will be endless.
Lymphogranuloma Western Medicine Treatment
- The earlier the treatment of venereal lymphogranuloma, the better. After initial medication, systemic symptoms can quickly disappear but the healing of local lymphadenopathy is limited. Treatment is difficult after severe complications in the later stages, and often require surgery. Treatment methods include systemic treatment and local treatment. Systemic treatment is mainly the timely application of antibacterial drugs.
Lymphogranuloma drug treatment
- 1. Doxycycline:
- 0.1g each time, twice a day for 21 days.
- Lymph node aspirate
- 500mg 4 times a day for 21-28 days. Tetracycline is effective in the acute phase, which can stop the development of the medium, or heal in a few weeks.
- 3. Erythromycin: 500mg, 4 times a day for 14-21 days. Pregnant women and children can choose erythromycin.
- 4. Compound Xinnuoming: start 2 times a day, 2g each time, 1g each time, even for 3 weeks. The alternative therapy is doxycycline.
- 5. Sulfadiazole, the first dose of 4.0 grams, and then 1.0 grams every 6 hours, for 3 weeks.
- Advanced patients can use hormonal or antibiotics combined with corticosteroids (prednisone), which can reduce lower abdominal pain, reduce rectal secretions and reduce fibrosis.
Local treatment of lymphogranuloma
- External application of potassium permanganate water can be used to clean the vulva. For those who have not purged, apply 10% fishstone fat ointment or use erythromycin and sulfonamide ointment. Those with softened lymph nodes (abscesses) can pierce the lesion to attract the pus, and inject the sulfa solution into the pus cavity. Do not perform an incision, because it is not easy to heal. For those who have been purulent, puncture and pus may be taken, and antibiotics may be injected. Drainage may not be opened to prevent fistula formation and adverse healing. For those with deep ulcers, surgical treatment is available to remove necrotic lymph nodes. For those who have vaginal or rectal stenosis in the late stage, dilation must be performed regularly. Severe rectal stenosis requires a rectal resection. Foreskin and scrotal rubber swelling can also be removed by surgery. Local lesions can also be treated with physical therapy such as ultrasound, ultraviolet, infrared, or X-rays.
Lymphogranuloma in Traditional Chinese Medicine
- According to clinical symptoms, traditional Chinese medicine often divides the disease into three types of treatments, namely, damp-heat syndrome, which is mainly seen in the disease; sputum accumulation syndrome, which is seen in the middle of the disease; liver and kidney deficiency, which is seen in the later stage of the disease.
Lymphogranuloma TCM etiology and pathogenesis
- The pathogenesis of traditional Chinese medicine for STD lymphogranuloma: (1) Initially, it is unclean sexual intercourse poisoning, hot and humid betting, interfering with genital parts, fighting with qi and blood, forming fish mouth or stool poison. (2) After the heat poisoning, the poison heat gathers the liver meridian, the liver qi stagnates, the qi stagnates the spleen, the spleen loses health, the sputum is endogenous, and it stagnates in the femoral palate to form the diaphragm. (3) In the later stage of the disease, the liver stagnates and dispels fire, hurts the kidney and yin, and if the prolonged period of time, the pus drips and does not close for a long time.
Lymphogranulomatous damp heat syndrome
- STD lymphogranuloma shows papules or blisters on the genitals, or surface erosion with exudate. May be accompanied by fever, poor appetite, red tongue, yellow tongue coating, and slippery pulses. This is because the damp and hot poisoning invades the liver veins, and the liver veins and meridians run around the genitals. Therefore, genital pimples or blisters, or surface erosion, exudation, accompanied by fever, poor appetite, red tongue, yellow tongue coating, and veins. The slippage numbers are the clinical manifestations of damp heat pinch. Treatment should be Qingre Lishi detoxification. Recipes are commonly used: Cork 10g, Atractylodes 10g, Coix seed 30g, Psyllium seed 10g, Poria cocos 30g, and dandelion 30g. The prescriptions of Huangbai and Atractylodes macrocephala are heat-clearing and damp-drying. Coix seed and psyllium are combined with the main medicines to clear away heat and dampness, and Poria cocos and dandelion clear heat and detoxify. For those who are hot and humid, 10 g of gentian can be added. For those who are poisonous and hot, 10 g of wild chrysanthemum can be added.
Symptomatic accumulation of lymphogranuloma and sputum
- Symptoms of lymphogranuloma, swollen inguinal lymph nodes, skin and nucleus connected, and some tuberculosis merged with each other, pushed forward, conscious pain, red tongue, yellow tongue coating, slippery pulse strings. This is caused by accumulation of phlegm and qi and blood stasis. Treatment should be Shugan Jieyu, Ruanjian Sanjie. Recipe: Chai 10g Angelica 10g Baiji 10g Atractylodes 10g Poria 20g Black ginseng 20g Calcined oyster 30g (fried first) Fritillaria edulis 10g Xiangfu 10g Chenpi 10g White silkworm 10g Green peel 10g Pinellia oleracea 6g. Fangzhong Bupleurum is used as medicine to relieve liver and stagnation; Angelica sinensis, Paeonia lactiflora nourishes and softens liver, Atractylodes chinensis, Poria spleen and spleen and dampness; Xuanshen, Calcined oyster, and Fritillaria cirrhosa are soft and loose; Xiangfu, Chenpi, Baixian silkworm , Qingpi, Pinellia ternata and Licorice all cooperate with the main medicine to regulate qi and reduce phlegm. For Yin deficiency, add 10g each of raw land and A. ginseng; for liver and fire, add 10g each of Huang Zhi and Qing Dai.
Lymphogranuloma liver and kidney deficiency syndrome
- STD lymphogranuloma, symptoms of rupture of the epidermal nucleus, unhealed for a long time, hot flashes, bone steaming, less complexion, mental fatigue, dizziness, shortness of breath, hot hands and feet, red tongue, less moss, pulse count. This is due to lack of liver and kidneys, caused by fiery fire. Treatment should nourish liver and kidney. Recipe: 10g of Rehmannia glutinosa, 10g of Yam, 10g of Yam, 10g of Poria, 10g of Poria, 10g of Danpi, 10g of Ophiopogon japonicus, 10g of Radix Ginseng, 10g of Chenpi, 10g of Licorice. Fang Zhong cooked with Dihuang, Shanshen, and Yam are the main medicines to nourish the liver and kidney yin; Zexie, Poria, Danpi are combined with the main medicine, which has more than diarrhea. Licorice tones the spleen and stomach. Add 10g pangolin to those who can't penetrate the pus, and add 10g dandelion to those who are poisonous and hot.
Lymphatic granuloma medicinal solution
- For the treatment of STD lymphogranuloma by external medicine, according to its different clinical stages, different drugs are commonly used and different treatment methods are applied. Generally speaking, it is advisable to wash the affected area with medicinal solution in the early stage, and to dissolve and detoxify with ointment in the middle stage, and to saprophytic muscle in the later stage with elixir or ointment.
Lymphogranuloma
- (1) 10g of dandelion, 10g of wild chrysanthemum, 10g of sky sunflower seed, 10g of black ginseng, 10g of Fritillaria chuanxiong. Decoction daily
- 1 time. Function of clearing heat and detoxifying, soft and firm. ("Modern Chinese and Western Medical Dermatology")
- (2) Stir-fried white silkworm 9g, angelica 9g, raw rhubarb 9g, licorice 4.5g, pangolin 4.5g, finely ground, and 9-12g of fasting wine. (Yang Dianxing and other "Practical Traditional Chinese Medicine STD")
- (3) Nine-headed lion grass 3g, Chuan Fritillaria 9g, decoction. (Yang Dianxing and other "Practical Traditional Chinese Medicine STD")
- (4) Liu Dan paste: Collect 5 kg of fresh willow leaves, boil it with water for 2 hours, remove the residue, and concentrate the filtrate to paste. Zhangdan 30g, plum slices 6g, realgar 10g, calcined keel 10g, catechin 10g, pearl 3g, light powder 6g, rosin 10g, calamine 10g, finely ground together, mix thoroughly with willow paste, and store in a bottle for later use. (Yang Dianxing and other "Practical Traditional Chinese Medicine")
- (5) Fresh purple peel garlic 250g, fresh ginger 250g, washed with cold water, sliced, mixed into a sterilization container and smashed, add an appropriate amount of 95% alcohol, stir to make a paste, sealed, and immerse in a cool place for 3 to 5 hours , Filter with sterile gauze, ready to use.