Introduction to amebic vaginitis
Amoebic vaginitis (amebicvaginitis) is directly infected by the amoebic pathogen with the stool after infection of the vulva or vagina. The amoeba pathogen directly invades the vagina, but if the systemic condition is poor or the vaginal mucosal epithelial cells are damaged, Miba trophozoites can invade the site of injury and cause inflammation. After the protozoa invades the vaginal mucosa, it relies on its pseudopod and its secreted tissue lytic enzyme to cause mucosal necrosis and ulceration. The lesions of patients with low body resistance can also invade the vulva, cervix and endometrium.basic knowledge
Sickness ratio: 0.0001%
Susceptible people: good for young women
Mode of infection: contact spread
Complications: shock, peritonitis, diarrhea, abdominal pain
The cause of amebic vaginitis
(1) Causes of the disease
You can get infected by drinking water and food contaminated by cysts. After infection with amoeba, not all of them are affected. According to the body's resistance, the number of trophozoites and the virulence of the strains, the disease is determined. Most of the babies come from trophozoites in the intestines of the body, and very few are transmitted through sexual contact.
The amoeba that is pathogenic to the human body is the amoeba, which has two phases of life cycle, nourishing the body and encapsulating period. The trophozoite can cause damage to the body tissues, and the cysts cause the body and the body. Inter-infection, human and animal rarely cause infection, amoeba invades the genital mucosa, relies on the tissue secreted by the enzyme to dissolve the enzyme, dissolve the surrounding tissue to damage the mucosa, ulcer formation, and the virulence of the strain can also Invading the submucosal tissue, the ulcer caused by it is larger and deeper. The scar is often left after the healing. The lesion is partially filled with yellow-brown necrotic material and cell debris, mucus, red blood cells and white blood cells. There are lymphocytes and a few plasma cells infiltrated around the lesion. .
Amoebic vaginitis prevention
To prevent amebic vaginitis: first of all, pay attention to personal hygiene and food hygiene, wash hands before and after meals, and then keep the vulva clean, prevent feces from continuing to contaminate the vulva and vagina, so as not to contaminate the amoebic trophozoites; Disinfection, isolation, prohibition of sexual life, after the onset, timely diagnosis and treatment.
Complications of amebic vaginitis Complications, shock, peritonitis, diarrhea, abdominal pain
Amebic vaginitis is secondary to intestinal infections. The main complications are intestinal complications and extraintestinal complications of amoebic dysentery.
(1) intestinal complications:
1 intestinal bleeding: intestinal wall ulcer involving blood vessels, can cause intestinal bleeding, the amount of bleeding varies, patients with bleeding often appear pale, pulse breakdown and blood pressure and other hemorrhagic shock performance.
2 intestinal perforation: more common in fulminant, perforation site is more common in the cecum, appendix and ascending colon, acute perforation can cause diffuse peritonitis, severe condition, chronic perforation caused by adhesion of surrounding tissue, the formation of local abscess.
3 appendicitis: amoebic appendicitis symptoms similar to common appendicitis, easy to form abscess, if there is chronic diarrhea or amoebic disease history, the discovery of amoebic trophozoites or cysts in the stool, it will help the differential diagnosis.
4 non-dysentery colonic lesions: caused by proliferative lesions, including amoebic tumors, intestinal amoebic granulomas and fibrous stenosis, amoebic tumors are inflammatory pseudotumors of the large intestine wall, with abdominal pain and Fecal habits change most, some with intermittent dysentery, can induce intussusception and intestinal obstruction, the main signs are: right ankle and movable, smooth goose oval or intestinal curved mass, see the place on the X line Sexual lesions have a good effect against amebic treatment.
(2) Extraintestinal complications:
Amoeba trophozoites can spread from the intestine through the blood? Lymphatic spread to distant organs and cause various parenteral complications, such as liver, lung, pleura, pericardium, brain, peritoneum and genitourinary tract, forming an abscess or ulcer. Among them, liver abscess is the most common.
Amoebic vaginitis symptoms common symptoms increased vaginal discharge, pruritus and diarrhea
The vaginal secretions are serous or mucinous, from which large trophozoites can be found. When the vaginal mucosa forms ulcers, the secretions can be converted into purulent or bloody, sometimes the crisp ulcers can appear in the cervix, vulva, fusion. Large pieces of necrosis, individual cases due to connective tissue reaction, can present irregular tumor-like hyperplasia, hard, ulcer surface covered with bloody mucus secretions, easily misdiagnosed as malignant tumors.
Examination of amebic vaginitis
1. Direct observation of the wet saline of the vaginal secretions under the microscope was observed directly under the microscope, and the amoeba trophozoites were observed.
2. Vaginal and cervical secretions for amoeba protozoa culture and culture method: clinically highly suspected, and the above two methods are negative, vaginal and cervical secretions can be used for culture, but amoebic culture requires higher conditions and more complicated techniques. General hospitals are more difficult to do.
Tissue biopsy: Live tissue was taken at the edge of the ulcer for pathological section, and amoeba trophozoites were seen.
Diagnosis and differentiation of amebic vaginitis
Because the disease is rare, it is sometimes ignored by clinicians, but according to the history of diarrhea or sputum disease and related tests, a diagnosis can be made. The most reliable diagnosis is to find the amoebic nourishment from the vaginal secretions (while checking the patient's stool). Body, direct smear method or culture method can be used to find the endogenous entamoeba histolylica protozoa, as well as the pathological examination of the lesions, and the case of chronic vaginal ulcers with negative secretion examination should be done biopsy.
(1) Differential diagnosis of leucorrhea:
The main clinical manifestations of trichomonas vaginitis are increased self-contained and genital itching, which should be identified with the following diseases:
1. Fungal vaginitis:
Patients with vaginal discharge, genital itching and trichomonas vaginitis symptoms are very similar, but the leucorrhea is mostly curd or bean dregs, without foam, vaginal mucosa with a white membrane, the lower mucosa often redness, vagina A secretion examination can confirm the diagnosis.
2. Non-specific vaginitis:
For vaginal injury, long-term uterine bleeding, pelvic inflammatory disease, etc., the main clinical symptoms are vaginal fall, burning sensation and pelvic discomfort, vaginal discharge smear can be seen Staphylococcus, Streptococcus, Escherichia coli and Proteus, etc., and trichomoniasis Inflammation is caused by direct or indirect infection. The main clinical manifestations are genital itching and discharge of a lot of foamy vaginal discharge. The vaginal secretion smear can find trichomoniasis.
3. Haemophilus vaginal vaginitis:
The disease is often accompanied by menstrual changes, vaginal discharge has a foul odor, but no foam; secretion smear test shows that a large number of Haemophilus colonizes the surface of vaginal cells, secretion culture can be confirmed.
4. Amoebic vaginitis:
More rare, the clinical manifestations of vaginal bleeding hemorrhagic serous secretions or yellow mucus purulent secretions, no foam-like, vaginal examination can be seen typical ulcers, vaginal discharge smear examination or culture, can find amoeba trophozoites .
5. Senile vaginitis:
More common in older women, after artificial menopause, the vaginal wall becomes old-age, thin mucosa, less wrinkles, poor elasticity, easy to hemorrhage; sometimes ulcers or adhesions, a large number of pus cells can be seen in the secretion examination, no Trichomonas vaginalis .
6. Vaginal mites infection:
The patient's genital area is itchy, including around the anus; there are many vaginal secretions, and the smear test shows the mites eggs, and there is no obvious inflammatory reaction in the vaginal wall.
7. Infants and children vulvovaginitis:
Children with vulva, vaginal itching, commonly used to grasp the vulva or crying, the vagina has a large amount of purulent secretion, odor, check the vaginal vestibular congestion, clitoris redness, secretion smear examination or culture, can find pathogens .
(B) the differential diagnosis of vaginal ulcers:
1. Acute simple ulcer:
Can be seen in the vaginal wall bulging during uterine prolapse, due to mucosal compression and friction, vaginal secretion smear examination without amebic trophozoites, pathological examination of vaginal mucosa squamous epithelial hyperplasia, bottom of granulation tissue, no Ami Baze nourishment, and amebic vaginitis smear or pathological examination can find amoeba trophozoites.
2. Tuberculous ulcers:
The edge of the vaginal ulcer is in a rat-like shape. The bottom of the ulcer may have granule-like tuberculous nodules. The pathological section has no amoebic trophozoites and is a caseous necrosis, a granuloma formed by epithelial cells and Langerhans giant cells.
(3) Malignant tumors:
When amebic vaginitis is tumor-like hyperplasia, it should be differentiated from vaginal malignant tumors and confirmed by tissue biopsy.