Bubo

BUBO (from Greek boubon - groin), a general term for lymphadenitis of the inguinal region of various etiologies and courses, incorrectly applied by some authors to adenitis of other regions (elbow, axilla, etc.). Acute, subacute, or chronic buboes are divided according to clinical and etiological data into: 1. Pyogenic buboes, caused by common pyogenic microorganisms; they are mostly caused by the presence of a primary or secondary suppuration focus (especially of the skin) in areas whose lymph flow is directed to the inguinal-femoral package of lymph nodes. Their main causes are: impetiginized balanoposthitis, scabies of the genitals; eczema of the latter or of the anus; pyoderma of the buttocks, lower extremities, etc. Sometimes an inflamed lymphatic cord stretches from the suppuration focus to the bubo. Usually one gland is affected, the course is acute. Outcome: involution or suppuration. - 2. Venereal buboes: a) gonorrheal, in acute gonorrhea, very rare; more often in the presence of balanoposthitis (or vulvitis), sometimes accompanied by acute edema of the foreskin or lymphangitis on the dorsum of the penis. Usually one gland is affected; the course is acute. Outcome is usually resolution; suppuration is extremely rare. Sometimes

Bubo Inguinalis.

gonococci are found in the pus; b) soft-chancre buboes - in venereal ulcer (usually of the genitals or anus). Most often one gland is affected, rarely several; sometimes simultaneously an acute lymphangitis of the dorsum or lateral surface of the penile shaft. The course is acute. The usual outcome is suppuration, less often resolution. After suppuration and evacuation, the cavity either rapidly cleanses and heals (simple bubo) or turns into a huge venereal ulcer ("chancre-like, virulent bubo"). The higher the febrile reaction, the greater the chances of a simple bubo; c) syphilitic buboes - multiple chronic, "cold" specific adenopathy with the presence of treponemes in the glands, which are enlarged, dense, movable relative to the skin and deeper lying parts, separate and painless. They arise at the end of the 1st or beginning of the 2nd week from the appearance of the chancre; more pronounced on the side of the chancre; resolve slowly, over months; d) syphilopyogenic buboes, of acute or subacute course, with a tendency to suppuration, in chancre complicated by pyogenic infection; e) syphilomild-chancre buboes - acute or subacute, with possible suppuration in a mixed chancre. Such buboes can lengthen the period of the second incubation of syphilis up to 3-4 months. - 3. Pruriginous buboes, as one of the symptoms of Hebra-type prurigo, - multiple, located below Poupart's ligament, chronic, voluminous, soft-to-the-touch swellings of the glands, not inclined to inflammation and suppuration. - 4. Strumous buboes - an old term to designate extensive chronic and multiple inguinal lymphadenitis with pronounced periadenitis, with multiple, long-non-healing fistulas, usually excreting a gum-like crumbly discharge. Etiologically they are divided into tuberculous (very rare); soft-chancre ones that have taken a chronic course, often from the addition of a gummatous (syphilitic) infiltrate; adenolymphatic lesions in "Nicolas-Favre disease". - 5. Plague buboes, acute purulent-necrotic adenitis as a symptom of bubonic plague (see). - Treatment depends on the course's acuteness and etiology. At the onset of an acute bubo - rest, warming compresses of camphor alcohol solution, protein therapy. In gonorrheal bubo - gonovaccine; in soft-chancre bubo - Nicolas vaccine. With overt accumulation of pus - puncture and aspiration of pus by Bier's method. In syphilitic bubo - general treatment and local mercurial plaster. In pruriginous bubo, treatment is fruitless; it might be useful to try X-rays. In strumous buboes, besides etiological treatment, X-rays are applied and give success. Bubon d'emblée (Bubon d'emblée) develops immediately as such, without prior lesion of the skin or mucous membrane; this name was given by French venereologists of the first half of the 19th century to those rare cases in which a soft-chancre inguinal bubo of an acute or chronic type (Gougerot) develops, apparently without a preceding soft chancre on the genitals and where, as is assumed, the soft-chancre virus, immediately entering the lymphatic pathways, got into the glands without causing infection on the skin. Later Diday admitted the possibility of the existence of vulgar pyogenic buboes d'emblée without pyoderma. Since 1921, some, predominantly French, authors (Audry and others) have described a number of cases of syphilitic buboes d'emblée, when, in the apparent absence of a chancre, the first sign of syphilitic infection is inguinal adenitis; in another series of cases (Bouguet and others) the chancre develops even later than the adenitis, alongside other so-called general phenomena. To explain this fact, they point to the "peculiar properties" of the virus or to the "lack of protective ability on the part of the skin, which (normally) prevents the passage (through it) of the virus into the glands." The doctrine of bubon d'emblée, theoretically admissible, encounters objections as well, e.g., the following: 1) most described cases are based only on the statements of patients; 2) often there is no indication of the state of other areas whose lymph flow is directed to the inguinal-femoral glands and on which a chancre could have localized; 3) hard and soft chancres can be small and superficial, leaving no visible traces; 4) the appearance of a syphilitic chancre sometimes differs in nothing from syphilitic papules.

G. Meshcheryakov.

Climatic (tropical) bubo is an endemic disease with a protracted course, encountered mostly in men of working age. This disease was first distinguished as an independent disease by Scheube; it is encountered predominantly in hot climates. It has been described in China, Japan, along the western coast of Africa, along the shores of the Mediterranean Sea, in Algeria, in Spain, in the south of France; in the USSR - in Central Asia (2 cases by V. Shtefko) and in the Kyrgyz steppes (12 cases in 1911 by Martsinovsky). Occasionally climatic bubo assumes an epidemic character. Thus, for example, in 1888-89 Ruge notes an outbreak of climatic bubo among German sailors during the blockade of the coasts of Zanzibar. Clinically the disease is expressed in painful swelling of the inguinal glands, less often of lymph glands in other areas, and is accompanied by an elevation of temperature (of a remittent type). The inflamed glands frequently form entire packets and reach the size of a goose egg. Sometimes joint pains are observed. In some cases, after several weeks, the temperature gradually decreases, the swelling resolves, and everything returns to normal. More often, however, the inflammatory process passes into suppuration, and then the entire mass of the gland consists of small abscesses, partly fusing among themselves with the formation of fistulous tracts. Pus obtained by puncture of the gland at the beginning of the inflammatory process is transparent, yellowish or grayish in color, with a predominance of mononuclears among the cellular elements. Climatic bubo must be differentiated from syphilitic, plague, septic, and fungal buboes. Letulle and Nattan-Larrier studied in detail the pathological significance of this disease and consider the following characteristic for it: 1) loosening of the connective tissue of the glands by the inflammatory process, 2) focal necroses, 3) plasmacellular infiltration, diffuse or in the form of islands, and 4) permeation of accumulations of plasma cells by groups of lymphocytes. - In recent years, many works have appeared confirming a special form of this disease, wherein, besides gland involvement, Muller, Durand, and others note frequently encountered small ulcerations of the genital organs, the size of a pinhead. Destefano and Vaccarezza likewise note these painless ulcerations of a follicular character. - Treatment is surgical. The etiology of climatic bubo has not yet been elucidated. With markedly expressed suppuration of the glands, pyogenic cocci are usually found. At the beginning of the inflammatory process, however, the pus is sterile. Gemna and Solli, as well as Letulle and Nattan-Larrier, describe special inclusions in the plasma cells, which they are inclined to consider as parasites. Scheube does not exclude the possibility of infection with climatic bubo through insect bites.

E. Marzynowski. Bubonulus, a small bubo, a clinical term for an infiltrate prone to disintegration, usually located under the skin on the dorsum of the penis along the course of one of the inflamed lymphatic trunks. Initially, an acute or subacute lymphangitis of the trunk develops, along the course of which several clearly arranged nodes can be palpated. One (rarely several) of them, increasing in size, reaches the size of a cherry pit, a pea, or a hazelnut, softens, fluctuates, and finally disintegrates, forming an ulcer that heals quickly or slowly. Bubonulus is sometimes located on the lateral or lower surface of the penis. Bubonulus is most often observed as a complication of soft chancre localized on the glans or prepuce, and has an inflammatory and purulent character. Similar to a bubo, in soft chancre, bubonulus either heals quickly after pus evacuation or transforms into a deep, slowly progressing soft chancre. If there were several bubonuli, the ulcers formed after their disintegration communicate with subcutaneous fistulous tracts. Bubonulus is less frequently encountered as a complication of hard chancre accompanied by lymphangitis (bubonul. syphil. Mau-riac'a); here disintegration occurs slowly, without acute inflammatory phenomena, and heals quickly with specific treatment. It is very rarely observed as a complication of gonorrhea. The development of bubonuli is also possible with any pyogenic process in the canal or sac of the prepuce (for example, with scabies, impetiginous balanitis, etc.). Histologically, in the development of bubonuli, not only lymphatic trunks but also the veins of the dorsum of the penis sometimes participate.