Phagedenism

PHAGEDENISM, a property of various ulcerative processes, especially on external organs or in the area of the inguinal glands, characterized by a sharply expressed tendency to spread rapidly in depth and circumference, causing significant necrosis of underlying tissues. L. L. Lukomsky, Care for the Sick, M.-L., 1931; A. Nobel and C. Pirquet, Guide to Feeding and Care for the Sick and Healthy Children, M.-L., 1930; Oxford-Shaptal, Care for the Sick, M.-L., 1929; D. Sivtsev and M. Yanchevsky, Care in Diseases of the Eye, Nose, Throat and Ear, M.-L., 1931; A. Tereshkovich, Guide to Care for the Mentally Ill, M.-L., 1927; L. Shidlovskaya, Essays on Care for the Mentally Ill Based on Personal Experience in Psychiatric Institutions, M., 1927.

Phagedenic, or tropical ulcer (phagedaenismus tropicus, ulcus phagedaenicum, tropical phagedena) occurs in hot and humid areas of the tropical and subtropical zones of both hemispheres, most frequently in Indochina, Madagascar, etc. Into this category of ulcerative processes were previously incorrectly included phagedenic ulcerative processes in syphilis, leishmaniasis, varicose ulcers, soft chancre, etc., with which tropical phagedenism has nothing in common. The latter occurs mainly on the sexual organs, as well as on the limbs in the lower third of the leg, on the dorsum of the foot, and less frequently on the hands. According to observations by some authors (Rost and others), it predominates in men.

A characteristic feature of this condition is the rapid development of the ulcer, which begins with a pustule and is covered with a wet, grayish diphtheroid coating, firmly fused with the underlying tissue. The ulcers are most often multiple, of irregular shape, of dense consistency with hard, roll-like swollen edges, they increase rapidly, confluence, and simultaneously penetrate in depth. Already after several days following infection, a large ulcer with reddened pointed edges and a necrotic center is formed. The discharge from the ulcers is watery-purulent, mixed with clots of blood and flakes of dead tissue, and emits a foul odor. With further progression, the process can lead to the destruction of tendons, joints, bones, and result in the formation of mushy scars and shapeless scars.

'Often there are complications with lymphangitis and neuritis. The lymph glands are rarely involved in the pathological process. The general condition is usually little disturbed, however, sometimes the process is accompanied by fever. In rare cases, mainly due to a change in climatic conditions, spontaneous healing occurs. Particular danger is posed by phagedenic ulcers located in the area of the coronal sulcus of the penis, because the extremely rapid necrotic decay of the glans can lead to the subsequent destruction of the blood vessels.

Phagedenic ulcer is most often observed in exhausted individuals, in malaria patients, alcoholics with reduced body resistance, in natives forced to work barefoot in water (for example, on rice plantations), etc. According to the latest research, phagedenic ulcer (or so-called fourth venereal disease) in terms of etiology is considered identical with angina Plaut-Vincent or ulcerative-membranous stomatitis and hospital gangrene (phagedaena nosocomialis), i.e., it is caused by a fusospirochete symbiosis of microbes. In favor of this, numerous observations of the simultaneous presence of phagedenic ulcers and Vincent's angina have been cited. A prerequisite for development is apparently the possibility of anaerobic growth. In this sense, the long, narrow prepuce due to the retention and decomposition of smegma causes damage to the epidermis and thus creates an entrance gate for the introduction of pathogenic agents.

Despite the fact that phagedenic ulcer is generally not very contagious, it has been possible to inoculate it in animals and humans. In the blood of patients with phagedenic ulcers, a positive Wassermann reaction is often found. In differential diagnosis, some difficulties may arise in relation to soft chancre, however, microscopic examination of the purulent discharge from the ulcers quickly resolves the issue.

TREATMENT. In initial cases, thorough cauterization with phenol, scraping with a sharp spoon should be performed, followed by the application of iodine vapor (Clement). However, even in these cases, it is advisable to immediately use intravenous infusions of neosalvarsan, which gives the best therapeutic effect. In progressive cases, it is recommended to use prolonged irrigation with a hot solution of sublimate (1%), hydrogen peroxide, potassium permanganate solution, tripaflavin, rivanol, zinc chloride, etc.