View source for Actinomycosis

'''For patient information click [[Actinomycosis(patient information)|here]]'''

{{Infobox_Disease |
  Name           = {{PAGENAME}} |
  Image          = Actinomycosis.jpg |
  Caption        = A patient with Actinomycosis on the right side of the face. |
  DiseasesDB     = 145 |
  ICD10          = {{ICD10|A|42||a|30}} |
  ICD9           = {{ICD9|039}} |
  ICDO           = |
  OMIM           = |
  MedlinePlus    = |
  eMedicineSubj  = med |
  eMedicineTopic = 31 |
  MeshID         = D000196 |
}}
{{SI}}
{{CMG}}

==Overview==
[[Image:Actinomycosis_2.jpg|thumb|left|A BHI plate culture of Actinomyces sp., strain X616, at 72hrs of growth]]
'''Actinomycosis''' ''(ak-tuh-nuh-my-KOH-sihs)'', is a rare [[infectious disease|infectious]] [[bacteria]]l disease of humans generally caused by ''Actinomyces israelii'', ''A. gerencseriae'' and ''Propionibacterium propionicus'', though the condition is likely to be polymicrobial.<ref name=Baron>{{cite book | author = Bowden GHW | title = Actinomycosis ''in:'' Baron's Medical Microbiology ''(Baron S ''et al'', eds.)| edition = 4th ed. | publisher = Univ of Texas Medical Branch | year = 1996 | id = [http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1883 (via NCBI Bookshelf)] ISBN 0-9631172-1-1 }}</ref> Characterized by the formation of painful [[abscess]]es in the [[mouth]], [[lungs]], or digestive organs, actinomycosis abscesses grow larger as the disease progresses, often over a period of months. In severe cases, the abscesses may penetrate the surrounding bone and muscle to the skin, where they break open and leak large amounts of pus.

Actinomycosis occurs in cattle and other animals as a disease called ''lumpy jaw''. This name refers to the large abscesses that grow on the head and neck of the infected animal.

In 1877 [[pathologist]] [[Otto Bollinger]] described the presence of ''Actinomyces bovis'' in cattle, and shortly afterwards, James Israel discovered ''Actinomyces israelii'' in humans. In 1890 [[Eugen Bostroem]] isolated the causative organism from a culture of grain, grasses, and soil. After Bostroem's discovery there was a general misconception that actinomycosis was a [[mycosis]] that affected individuals who chewed grass or straw.

==Causative organism==
Actinomycosis is primarily caused by any of several members of the bacterial [[genus]] ''[[Actinomyces]]''. These bacteria are generally [[Anaerobic organism|anaerobes]].<ref name=Sherris>{{cite book | author = Ryan KJ; Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | publisher = McGraw Hill | year = 2004 | id = ISBN 0838585299 }}</ref> ''Actinomyces'' spp. normally live in the small spaces between the teeth and gums, causing infection only when they can multiply freely in anoxic environments. The three most common sites of infection are decayed teeth, the lungs, and the [[intestines]].

Since ''Actinomyces'' bacteria are generally sensitive to [[penicillin]], it is frequently used to treat actinomycosis.

== Pathophysiology & Etiology== 

* 6 species cause disease in humans: 
*:* ''A. israelii''
*:* ''A. Naeslundii''
*:* ''A. odontolyticus''
*:* ''A. viscosus''
*:* ''A. Meyeri''
*:* ''A. gerencseriae''
* Gram positive filamentous rod
* Sulfur Granules
* Actinomyces from within, Nocardia from without
* Generally low pathogenicity and cause disease only in the setting of antecedent tissue injury	


== Symptoms == 
* Cervicofacial Actinomycosis (55%)
*:* Acute painful [[pyogenic]] [[abscess]] or indolent angle-of-jaw mass
* Thoracic Actinomycosis 
*:* [[Lungs]]
*:* [[Pleura]]
*:* [[Mediastinum]]
*:* Chest wall ([[aspiration]], extension of cervicofacial disease, transdiaphragmatic or retroperitoneal spread)
*:*:* Clinical picture of  [[tuberculosis]] (TB) or [[malignancy]]
* [[Abdominal]] and [[Pelvic]] Actinomycosis
*:* Following: 
*:*:* Penetrating [[trauma]]
*:*:* [[Gut perforation]]
*:*:* [[Surgical]] manipulation 
*:* [[Ileocecal]] predilection
*:*:* Confused with: 
*:*:*:* [[TB]]
*:*:*:* Ameboma
*:*:*:* Chronic appy
*:*:*:* [[Regional enteritis]]
*:*:*:* [[Carcinoma]]
*:*:*:* [[Intrauterine devices]] (IUD’s)
* [[Central Nervous System]] (CNS)
*:* [[Brain abscess]]
*:* [[Meningitis]]
*:* [[Meningoencephalitis]]
*:* [[Subdural empyema]]

== Pharmacotherapy ==

* In vitro susceptible to:
*:* [[Penicillin]]
*:* [[Chloramphenicol]]
*:* The [[tetracycline]]s
*:* [[Erythromycin]]
*:* [[Clindamycin]]
*:* [[Imipenem]]
*:* [[Streptomycin]]
*:* The [[cephalosporin]]s
*:*:* Prolonged treatment (6-12 months)

== Surgery and Device Based Therapy == 
* [[Surgery]] often required for disease of the [[chest]], [[abdomen]], [[pelvis]], and [[central nervous system]] (CNS)

==References==
<div class="references-small"><references/></div>

==External links==
* [http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijid/vol6n1/actino.xml Journal of Infectious Diseases, Actinomycosis of the Tongue]

== Acknowledgements ==
The content on this page was first contributed by: Dr. Steve Wiviott 


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