Actinomycosis pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pathophysiology

• Actinomycosis is caused by the bacteria Actinomyces which is a normal commensal of the human oral cavity but less common in the female genital tract and lower gastrointestinal tract.
• The common clinical forms of are:

• Cervicofacial actinomycosis (lumpy jaw)
• Thoracic actinomycosis
• Abdominal actinomycosis
• Pelvic actinomycosis
• Dermatologic actinomycosis
• Pediatric actinomycosis
• Opthalmological actinomycosis

Pathogenesis

• Actinomyces does not grow in oxygen rich environment. When there is a break through the protective lining surrounding the cavities (from mouth to rectum), the Actinomycetales penetrate through the deeper tissues where the bacteria grow rapidly due to low oxygen levels.

Types	Site of Infection	Source of infection	Pathogenesis
Cervicofacial actinomycosis	Neck Jaw Mouth	Dental problems like tooth decay	Most common type of actinomycosis 50% of cases
Thoracic actinomycosis	Lungs Pleura Chest wall Mediastinum	Inhalation of droplets of contaminated fluid Aspiration of oropharyngeal secretions or gastric contents Direct extension of cervicofacial infection into the mediastinum Transdiaphragmatic or retroperitoneal spread from the abdomen Hematogenous spread	15%-20% of cases
Abdominal actinomycosis	Abdomen	Secondary to abdominal infections like appendicitis Accidental swallowing of a foreign body such as chicken bone containing the actinomycetes bacteria Penetrating trauma Perforation of the gut (e.g., the colon or appendix) Surgical manipulation of GI tract	20% of cases
Pelvic actinomycosis	Pelvis	Occurs most commonly in woman as the bacteria passes from the female genitals into the pelvis Long-term use of IUD type of contraceptive	10% of cases
Central nervous system actinomycosis	CNS	Secondary to hematogenous spread from primary infection in the lung, abdomen, or pelvis Direct extension from paranasal sinuses, ears, and cervicofacial regions	Types of lesions Brain abscess (67%) Meningitis or meningoencephalitis (13%) Actinomycoma (7%) Subdural empyema (6%) Epidural abscess (6%)

References

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