Actinomycosis pathophysiology

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

Pathophysiology

• 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

Actinomycosis is most frequently caused by Actinomyces israelii and is sometimes known as the "most misdiagnosed disease," as it is frequently confused with neoplasms. A. israelii is a normal colonizer of the vagina, colon, and mouth. Infection is established first by a breach of the mucosal barrier thru various procedures (dental, GI), aspiration, or pathologies such as diverticulitis. The chronic phase of this disease is also known the "classic phase" because the acute, early phase is often missed by health care providers. This is characterized by slow contiguous growth that ignores tissue planes and forms a sinus tract that can spontaneously heal and recur, leading to a densely fibrotic lesion. This lesion is often characterized as "wooden." Sulfur granules form in a central purulence surrounded by neutrophils. This conglomeration of organisms is virtually diagnostic of Actinomyces israelii. Oral-cervicofacial disease is the most common form of actinomycosis. It is characterized by a painless "lumpy jaw." Lymphadenopathy is uncommon in this form of the disease. Another form of actinomycosis is thoracic disease, which is often misdiagnosed as a neoplasm, as it forms a mass that extends to the chest wall. It arises thru aspiration of organisms from the oropharynx. Symptoms include chest pain, fever, and weight loss. Abdominal disease is another manifestation of actinomycosis. This can lead to a sinus tract that drains to the abdominal wall or the perianal area. Pelvic actinomycosis is often caused by intrauterine devices (IUD). Symptoms include fever, abdominal pain, and weight loss. Actinomyces sp. have also been shown to infect the central nervous system in a dog "without history or evidence of previous trauma or other organ involvement." [2]

References

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