Actinomycosis differential diagnosis

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

Overview

The differential diagnosis of actinomycosis consists of blastomycosis, brain abscess, colon cancer, crohn disease, diverticulitis, liver abscess, lung abscess, lymphoma, nocardiosis, pelvic inflammatory disease, pneumonia, tuberculosis and uterine cancer.

Differential Diagnosis

Disease	Differentiating signs/symptoms	Differentiating tests
Abdominal Abscess
Nocardiosis
Ovarian/Oviductal tumor
Appendicitis
Blastomycosis
Brain abscess
Colon cancer
Gastric adenocarcinoma
Crohn disease
Ulcerative colitis
Diverticulitis
Liver abscess
Lung abscess
Lung cancer
Pelvic inflammatory disease
Pneumonia (fungal, bacterial, or aspiration)
Pulmonary tuberculosis
Intestinal tuberculosis
Uterine cancer
Whipple disease

Actinomycosis	Nocardiosis
Gram positive anaerobic species	Gram positive aerobe
Decreasing incidence	Increasing incidence
Occurs primarily in immunocompetent host	Occurs primarily in immunocompromised host
Predominant cervicofacial	Predominant pulmonary
Chest wall involvement and bony erosions are common	Chest wall involvement is uncommon
Granuloma formation and intense fibrosis are common. Form characteristic sulphur granules	Granuloma formation and fibrosis are uncommon
Spread by direct invasion	Metastatic spread is common (especially to brain)
Diagnosis is made through cytologic or histologic examination	Diagnosis is made through BAL (bronchoalveolar lavage), sputum, or pleural fluid culture
Treatment: Penicillin Treatment with antibiotics alone	Treatment: Sulfonamides Often need surgical drainage

References

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