Actinomycosis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Actinomycosis is a rare infectious bacterial disease of humans generally caused by Actinomyces israelii, A. gerencseriae and Propionibacterium propionicus, though the condition is likely to be polymicrobial.Characterized by the formation of painful abscesses 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.
Historical Perspective
Acitnomycosis was first identified in 1877 in cattle by pathologist Otto Bollinger. Later in the year, James Israel discovered it in humans and classified it under fungal origin. In 1939, Bergey classified to be bacteria.
Classification
Actinomycosis can be classified based on the anatomical site involved into[1]
- Orocervicofacial actinomycosis
- Thoracic actinomycosis
- Abdominopelvic actinomycosis
- central nervous system actinomycosis
- Musculoskeletal actinomycosis
- Disseminated actinomycosis
Pathophysiology
Actinomycosis is a chronic pyogenic bacterial infection caused by Actinomyces species. Infection most frequently follows dental work, trauma, surgery, or other medical conditions. When there is break in the mucosa, anywhere from the mouth to the rectum they reach tissues and cause damage. Incubation period of Actinomycosis varies from one to four weeks. But occasionally, it may be as long as several months. Actinomycosis elicits both humoral and cell-mediated immune responses.[2][3][4][5][6][7]
Causes
Actinomyces is a genus of Gram-positive bacteria. Some species are anaerobic, while others are facultatively anaerobic . Actinomyces species do not form spores, and, while individual bacteria are rod-shaped, morphologically Actinomyces colonies form fungus-like branched networks of hyphae. Many Actinomyces species are opportunistic pathogens of humans and other mammals, particularly in the oral cavity. In rare cases, these bacteria can cause actinomycosis, a disease characterized by the formation of abscesses in the mouth, lungs, or the gastrointestinal tract.[8][9][10]io
Differentiating Actinomycosis from other diseases
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.
Epidemiology and Demographics
In 1970, its annual incidence was estimated to be 1 per 300,000. Its incidence has been declined due the advent of widespread use of antibiotics following dental surgeries. Actinomycosis is commonly found between 4th to 6th decade of life and very rare in infants and children. Males are more commonly affected by Actinomycosis than females.
Risk factors
Common risk factors in the development of Actinomycosis include dental abscess, oral surgery, and facial trauma.
Screening
According to the Centers for disease control and prevention, screening for Actinomycosis is not recommended.
Natural history, Complications and Prognosis
Natural History
Actinomycosis is a chronic pyogenic bacterial infection caused by Actinomyces species. Infection most frequently follows dental work, trauma, surgery, or other medical conditions. Once in the tissue, Actinomyces multiply and forms an abscess, producing a hard, red to reddish-purple lump, often on the jaw, from which comes the condition's common name, "lumpy jaw." Eventually, the abscess breaks through the skin surface to produce a draining sinus tract.If left untreated, patients with Actinomycosis may progress to develop focal organ involvement with mass-like features and dvelopment of sinus tracts (which can heal and re-form) leading to multiple abscess.[2][3][4][5][6][7]
Complications
Complications that can develop as a result of actinomycosis are [11]
- Extension of disease can result in osteomyelitis of the mandible, ribs, or vertebrae.
- Endocarditis
- Pericarditis
- CNS disease, including brain abscess; chronic meningitis
Prognosis
- The prognosis is generally excellent with prompt and effective antimicrobial treatment in patients with uncomplicated actinomycosis that does not affect the CNS. Mortality range from 0% to 28%.( hightest being in CNS)
History and Symptoms
References
- ↑ Valour F, Sénéchal A, Dupieux C, Karsenty J, Lustig S, Breton P, Gleizal A, Boussel L, Laurent F, Braun E, Chidiac C, Ader F, Ferry T (2014). "Actinomycosis: etiology, clinical features, diagnosis, treatment, and management". Infect Drug Resist. 7: 183–97. doi:10.2147/IDR.S39601. PMC 4094581. PMID 25045274.
- ↑ 2.0 2.1 Volante M, Contucci AM, Fantoni M, Ricci R, Galli J (2005). "Cervicofacial actinomycosis: still a difficult differential diagnosis". Acta Otorhinolaryngol Ital. 25 (2): 116–9. PMC 2639881. PMID 16116835.
- ↑ 3.0 3.1 Sharkawy AA (2007). "Cervicofacial actinomycosis and mandibular osteomyelitis". Infect. Dis. Clin. North Am. 21 (2): 543–56, viii. doi:10.1016/j.idc.2007.03.007. PMID 17561082.
- ↑ 4.0 4.1 Peipert, Jeffrey F. (2004). "Actinomyces: Normal Flora or Pathogen?". Obstetrics & Gynecology. 104 (Supplement): 1132–1133. doi:10.1097/01.AOG.0000145267.59208.e7. ISSN 0029-7844.
- ↑ 5.0 5.1 Higashi Y, Nakamura S, Ashizawa N, Oshima K, Tanaka A, Miyazaki T, Izumikawa K, Yanagihara K, Yamamoto Y, Miyazaki Y, Mukae H, Kohno S (2017). "Pulmonary Actinomycosis Mimicking Pulmonary Aspergilloma and a Brief Review of the Literature". Intern. Med. 56 (4): 449–453. doi:10.2169/internalmedicine.56.7620. PMID 28202870.
- ↑ 6.0 6.1 Schaal KP, Lee HJ (1992). "Actinomycete infections in humans--a review". Gene. 115 (1–2): 201–11. PMID 1612438.
- ↑ 7.0 7.1 Brown, James R. (1973). "Human actinomycosisA study of 181 subjects". Human Pathology. 4 (3): 319–330. doi:10.1016/S0046-8177(73)80097-8. ISSN 0046-8177.
- ↑ Bowden GHW (1996). Actinomycosis in: Baron's Medical Microbiology (Baron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN 0-9631172-1-1.
- ↑ Holt JG (editor) (1994). Bergey's Manual of Determinative Bacteriology (9th ed. ed.). Williams & Wilkins. ISBN 0-683-00603-7.
- ↑ Madigan M; Martinko J (editors). (2005). Brock Biology of Microorganisms (11th ed. ed.). Prentice Hall. ISBN 0-13-144329-1.
- ↑ Agrawal P, Vaiphei K (2014). "Renal actinomycosis". BMJ Case Rep. 2014. doi:10.1136/bcr-2014-205892. PMC 4244330. PMID 25406215.
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