Actinomycosis

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Actinomycosis
A patient with Actinomycosis on the right side of the face.
ICD-10	A42
ICD-9	039
DiseasesDB	145
eMedicine	med/31
MeSH	D000196

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

Overview

A BHI plate culture of Actinomyces sp., strain X616, at 72hrs of growth

Actinomycosis (ak-tuh-nuh-my-KOH-sihs), 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.

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 anaerobes. 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 tetracyclines
  • Erythromycin
  • Clindamycin
  • Imipenem
  • Streptomycin
  • The cephalosporins

    • 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)

External links

• 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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