actinomycosis


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Related to actinomycosis: abdominal actinomycosis, cervicofacial actinomycosis

Actinomycosis

 

Definition

Actinomycosis is an infection primarily caused by the bacterium Actinomyces israelii. Infection most often occurs in the face and neck region and is characterized by the presence of a slowly enlarging, hard, red lump.

Description

Actinomycosis is a relatively rare infection occurring in one out of 300,000(1/300,000) people per year. It is characterized by the presence of a lump or mass that often forms, draining sinus tracts to the skin surface. Fifty percent of actinomycosis cases are of the head and neck region (also called "lumpy jaw" and "cervicofacial actinomycosis"), 15% are in the chest, 20% are in the abdomen, and the rest are in the pelvis, heart, and brain. Men are three times more likely to develop actinomycosis than women.

Causes and symptoms

Actinomycosis is usually caused by the bacterium Actinomyces israelii. This bacterium is normally present in the mouth but can cause disease if it enters tissues following an injury. Actinomyces israelii is an anaerobic bacterium which means it dislikes oxygen but grows very well in deep tissues where oxygen levels are low. Tooth extraction, tooth disease, root canal treatment, jaw surgery, or poor dental hygiene can allow Actinomyces israelii to cause an infection in the head and neck region.
The main symptom of cervicofacial actinomycosis is the presence of a hard lump on the face or neck. The lump may or may not be red. Fever occurs in some cases.

Diagnosis

Cervicofacial actinomycosis can be diagnosed by a family doctor or dentist and the patient may be referred to an oral surgeon or infectious disease specialist. The diagnosis of actinomycosis is based upon several things. The presence of a red lump with draining sinuses on the head or neck is strongly suggestive of cervicofacial actinomycosis. A recent history of tooth extraction or signs of tooth decay or poor dental hygiene aid in the diagnosis. Microscopic examination of the fluid draining from the sinuses shows the characteristic "sulfur Granules" (small yellow colored material in the fluid) produced by Actinomyces israelii. A biopsy may be performed to remove a sample of the infected tissue. This procedure can be performed under local anesthesia in the doctor's office. Occasionally the bacteria can be cultured from the sinus tract fluid or from samples of the infected tissue.

Key terms

Biopsy — The process that removes a sample of tissue for microscopic examination to aid in the diagnosis of a disease.
Sinus tract — A narrow, elongated channel in the body that allows the escape of fluid.
Actinomycosis in the lungs, abdomen, pelvis, or brain can be very hard to diagnose since the symptoms often mimic those of other diseases. Actinomycosis of the lungs or abdomen can resemble tuberculosis or cancer. Diagnostic x-ray results, the presence of draining sinus tracts, and microscopic analysis and culturing of infected tissue assist in the diagnosis.

Treatment

Actinomycosis is difficult to treat because of its dense tissue location. Surgery is often required to drain the lesion and/or to remove the site of infection. To kill the bacteria, standard therapy has included large doses of penicillin given through a vein daily for two to six weeks followed by six to twelve months of penicillin taken by mouth. Tetracycline, clindamycin, or erythromycin may be used instead of penicillin. The antibiotic therapy must be completed to ensure that the infection does not return. However, a report in 2004 on several cases of actinomycosis said that therapy depends on the individual case and that many patients today will be diagnosed in earlier stages of the disease. Sometimes, shorter courses of antibiotic treatment are effective, with close diagnostic x-ray monitoring. Hyperbaric oxygen (oxygen under high pressure) therapy in combination with the antibiotic therapy has been successful.

Prognosis

Complete recovery is achieved following treatment. If left untreated, the infection may cause localized bone destruction.

Prevention

The best prevention is to maintain good dental hygiene.

Resources

Periodicals

Sudhaker, Selvin S., and John J. Rose. "Short-term Treatment of Actinomycosis: two Cases and a Review." Clinical Infectious Diseases (February 1, 2004): 444-448.

actinomycosis

 [ak″tĭ-no-mi-ko´sis]
an infection involving the deeper tissues of the skin and mucous membranes, most often of the head and neck, caused by bacteria of the genus Actinomyces. The lesions begin as painless tumorlike masses around the jaw and neck that later break down and begin to suppurate with a discharge through a network of sinuses extending through the skin. Intraperitoneal abscesses and lung abscesses may also occur. The source of infection is unknown, although the mouth is thought to be the portal of entry because the organisms are often found in decayed teeth and in the tonsillar crypts of persons who are otherwise normal.

The infection progresses slowly, without remission, and without at first seeming to affect the general health of the patient. If it is not treated successfully the condition may eventually be fatal.

Diagnosis is established by identifying the causative microorganisms in anaerobic culture from a lesion. The usual treatment is with penicillin, the drug of choice. In cases of allergy to this drug, tetracycline, clindamycin, or chloramphenicol can be used. Surgical measures include resection, incision, and drainage of chronic abscesses and sinuses.

ac·ti·no·my·co·sis

(ak'ti-nō-mī-kō'sis),
A disease primarily of cattle and humans caused by the bacterium Actinomyces bovis in cattle and by A. israelii and Arachnia propionica in humans. These actinomycetes are part of the normal bacterial flora of the mouth and pharynx, but when introduced into tissue they may produce chronic destructive abscesses or granulomas that eventually discharge a viscid pus containing minute yellowish granules (sulfur granules). In humans, the disease commonly affects the cervicofacial area, abdomen, or thorax; in cattle, the lesion is commonly found in the mandible.
Synonym(s): actinophytosis (1) , lumpy jaw
[actino- + G. mykēs, fungus, + -osis, condition]

actinomycosis

/ac·ti·no·my·co·sis/ (-mi-ko´sis) an infectious disease caused by Actinomyces, marked by indolent inflammatory lesions of the lymph nodes draining the mouth, by intraperitoneal abscesses, or by lung abscesses due to aspiration.actinomycot´ic

actinomycosis

(ăk-tĭn′ō-mī-kō′sĭs, ăk′tə-nō-)
n.
An inflammatory disease of cattle, hogs, humans, and other mammals, caused by actinomyces and characterized by lumpy tumors of the mouth, neck, chest, and abdomen. Also called lumpy jaw.

ac·tin′o·my·cot′ic (-kŏt′ĭk) adj.

actinomycosis

[ak′tinōmīkō′sis]
a chronic bacterial disease most frequently located in the jaw, thorax, or abdomen. It is characterized by deep, lumpy abscesses that extrude a thin, granular pus through multiple sinuses. The disease occurs worldwide but is seen most frequently in those who live in rural areas. It is not spread from person to person or from animals to humans. The most common causative organism in humans is Actinomyces israelii, a normal inhabitant of the bowel and mouth. Disease occurs after tissue damage, usually in the presence of another infectious organism. It can be diagnosed by microscopic identification of sulfur granules, pathognomonic of Actinomyces, in the exudate. There are several forms of actinomycosis. Orocervicofacial actinomycosis occurs with the spread of the bacterium into the subcutaneous tissues of the mouth, throat, and neck as a result of dental or tonsillar infection. Thoracic actinomycosis may represent proliferation of the organism from cervicofacial abscesses into the esophagus, or it may result from inhalation of the bacterium into the bronchi. Abdominal actinomycosis usually follows an acute inflammatory process in the stomach or intestines, such as appendicitis, diverticulum of the large bowel, or a perforation found in the groin or another area that drains exudate into the stomach. A large mass may be palpated, and sinus tracts from abscesses deep in the abdomen may form. Pelvic actinomycosis is most commonly associated with intrauterine devices. Central nervous system actinomycosis is a rare cause of brain abscess. Bacterial endocarditis is very rarely caused by actinobacillus infection. Musculoskeletal actinomycosis involves subcutaneous tissue, muscle, and bone. Disseminated Actinomycosis follows hematogenous spread of the infection and may involve the skin, brain, liver, and urogenital system. All forms of actinomycosis are treated with at least 6 weeks of daily injections of penicillin in large doses. Abdominal actinomycosis can be cured in 40% of cases, thoracic actinomycosis in 80%, and orocervicofacial actinomycosis in 90%.
enlarge picture
Actinomycosis

Actinomycosis

A chronic local or systemic granulomatous infection by Actinomyces israelii, a filamentous, gram-positive bacterium.
Clinical findings Weight loss, weakness, fever, local pain, and indolent suppurative lesions of face & neck (40%–60% of cases), lungs & chest (15%), abdomen and other regions, often accompanied by draining sinus tracts/abscesses containing yellow aggregates (“sulphur granules”). 
Main types Oral cervicofacial actinomycosis—accounts for half of cases of actinomycosis and is classically linked to dental caries; thoracic—linked to aspiration of infected droplets; abdominal—linked to appendicitis or foreign body ingestion (e.g., chicken bones); pelvic—often associated with IUDs which have been in place for prolonged periods of time.
Management IV penicillin for weeks to months.

actinomycosis

Infectious disease A chronic local or systemic granulomatous infection by Actinomyces israelii, a filamentous, gram-positive bacterium Clinical Weight loss, weakness, fever, local pain, indolent suppurative lesions of face & neck–40-60% of cases, lungs & chest–15%, abdomen and other regions, often accompanied by draining sinus tracts/abscesses containing yellow aggregates–'sulfur granules' Treatment IV penicillin. See Actinomyces, Sulfur granules.

ac·ti·no·my·co·sis

(ak'ti-nō-mī-kō'sis)
A disease primarily of cattle and humans caused by Actinomyces bovis in cattle and by Actinomyces israelii and Arachnia propionica in humans. These actinomycetes are part of the normal bacterial flora of the mouth and pharynx, but they may produce chronic destructive abscesses or granulomas that eventually discharge a viscid pus containing minute yellowish granules (sulfur granules). In humans, the disease commonly affects the cervicofacial area, abdomen, or thorax.
[actino- + G. mykēs, fungus, + -osis, condition]

actinomycosis

A persistent disease caused by filamentous, branching bacteria such as Actinomyces israelii whose colonies resemble those of a fungus. The organism exists in the mouth, especially around the teeth and may be transmitted by bites or knuckle injuries by teeth. The disease features multiple abscesses, often around the jaws or in the abdomen or lungs, which discharge thin pus, containing yellow ‘sulphur granules’. It has been reported in women fitted with intrauterine contraceptive devices (IUCDs). Treatment is with benzylpenicillin or other antibiotics.

ac·ti·no·my·co·sis

(ak'ti-nō-mī-kō'sis)
Disease primarily of cattle and humans caused by the bacterium Actinomyces bovis in cattle and by A. israelii and Arachnia propionica in humans. Part of the normal bacterial flora of the mouth and pharynx, but when introduced into tissue they may produce chronic destructive abscesses or granulomas that eventually discharge a viscid pus containing minute yellowish granules (sulfur granules). In humans, commonly affects cervicofacial area, abdomen, or thorax.
[actino- + G. mykēs, fungus, + -osis, condition]

actinomycosis (ak´tinōmīkō´sis),

n (lumpy jaw), an infection of humans and some animal species caused by species of
Actinomyces, which are gram-positive, filamentous, micro-aerophilic microorganisms.
Enlarge picture
Actinomycosis.

actinomycosis

in cattle, caused by Actinomyces bovis, commonly a rarefying osteomyelitis of the bones of the head particularly the maxilla and mandible. There is obvious swelling of the bone which is painful and causes interference with eating, and sinuses onto the cheek which discharge sticky, honey-like material containing granules. Rare occurrences are granulomatous lesions of the skin about the head, soft tissue lesions in the testicles and sow mammary gland, and infection of the esophageal groove causing a vagus indigestion. Called also lumpy jaw. See also actinobacillosis, actinomycotic.
In dogs and cats, actinomycosis usually consists of localized pyogranulomatous infections, most often in subcutaneous tissues around the head and neck, bone, and thoracic or abdominal cavities. Disseminated infections are uncommon. See also nocardiosis.

cutaneous actinomycosis
see mycotic dermatitis.
References in periodicals archive ?
5) Unfortunately, most actinomycosis infections are diagnosed postoperatively on specimen histology.
Risk factors for cervicofacial actinomycosis include poor dental hygiene, dental procedures, chronic tonsillitis, otitis, mastoiditis, maxillofacial trauma, and immunocompromise.
While rare, actinomycosis remains an important diagnostic consideration in the head and neck, especially when there is a clinical history of mucosal damage.
Chronic antibiotic treatment of actinomycosis with penicillin as the drug of choice is the prevailing recommendation,[sup.
Patchy air space consolidation with central areas of low attenuation (75%) and adjacent pleural thickening (73%) at chest CT scans have been shown to be suggestive of thoracic actinomycosis [5].
In conclusion, he was diagnosed as cervicofacial actinomycosis by clinical signs and histopatological examination.
Systemic actinomycosis caused by Actinomyces odontolyticus.
Classically, cervicofacial actinomycosis involves the parotid glands, the submandibular area, and the mandible: Laryngeal involvement is rare; when it does occur, it is believed to arise secondary to oral, cervical, or mandibular disease.
1) Abdominal and pelvic actinomycosis accounts for approximately 10% to 20% of reported cases.
In addition to cocaine abuse, the differential diagnosis of palatal perforations includes trauma, inhalation of other narcotics, midline lethal granuloma, Wegener granulomatosis, malignancy, and infection caused by tuberculosis, tertiary syphilis, leishmaniasis, mucormycosis, actinomycosis, diphtheria, or leprosy.
A limited number of cases of esophageal actinomycosis have been reported.
Unilateral tubo-ovarian actinomycosis in the presence of an intrauterine device.