actinomycosis


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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.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

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.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

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]
Farlex Partner Medical Dictionary © Farlex 2012

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.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

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.
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.

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.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

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]
Medical Dictionary for the Health Professions and Nursing © Farlex 2012

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.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005

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]
Medical Dictionary for the Dental Professions © Farlex 2012
References in periodicals archive ?
This case report reviews a postsurgical pelvic actinomycosis caused by A.
Actinomyces have traditionally been classified as bacteria although they have some homology to fungi.1,2 These filamentous gram positive bacteria produce multiple abscesses and sinus tracts often producing a yellowish discharge termed "sulfur granules".2 Actinomycosis can affect many organ systems.
Broncholithiasis secondary to pulmonary actinomycosis. Respir Care 2014; 59(3):e27-e30.
Kerl, "Actinomycosis and nocardiosis," Compendium on Continuing Education for the Practising Veterinarian, vol.
A mimicker of tuberculomas is actinomycosis which typically manifests as an area of persistent consolidation or a mass, either of which may contain cavitation [41].
israeli may be an etiological factor for actinomycosis. The following species were also eliminated: Bacteroides uniformis and Parabacteroides distasonis classified as Gram(-) anaerobes; Acinetobacter freundii, Burkholderia cepacia, and Neisseria sicca (Gram(-) aerobe), as well as Staphylococcus epidermidis MSCNS (Gram(+) aerobe), which can cause opportunistic infections, including sepsis.The microflora gained the following species, Gram(+) anaerobes: Atopobium minutum and Clostridium butyricum, Gram(-) anaerobes: Capnocytophaga ochracea and Prevotella melaninogenica, Gram(+) aerobes: Microccus spp.
Extraradicular causes of endodontic failures include periapical actinomycosis, a foreign body reaction, accumulation of endogenous cholesterol crystals in apical tissues and unresolved cystic lesion.
Carrion has 9 articles (e.g., actinomycosis, chromoblastomycosis, dermatomycosis); and 3) medical parasitologist Rafael Rodriguez Molina also with 9 articles (e.g., experimental studies with hogs, intestinal infections, macrocytic anemia, malaria, sprue, uncinariasis).