Actinomycosis

This infection is primarily caused by the gram-positive, anaerobic bacillus Actinomyces israelii, which produces granulomatous, suppurative lesions with abscesses. Common infection sites are the head, neck, thorax, and abdomen, but actinomycosis can spread to contiguous tissues, causing multiple draining sinuses. Rare sites of actinomycotic infection are the bones, brain, liver, kidneys, and female reproductive organs.

Actinomycosis can occur at any time of life. It affects three times as many males - with peak incidence in middle decades - as females. It's most likely to affect a person with poor dental hygiene or a person who doesn't have access to health care. There is also a higher incidence in those who use intrauterine contraceptive devices or have lower GI tract or female genitourinary tract problems.

Causes

Actinomycosis is usually caused by an anaerobic bacterium called Actinomyces israelii, which is a common and normally nonpathogenic (not disease-causing) organism found in the nose and throat.

Because of the bacterium's normal location in the nose and throat, actinomycosis most commonly appears in the face and neck. And since it is normal for people to carry this organism, the infection is not contagious.

Symptoms and Signs

• Fever
• Weight loss
• Pain is minimal to absent
• A swelling or hard, red-to-reddish-purple lump on the face or upper neck
• Draining sores in the skin, particularly those on the chest wall resulting from lung infection with Actinomyces

Diagnostic tests

Isolation of A. israelii in exudate or tissue confirms actinomycosis. Other tests that help identify it are:

• microscopic examination of sulfur granules
• immunofluorescence testing through the Centers for Disease Control and Prevention
• chest X-ray to show lesions in unusual locations, such as the shaft of a rib.

Treatment

Treatment involves high-dose I. V. penicillin or tetra­cycline therapy for 2 to 6 weeks followed by oral therapy for 6 to 12 months. Surgical excision and drainage of abscesses in all forms of the disease may also be performed, but medical therapy alone is sufficient if me patient isn't critically ill.

Prevention

Good dental hygiene helps prevent actinomycosis.

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