Actinomycosis

A chronic bacterial infection

Actinomycosis lesion

Grocott's methenamine silver stain of actinomycosis

Gram stain of actinomycosis

Actinomycosis is a chronic bacterial infection characterized by the formation of painful abscesses in the mouth, lungs, or gastrointestinal tract. It is caused by bacteria of the genus Actinomyces, which are normally found in the mouth and throat and are typically harmless. However, when the mucosal barrier is disrupted, these bacteria can invade deeper tissues and cause infection.

Etiology

Actinomycosis is primarily caused by Actinomyces israelii, a gram-positive, anaerobic bacterium. These bacteria are part of the normal flora of the oral cavity, gastrointestinal tract, and female genital tract. Infection occurs when the bacteria breach the mucosal barrier, often due to trauma, surgery, or infection, leading to the formation of abscesses.

Clinical Presentation

The clinical manifestations of actinomycosis can vary depending on the site of infection. Common forms include:

• Cervicofacial actinomycosis: Often referred to as "lumpy jaw," this form affects the face and neck and is the most common presentation. It typically follows dental procedures or trauma.
• Thoracic actinomycosis: Involves the lungs and chest cavity, often presenting with symptoms similar to tuberculosis or lung cancer.
• Abdominal actinomycosis: Affects the abdomen and can mimic other conditions such as appendicitis or Crohn's disease.
• Pelvic actinomycosis: Associated with the use of intrauterine devices (IUDs) and can present with pelvic pain and mass formation.

Diagnosis

Diagnosis of actinomycosis is challenging due to its nonspecific symptoms and the slow-growing nature of the bacteria. It often requires a combination of clinical suspicion, imaging studies, and microbiological culture. Imaging techniques such as CT scan or MRI can help identify the extent of the infection. Definitive diagnosis is made by culturing Actinomyces from clinical specimens, although this can be difficult due to the anaerobic nature of the bacteria.

Treatment

The treatment of actinomycosis involves prolonged antibiotic therapy, typically with penicillin. In cases of penicillin allergy, alternatives such as doxycycline or clindamycin may be used. Surgical intervention may be necessary to drain abscesses or remove infected tissue.

Prevention

Preventive measures include maintaining good oral hygiene and prompt treatment of dental infections. For individuals using IUDs, regular gynecological check-ups are recommended to monitor for signs of infection.

Related pages

• Bacterial infection
• Abscess
• Anaerobic bacteria
• Penicillin

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