Actinomycosis

Last Updated: 2020-11-19

Author(s): Anzengruber, Navarini

  • Bollinger 1877.
  • Israel 1878.

Lumpy Jaw, streptotrichosis, radiation fungus, leptotrichosis.

Infection by the facultative pathogenic, anaerobic, pleomorphic, non-acid-resistant, gram-positive pathogens Actinomyces israelii, rarely Actinomyces naeslundi, Actinomyces radingae and in individual cases Actinomyces bovi. These are often mixed infections (Actinobacillus actinomycetemcomitans, staphylococci, streptococci etc.).

  • Clinical classification
    • Cervicofacial actinomycosis (80-95% of all cases): lower jaw and oral mucosa.
    • Abdominal actinomycosis (approx. 3% of all cases): mostly after surgery (e.g. appendicitis).
    • Thoracic actinomycosis (up to 15% of all cases).
  • Occurs worldwide.
  • More common among the rural population.
  • Men > Women.
  • Particularly prevalent in developing countries.
  • Frequency peak 20 - 40 years of life
  • Predisposing factors
  • Bone fractures
  • Tooth extractions
  • Actinomyces israelii occurs physiologically in the mouth or throat (in 50% of the excised tonsils). Occasionally it can also be found in the large intestine. Infection is therefore endogenous. The bacteria penetrate the deeper tissue. It can be assumed that this requires the help of other bacteria.
     
  • Rough, purple, overheated, board hard, bulging, painful lumps and indurations, partly also ulcerations. Fistula openings can release a serous to purulent content under pressure, in which yellow granules, the Actinomycesdrusen, can be seen. The affected region is edematologically altered. Spontaneous healing does not occur. Periostitis, osteomyelitis.
  • Reduced general condition, fever, locoregional lymphadenopathy, weight loss and night sweats.
  • Cervicofacial actinomycosis: Carious teeth or mucosal defects are the main entry point.
  • Abdominal actinomycosis: Cause is usually a previous operation (e.g. appendicitis). Clinically, there is an intraadominal mass, often a psoas abscess can be diagnosed as a side effect. A secondary skin division is possible.
  • Thoracic actinomycosis: Characteristic features are fistulas and abscesses, pleural pain and productive cough with sputum.
  • Clinic.
  • Dermatopathological protection (deep biopsy, punch biopsy is not enough).
  • Bacterial smear.

Non-specific granulation tissue with plasma cells or eosinophilic granulocytes, leukocyte-rich enamel necrosis. The acidophilic granules (drusen) are detectable in the HE staining and the Grocott method. Thread-like filaments appear in the periphery.

  • Phlegmone of the base of the mouth
  • Millare sowing
  • Lockjaw

However, there is often a favourable prognosis with timely diagnosis and therapy.

  • Both surgical and antibiotic procedures are necessary.
  • Strips must be incised and drained. An excision of bloodless tissue is necessary.
  • PenicillinV p.o. 0,5- 1g 4x daily for 2-6 months.
  • Alternative: PenicillinG IV 4 Mio IU 5x daily.
  • Alternative: Doxycycline p.o. 0,5 g 3-4x daily.
  • Alternative: Clindamycin p.o. 600 mg 3x daily.
  • Alternative: Erythromycin p.o. 1 g 3x daily.
  • Less effective: cephalexin, oxacillin, fluoroquinolones, metronidazole, aminoglycosides and aztreonam.
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  3. Lerner PI. Susceptibility of pathogenic actinomycetes to antimicrobial compounds. Antimicrob Agents Chemother 1974;5:302-9.
  4. Sudhakar SS, Ross JJ. Short‐Term Treatment of Actinomycosis: Two Cases and a Review. Clinical Infectious Diseases 2004;38:444-7.
  5. Warren NG. ACTINOMYCOSIS, NOCARDIOSIS, AND ACTINOMYCETOMA. Dermatologic Clinics 1996;14:85-95.
  6. Yeruham I, Elad D, Perl S, Avidar Y, Israeli B, Shlosberg A. Isolation of Corynebacterium pilosum and Actinomyces pyogenes from cystitis and vulvovaginitis infection in a 2-month-old female calf. Zentralbl Veterinarmed B 1999;46:127-30.