Actinomycosis: Causes, Clinical Types, and Treatment Strategies

Actinomycosis: Causes, Clinical Types, and Treatment Strategies

Actinomycosis is a chronic granulomatous suppurative disease which is caused by anaerobic or microaerophilic Gram-positive non-acid-fast branched fiamentous bacteria.

The most common organism is Actinomyces israelii, A.naeslundii, A. viscosus, A. odontolyticus and A. propionica.

Clinical types of Actinomycosis

• Faciocervical: It is the most common type. Infection spreads either from tonsil or from adjacent infected tooth.
  • Initially,an induration develops. Nodules form with involvement of skin of face and neck. It softens and bursts through the skin as sinuses which discharge pus- which contains sulphur granules (60%).
• Thorax: Lungs and pleura get infected by direct spread from pharynx or by aspiration. Empyema develops.
  • Later chest wall nodules appear leading to sinuses with discharge (20%).
• In right iliac fossa: It presents as a mass abdomen with discharging sinus.
• Liver is infected through portal vein (Honeycomb liver).
• Pelvic: Pelvic actinomycosis can occur due to intra—uterine devices.

“Actinomycosis Clinical Features”

Actinomycosis Pathogenesis

Organism enters through deeper plane of the tissue,causes subacute inflammation with induration and nodule formation.

Eventually discharging sinus forms at the surface.

Pus collected in a swab or sterile tube will show sulphur granules.

Actinomycosis Predisposing Factors

• Trauma
• Presence of carious tooth
• Secondary bacterial invasion
• Hypersensitivity reaction.

“Actinomycosis And Dental Infections”

Actinomycosis Clinical Features

Cervicofacial actinomycosis/ actinomycosis of Jaw/Faciomaxillary

• Its occurrence is more common in males.
• Disease may remain localized to soft tissues or spread to involve salivary glands, bone (maxilla or mandible), skin of face and neck.
  Most commonly involve area is submandibular region.
• Presence of trismus is there before formation of pus.
• The disease is characterized by presence of palpable mass which is indurated and is painless. Skin surrounding the lesion has wooden indurated area of firosis.
• Multiple subcutaneous nodules over bluish-colored skin of jaw.
• Nodules rupture resulting in multiple discharging sinuses.

“Actinomycosis Diagnosis Challenges”

Abdominal Actinomycosis

• It is more severe form of disease.
• Patient complains of fever with chills and vomiting.
• There is involvement of liver and spleen.
• On palpation, abdominal mass is felt which is the sign in diagnosis of disease.

“Actinomycosis Treatment Protocols”

Thoracic Actinomycosis

• Patient gives history of aspiration.
• Dry or productive cough, occasionally blood streaked sputum, shortness of breadth and chest pain.
• Sinus tracts are present with drainage from chest wall.

Pelvic Actinomycosis

• History of IUCD is present.
• Presence of lower abdominal discomfort, abnormal vaginal bleeding or discharge.

“Actinomycosis And Antibiotic Therapy”

Pelvic Actinomycosis Investigations

• Pus under microscopy shows branching fiaments.
• Gram ’s staining shows Gram-positive mycelia in centre with Gram-negative radiating peripheral fiaments.
  These clubs are due to host reaction which are lipoid material (antigen-antibody complex).
• Cultured in brain heart infusion agar and thioglycolate media.

Pelvic Actinomycosis Differential Diagnosis

• Chronic pyogenic osteomyelitis.
• Carcinomas at the site
• Tuberculous disease

“Actinomycosis And Abdominal Infections”

Pelvic Actinomycosis Management

• Penicillins are the drug of choice and should be given for longer period (6 to l2 weeks). If patient is allergic to penicillin doxycycline can be given.
• Antifungals are often given because it is fungal-like bacterium.
• Surgical debridement is occasionally required. Surgical therapy include incision and drainage of abscess, excision of sinus tracts and recalcitrant firotic lesions, decompression of closed space infections and the interventions which are aimed for relieving the obstruction.
• Welsh regimen: Injection amikacin l5 mg/kg IV daily for 21 days; such cycle is repeated 3 times at a gap of l5 days along with tablet trimethoprim (7 mg/kg)—sulfamethoxazole (35 mg/kg) daily for 6 months.