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

A. israelii occurs as part of the normal flora of the mouth. Infection results from its traumatic introduction into body tissues.

They can be spread by human or animal bites (from people or animals with the bacteria ), and there have been cases in people who have punched someone else in the teeth. The disease has also been reported in some women fitted with an intrauterine contraceptive device (IUD). This is called pelvic actinomycosis and happens only very rarely.

Poor oral hygiene and tooth decay are a primary factor that increases the likelihood of this infection.

Signs and Symptoms

• A swelling or hard, red-to-reddish-purple lump on the face or upper neck (see neck lumps)
• Fever
• Weight loss
• Pain is minimal to absent
• 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

The best prevention is to maintain good dental hygiene.

A common site of infection is the mouth, through decayed teeth, so regular tooth brushing and dental check ups are important preventative measures.