Diagnosis and Risks of Actinomycosis | Dermatology

Actinomycosis

What is actinomycosis?

Actinomycosis is a rare infectious disease in which bacteria feast from one part of the body to another through body tissues. Over time, it can lead to related abscesses, pain, and inflammation.

It can affect the skin or deeper areas of the body, and sometimes the blood. Many people have actinomycosis bacteria in their body, but the bacteria generally stay in one place and do not cause disease in healthy tissues. If damage occurs in the area where the bacteria live, due to injury or trauma, the bacteria can move to other areas.

As the condition progresses, deep tissue can become inflamed and fill with pus. It can result in abscesses, tissue death, tooth decay, and fibrous tissue masses in the body.

Symptoms of actinomycosis

If the tissue in your mouth is infected, it can cause what is commonly known as a “bulging jaw.” A hard lump may be felt in the jaw. The lump itself is usually not painful. However, it can result in a painful skin abscess that first appears as a reddish hematoma at the site. It can also cause muscle shudders in the jaw or a “locked jaw.” If this occurs, the mouth cannot be opened normally.

The other symptoms of actinomycosis are:

  • Fever
  • Weightloss
  • Lumps in the neck or face
  • Suppuration of skin sores
  • Excess drainage from the sinuses
  • Coughing
  • Chest pain

Causes of actinomycosis

Actinomycosis is usually caused by bacteria called Actinomyces israelii. This is a shared organism create in the nose and throat. It does not normally cause disease.

Due to the normal location of the bacteria in the nose and throat, actinomycosis most often affects the face and neck. Sometimes the infection can occur in the chest (pulmonary actinomycosis), abdomen, pelvis, or other areas of the body. The infection is not contagious. This means that it is not passed on to other people.

Symptoms happen when bacteria enter the tissues of the face after trauma, surgery, or infection. Common triggers include dental abscesses or oral surgery. The infection can also distress certain women who have had an intrauterine device (IUD) to stop pregnancy.

Once in the tissue, the bacteria cause an abscess that produces a hard, red to reddish-purple lump, often on the jaw, hence the common name for the condition, “bulging jaw.” Finally, the abscess breaks through the surface of the skin to produce a sinus tract that drains.

Diagnosis of actinomycosis

  • Microscopy
  • Culture

Actinomycosis is supposed clinically and confirmed by identification of A. israelii or other Actinomyces species by microscopy and culture of sputum (ideally obtained endoscopically), pus, or a biopsy specimen. Imaging tests (e.g., chest x-ray, abdominal or chest CT) are often performed based on the findings.

In pus or tissue, the organism seems as the distinctive sulfur granules or as tangled masses of branched and unbranched wavy bacterial threads, pus cells, and debris, surrounded by an outer region of radiating, club-shaped, hyaline, and refractive that take hematoxylin-eosin tint in tissue but are positive in Gram stain. The laboratory should be notified that actinomycosis is suspected because special procedures are required to isolate and identify these organisms.

Lesions in any location can mimic malignant growths. Pulmonary lesions must be distinguished from those of tuberculosis and cancer. Most abdominal injuries occur in the ileocecal region and are difficult to diagnose, except during laparotomy or when draining sinuses appear in the abdominal wall.

Risk of developing actinomycosis

This infection can affect people of any age or origin. While there is a slight predilection for men when it originates to cervicofacial disease, the pelvic disease is nearly entirely found in women. It can be current in all parts of the world. The rarity of this disease means that most doctors will see very few cases in their lifetime, and even a busy infectious disease practice may see few.

Local pathology appears to be permissive for actinomycosis, although it is not universal. Tooth decay and gingivitis can be found in patients with cervicofacial actinomycosis, but these are common conditions. The contribution of aspects associated with poor health such as diabetes, cancer, malnutrition, etc., has been suggested, but a causal association is not firmly established and even in patients with many comorbidities it is rare to progress actinomycosis.

Treatment of actinomycosis

The goal of treating actinomycosis is to treat the infection with large doses of antibiotics and surgery to create aerobic conditions unfavourable for the growth of Actinomyces species.

Actinomycosis is treated with antibiotics, such as penicillin. High doses of intravenous penicillin followed by oral penicillin are usually required to penetrate the areas of fibrosis and suppuration. Long-term treatment is often required to prevent relapse.

Alternative antibiotics include tetracyclines, erythromycin, and clindamycin. Surgical treatment includes drainage of deep abscesses, removal of sinus tracts, and removal of bulky infected masses. The mutual treatment of penicillin and surgery almost always produces a cure.

Prevention

One of the best ways to stop actinomycosis is to practice good oral hygiene. Schedule regular visits with your dentist so you can check for potential problems. If you receive the proper treatment for actinomycosis, it is highly durable and you will likely make a full recovery.

Possible complications

In rare cases, meningitis can develop from actinomycosis. Meningitis is an infection of the membranes that line the brain and spinal cord. This membrane is called the meninges.

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