Actinomycosis is a rare infection 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 it can spread to contiguous tissues, causing multiple draining sinuses.
A. israelii occurs as part of the normal flora of the throat, tonsillar crypts, and mouth (particularly around carious teeth); infection results from its traumatic introduction into body tissues.
Actinomycosis affects twice as many males — especially those ages 15 to 35 —
as females. People with dental disease or human immunodeficiency virus infection are at increased risk.
Symptoms appear from days to months after injury and may vary, depending on the site of infection.
In cervicofacial actinomycosis (lumpy jaw), painful, indurated swellings appear in the mouth or neck up to several weeks after dental extraction or trauma. They gradually enlarge and form fistulas that open onto the skin. Sulfur granules (yellowish gray masses that are actually colonies of A. israelii) appear in the exudate.
In pulmonary actinomycosis, aspiration of bacteria from the mouth into areas of the lungs already anaerobic from infection or atelectasis produces a fever and a cough that becomes productive and occasionally causes hemoptysis. Eventually, empyema follows, a sinus forms through the chest wall, and septicemia may occur.
In GI actinomycosis, ileocecal lesions are caused by swallowed bacteria, which produce abdominal discomfort, fever, sometimes a palpable mass, and an external sinus. This follows intestinal mucosa disruption, usually by surgery or an inflammatory bowel condition such as appendicitis.
Rare sites of actinomycotic infection are the bones, brain, liver, kidneys, and female reproductive organs. Symptoms reflect the organ involved.
CONFIRMING DIAGNOSIS Isolation of A. israelii in exudate or tissue confirms actinomycosis. Other tests that help identify this condition are:
❑microscopic examination of sulfur granules
❑Gram staining of excised tissue or exudate to reveal branching gram-positive rods
❑chest X-ray to show lesions in unusual locations such as the shaft of a rib.
Treatment is long term, with 1 to 2 months of penicillin I.V. followed by 6 to 12 months of penicillin taken by mouth. Doxycycline usually isn’t prescribed for children until after permanent teeth have erupted. In some cases, surgical drainage of the lesion may be required.
❑Dispose of all dressings in a sealed plastic bag.
❑After surgery, provide proper sterile wound management.
❑Administer antibiotics as ordered. Before giving the first dose, obtain an accurate patient history of allergies. Watch for hypersensitivity reactions, such as rash, fever, itching, and signs of anaphylaxis. If the patient has a history of any allergies, keep epinephrine 1:1,000 and resuscitation equipment available.
❑Stress the importance of good oral hygiene and proper dental care.
Review other book chapters online related to Actinomycosis:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
|
|
What do you think about the features of this website? Take our user survey and have your say:
Next articles:
Tools & Services:
Medical Articles:
Search Specialists by State and City
By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.
Copyright © 2009 Health Grades Inc. All rights reserved.
