SWO

ACTINOMYCES
Anaerobe

WHAT IS ACTINOMYCES?

The Actinomyces species are straight to slightly curved gram-positive bacilli that can range from short rods to long, branching rods. This anaerobic bacterium is found normally in the oral cavity, upper respiratory tract and, to a lesser extent, the gastrointestinal tract. They are not a particularly virulent species of bacteria and usually only cause infection when there is some disruption in the surface of the oral cavity or upper respiratory tract (opportunistic infection).

Also, the causative organisms, Actinomyces species (most commonly A. israelii), are often present commensally on the gums, tonsils, and teeth and may be present in the intestines and vagina.

Actinomycosis most often occurs in adult males and takes several forms:

  • Cervicofacial (lumpy jaw): The most common portal of entry is periodontal disease.

  • Thoracic: Pulmonary disease results from aspiration of oral secretions.

  • Abdominal: Disease presumably results from a break in the mucosa of a diverticulum or the appendix or from trauma.

  • Uterine: This localized pelvic form is a complication of certain types of intrauterine device (IUD).

  • Generalized: Rarely, the infection spreads from primary sites, presumably by hematogenous seeding.

 

Actinomycosis is a chronic localized or hematogenous anaerobic infection caused by Actinomyces israelii and other species of Actinomyces. Findings are a local abscess with multiple draining sinuses, a tuberculosis-like pneumonitis, and low-grade systemic symptoms.

Larry M. Bush , MD, FACP, Charles E. Schmidt College of Medicine, Florida Atlantic University; Maria T. Vazquez-Pertejo , MD, FACP, Wellington Regional Medical Center

COMMON SYMPTOMS OF ACTINOMYCES

Actinomycosis is a long-term (chronic) bacterial infection that commonly affects the face and neck. It is usually caused by the bacterium called Actinomyces israelii. This is a common organism found in the nose and throat. Actinomycosis most commonly affects the face and neck. The infection can sometimes occur in the chest (pulmonary actinomycosis), abdomen, pelvis, or other areas of the body. 

1. DRAINING SORES ON THE SKIN

 especially on the chest wall from lung infection with actinomyces

2. LUMPS ON THE NECK OR FACE

Swelling or a hard, red to reddish-purple lump on the face or upper neck

3. COUGHING

4. CHEST PAIN

5. WEIGHT LOSS

6. FEVER

7. EXCESS SINUS DRAINAGE

When the bacteria enter the tissues of the face after trauma, surgery, or infection, it triggers dental abscess or oral surgery.

Once in the tissue, the bacteria cause an abscess, producing a hard, red to reddish-purple lump, often on the jaw, from which comes the condition’s common name, “lumpy jaw.”

Eventually, the abscess breaks through the skin surface to produce a draining sinus tract.

References : 

  1. Brook I. Actinomycosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 313.
  2. Gardella C, Eckert LO, Lentz GM. Genital tract infections: vulva, vagina, cervix, toxic shock syndrome, endometritis, and salpingitis. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 23.
  3. Russo TA. Agents of actinomycosis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 254.