Actinomycosis

Actinomycosis Definition

Actinomycosis is a type of bacterial infectious disease that is quite uncommon. The characteristic signs include localized swelling with suppuration, fibrosis, and formation of abscesses as well as sinus draining of pus that contains sulfur granules.

It is not a contagious condition.

Actinomycosis Types

Theoretically, the inflammation associated with the disease can occur practically anywhere within the tissues present in a human body. However, the condition primarily tends to develop in only certain parts of the body.

Based on the point of origin, the disorder has been categorized into four types:

Pelvic Actinomycosis

It develops when the inner parts of the pelvis are affected by Actinomyces bacterial infection. It typically affects women when the bacteria residing in the female genitalia spread into the pelvis. Most instances of the disorder are believed to be caused by the long-time use of IUD (intrauterine device) contraceptives, which are referred to as coil. In some quite rare cases, usage of IUD over a long time may lead to damage of the womb lining. This may allow the bacteria to infiltrate and make way to the deep tissues.

This type comprises around an estimated ten percent of all cases of Actinomycosis.

Abdominal Actinomycosis

This type occurs when the infection takes root inside the abdomen or tummy, and can have various potential causes. It can also develop as a type of secondary complication of appendicitis or other infections. It may even affect an individual after an injury caused by swallowing an alien object. The form constitutes almost 20% of all cases of the disorder.

Thoracic Actinomycosis

It arises due to the infections that develop within the lungs or the associated airways. Most instances of this form are thought to be caused by individuals accidentally inhaling the droplets of polluted fluids into their lungs. This type affects around 15 to 20% of all Actinomycosis sufferers.

Oral Cervicofacial Actinomycosis

It arises when the inside of the jaw, mouth or neck is affected. Most instances of this condition occur as a result of dental problems like tooth decay. This is the most prevalent form of Actinomycosis and accounts for almost 50% of all cases of this condition.

Actinomycosis Causes

The condition is mainly caused by one of the several members of a genus of anaerobic bacteria known as Actinomyces. When affecting animals, they normally reside in the small areas between teeth and gums thereby causing infections only when the opportunity of multiplying freely in an anoxic environment is present. Humans often get affected by the condition after some form of dental work, periodontal diseases, poor oral hygiene, or a radiation therapy that causes damage to the local tissue of the oral mucosa. These oral issues can predispose an individual to Actinomycosis. Normal commensals may also be present within the caecum. Hence, Abdominal Actinomycosis may occur after the appendix is removed. The 3 most common sites affected by infection are the lungs, decayed teeth as well as the intestines. The bacteria often reside in or near the nose, throat, digestive system of humans as well as the vagina in women. Hence, infections are often seen in the face and neck. When Actinomycosis occurs in the chest, it is known as Pulmonary Actinomycosis. Other common areas of infection include pelvis and the abdomen. Women might get infected in certain cases after they have used an intrauterine device for preventing pregnancy. Actinomycosis does not generally occur in isolation or separation from other forms of bacteria. It depends on the other bacterial species, such as gram negative, gram positive and cocci, to facilitate in the invasion of tissues.

Actinomycosis Symptoms

The condition is characterized by painful abscesses that form within the mouth, lungs or the gastrointestinal tract which may grow larger with further progression of the disease. In severe instances, they may infiltrate surrounding bones and muscles, break open and then leak large quantities of pus. The symptoms of Actinomycosis depend on the area of the body where it develops. The common signs of this condition are listed below, based on its various types.

Pelvic Actinomycosis

It is characterized by problems like:

  • Fatigue
  • Mild fever
  • Loss of appetite
  • Vaginal bleeding
  • Atypical vaginal discharge
  • Pain in the lower abdominal area
  • Formation of noticeable lump or bulge in the pelvis area or an adnexal mass

Abdominal Actinomycosis

It is manifested by the following difficulties:

  • Nausea
  • Fatigue
  • Diarrhea
  • Vomiting
  • Weight loss
  • Constipation
  • Stomach pain
  • Mild fever, less than 38° C
  • Appearance of the sinus tracts on abdominal surface
  • Formation of noticeable lump or bulge in lower abdomen

Thoracic Actinomycosis

The following health issues mark its presence:

  • Fatigue
  • Chest pain
  • Weight loss
  • Fever of 38°C
  • Poor appetite
  • Lack or shortness of breath
  • Dry cough, or cough producing phlegm
  • Formation of sinus tracts on the chest surface
  • Blood-stained phlegm or drops of blood found when coughing

Oral Cervicofacial Actinomycosis

It is characterized by various health problems, such as:

  • Fever of 38°C
  • Formation of swollen lumps on neck or cheek which slowly harden, turn painless and decrease in number and size with time
  • Skin over lumps takes on a reddish or bluish-colored tone
  • The jaw muscles might get adversely affected which can make chewing difficult
  • Sinus tracts can develop on skin surface that leak pus

Actinomycosis Diagnosis

The bacterial infections associated with the disorder can often be very difficult to diagnose at the earlier stages. Due to this reason, many instances of this condition are discovered only when doctors conduct tests or surgeries in order to check out the presence of other conditions. Many cases are diagnosed when biopsies are conducted to detect cancer. The drained fluid can be checked under a microscope to detect sulfur granules. The condition can more easily be diagnosed during the later stages once the sinus tracts start appearing in the skin surface. This is due to the fact that the sulfur granules generated by sinus tracts during Actinomycosis infection are characterized by a distinct shape that is easily identifiable under a microscope.

Other diagnostic tests for Actinomycosis include CT scans and fine needle aspiration (FNA) tests guided by Ultrasonography.

Actinomycosis Differential Diagnosis

The condition shares characteristics similar to many other health issues. The differential diagnosis of this bacterial disease includes taking the following health conditions into account:

  • Nocardiosis
  • Appendicitis
  • Diverticulitis
  • Lung Abscess
  • Tuberculosis
  • Liver Abscess
  • Colon Cancer
  • Brain Abscess
  • Blastomycosis
  • Crohn Disease
  • Uterine Cancer
  • Adnexal Tumors
  • Adenocarcinoma
  • Abdominal Abscess
  • Pneumonia, Fungal
  • Pneumonia, Bacterial
  • Pneumonia, Aspiration
  • Lymphoma, Non-Hodgkin
  • Pelvic Inflammatory Disease
  • Lung Cancer in Non-Small Cell
  • Lung Cancer in Small Cell (Oat Cell)
  • Malignant Neoplasms of Small Intestine

Actinomycosis Treatment

The disorder is usually treated by administering antibiotics for several months. A doctor initially recommends antibiotic injections to be used for 2 to 6 weeks. This is then be followed by a 6 to 12 months course of appropriate antibiotic tablets. Antimicrobial agents like penicillin are commonly used to get rid of the Actinomyces bacteria. The preferred form of antibiotic treatment includes benzylpenicillin injections followed by phenoxymethylpenicillin tablets. However, doxycyclin, tetracycline or erythromycin may also be used in cases where patients are allergic to penicillin. Sulfonamides like sulfamethoxazole can be used as a form of alternative treatment for Actinomycosis. A daily dosage of 2 to 4 grams is sufficient to treat this condition. Response to treatment is often slow and it may take several months for any signs of improvement to become apparent. In some cases, surgery may be needed to repair the tissue damage or for draining the pus from the abscesses that have developed within the body. If Actinomycosis is caused by IUD, the device should be removed immediately.

Side effects of Actinomycosis Treatment

Treatment by penicillin can have the following side effects:

  • Nausea
  • Diarrhea
  • Skin rashes
  • Increased susceptibility to fungal infections like oral thrush

Actinomycosis Complications

The condition of Actinomycosis can lead to the following complications:

  • Endocarditis
  • Brain abscess
  • Hepatic abscess
  • Chronic meningitis
  • Spreading of the abscesses
  • Disseminated Actinomycosis
  • Spinal and cranial infections of dural spaces
  • Osteomyelitis of the ribs, vertebrae and the mandible

Actinomycosis Prognosis

The cutaneous and cervicofacial Actinomycosis cases have a good outcome when diagnosed and treated early. Thoracic and abdominal manifestations of this condition require aggressive antibiotic treatment and/or surgery. However, the prognosis can still be fatal on certain occasions.

Actinomycosis Prevention

Regular maintenance of oral hygiene can help to reduce the propensity of developing this disease.

Actinomycosis Epidemiology

Men are slightly more affected by this disorder than females. Over the last few decades, occurrence of Oral Actinomycosis has increased along with cases of genitourinary Actinomycosis due to the usage of intrauterine devices.

Actinomycosis in Animals

Actinomycosis can be frequently seen in animals such as cattle in a condition known as lumpy jaw. Various animals to have been affected by this disorder in the past include dogs, horses, pigs, sheep and some other wild beasts.

Actinomycosis Pictures

The following images would give you an idea of how Actinomycosis can affect humans.
Actinomycosis Image

 

Picture of Actinomycosis

Actinomycosis is a bacterial disorder that is known to cause lump-like growth in the affected parts as well as other physiological symptoms such as fatigue and weight loss. The condition responds positively to treatment although the results may take time to manifest.

Leave a Reply