Actinomycosis
sulfur granules
Actinomyces israelii - central calcified core - surrounded by branching filaments & PMNs - necrosis, abscess formation & draining sinuses - sulfur granules in other infections such as Nocardia
Actinomyces cause Actinomycosis
- "the Great Pretender" - rare, chronic slowly progressive suppurative granulomatous disease - mimics periapical / periodontal abscess malignant disease, tuberculosis, Nocardiosis - most caused by *Actinomyces israelii* - treatment: antibiotic therapy, surgical debridement - mortality up to 28% depending on site and time to diagnosis
abdominal/pelvic actinomycosis
- 20% of cases - follows abdominal surgery - spread from GI tract or female GU tract - linked to prolonged IUD use result in multiple nodules on the back of a patient with abdominal actinomycosis
thoracic actinomycosis
-spread of actinomycosis to chest wall and ribs - cellulitis with a fistula on the back discharging pus
diagnosis of actinomycosis
medical history fine needle aspiration microscopic exam of discharge culture discharge (<50% culture positive)
actinomycosis
men 20-60 years > women 1:100,000 inhabitants/year endogenous infection break in mucosa types: - cervicofacial (55%) - thoracic (15-30%) - abdominal (20%)
treatment of actinomycosis
prolonged (months) antibiotic treatment - penicillin G --- four weeks of high dose IV --- 3-6 months of oral --- risk of developing penicillin resistance is low - tetracycline - erythromycin - clindamycin incision & drainage & surgical drainage might be required
lumpy jaw syndrome
results from cervicofacial actinomycosis common locations: - angle of mandible (most common) - cheek - chin - TMJ & retro-mandibular area (least common) bone involvement in 10%
Cervicofacial actinomycosis
symptoms: - inflamed indurated mass - submandibular lymphadenopathy - low grade fever (100*F) - drainage milky white with yellow flecks - relapsing/refractory clinical course after short-term antibiotics - bone infection in 12% of cases
formation of dental plaque
this comprises STEP 2 of initial bacterial colonization - early (primary) colonizers --- generally non-pathogenic --- gram-positive cocci and rods : ---- Streptococcus sanguis ---- Streptococcus mutans ---- Actinomyces viscous
causes of cervicofacial actinomycosis
tooth extraction/oral surgery dental caries poor dental hygiene periodontal disease penetrating trauma through oral mucosa
causes of thoracic actinomycosis
- aspiration into the lung - spread of cervicofacial form
Actinomyces israelii
- commensal in the mouth & female GU tract - most important cause of actinomycosis
signs & symptoms of thoracic actinomycosis
- fever, cough, shortness of breath - night sweats, weight loss - chest wall sinus with sulfur granules (26%) frequently wrongly diagnosed : cancer, lung cavitation resembling TB
Actinomyces
- gram positive rods/ branching filaments - soil microorganisms - anaerobes - source of most antibiotics - normal flora, commensals: opportunistic pathogens - cause suppurative granulomatous lesions
complications of pulmonary actinomycosis
- life threatening? - spread into lungs: --- pneumonia --- thoracic draining fistulas - spread to bloodstream - central nervous system involvement --- brain abscess --- meningitis
Actinomyces in oral cavity
- major component of dental plaque - increase in numbers in gingivitis - ? associated with root surface
