infectious diseases
Actinomycosis
Introduction
Actinomycosis is a chronic localized or hematogenous anaerobic infection caused byActinomyces israeliiand other species ofActinomyces. Findings are a local abscess with multiple draining sinuses, a tuberculosis-like pneumonitis, and low-grade systemic symptoms. Diagnosis is by the typical appearance plus laboratory identification. Treatment is with a long course of antibiotics and surgery. (See also Overview of Anaerobic Bacteria .) The causative organisms,Actinomycesspecies (most commonlyA. israelii), are often present commensally on the gums, tonsils, and teeth and may be present in the intestines and vagina. However, many, if not most, infections are polymicrobial, with other bacteria (oral anaerobes, staphylococci, streptococci,Aggregatibacter[previouslyActinobacillus]actinomycetemcomitans, Enterobacterales [previously Enterobacteriaceae]) frequently cultured from lesions. 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. 