Updated: 12/19/2019

Actinomycosis

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Snapshot
  • A 40-year-old woman presents to her gynecologist for discomfort after having an intrauterine device implanted. She has noted some yellow-tinged fluids when wiping, reports feeling some irritation, and had a low-grade fever. On physical exam, yellow fluid is noted draining from the cervical os. A pap smear is done, which reveals branching filamentous gram + rods.
Introduction
  • Classification
    • Actinomyces israelii
      • an anaerobic, branching, filamentous gram + rod
      • produces yellow sulfur-colored granules
    • transmission
      • direct contact with bacteria
  • Epidemiology
    • demographics
      • male > female
    • location
      • most commonly affects the face and neck
      • may also cause pelvic inflammatory disease
    • risk factors
      • poor oral hygiene
        • dental caries
        • dental extraction or procedure
      • dental trauma
      • intrauterine device (IUD)
  • Pathogenesis
    • anaerobic environment in abscess cavities allow the bacteria to flourish
  • Associated conditions
    • cervicofacial actinomycosis
  • Prognosis
    • slowly progressive over weeks to months
    • may relapse even after treatment
Presentation
  • Symptoms
    • mass on the face or neck
  • Physical exam
    • may have a fever
    • facial actinomycosis
      • nontender, indurated mass
      • sinus tracts may drain thick yellow pus
        • may contain sulfur granules
    • cervicoactinomycosis
      • may have draining yellow pus from cervical orifice
Studies
  • Labs
    • tissue biopsy, culture, or pap smear
      • gram + branching rods
      • not acid-fast
    • microscopy of draining pus
      • yellow granules filled with bacteria
  • Making the diagnosis
    • most cases are clinically diagnosed
Differential
  • Nocardiosis
    • distinguishing factors
      • weakly acid fast and aerobic branching filamentous gram + rod
      • primarily causes pulmonary infections that can spread to central nervous system
      • SNAP = Sulfa for Nocardia; Actinomyces use Penicillin
Treatment
  • Conservative
    • improved oral hygiene
      • indication
        • all patients
  • Medical
    • penicillin  
      • all patients
    • tetracyclines
      • indications
        • penicillin allergy
  • Operative
    • surgical drainage or excision
      • indication
        • all patients along with antibiotics
Complications
  • Fistula formation
  • Scarring

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