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Updated: Dec 23 2021


  • 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
    • Associated conditions
      • cervicofacial actinomycosis
  • 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
  • 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
  • Prognosis
    • Slowly progressive over weeks to months
    • May relapse even after treatment
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