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Actinomycosis: Causes, Symptoms and Treatment

Actinomycosis is a rare bacterial infection caused by Actinomyces bacteria. It typically affects the jaw, lungs, or abdomen, forming chronic abscesses and characteristic sinus tracts.

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Things worth knowing about "Actinomycosis"

Actinomycosis is a rare bacterial infection caused by Actinomyces bacteria. It typically affects the jaw, lungs, or abdomen, forming chronic abscesses and characteristic sinus tracts.

What is Actinomycosis?

Actinomycosis is a rare, slowly progressing bacterial infection caused by bacteria of the genus Actinomyces. These bacteria are part of the normal flora of the mouth, gastrointestinal tract, and urogenital tract. They become pathogenic only when they invade deeper tissues through mucosal injuries or defects. The disease often goes unrecognized for a long time due to its insidious onset and non-specific symptoms.

Causes and Risk Factors

Actinomyces bacteria are anaerobic or facultatively anaerobic rod-shaped bacteria, meaning they thrive in oxygen-poor environments. Common triggering factors include:

Tooth extractions, jaw surgery, or dental trauma (cervicofacial form)
Aspiration of saliva or gastric contents (pulmonary form)
Abdominal surgery, intestinal perforation, or appendicitis (abdominal form)
Use of intrauterine devices (IUDs) in the urogenital form
Weakened immune system or poor oral hygiene as contributing factors

Forms of Actinomycosis

Actinomycosis is classified by the region of the body affected:

Cervicofacial Actinomycosis

The most common form, affecting the jaw and neck area. It presents as slowly growing, firm swellings that develop into abscesses, which often drain through the skin via sinus tracts. A hallmark finding is the presence of sulfur granules (yellowish bacterial colonies) in the pus.

Pulmonary Actinomycosis

This form affects the lungs and chest. Symptoms include cough, fever, night sweats, and weight loss. It can closely mimic lung cancer or tuberculosis, making diagnosis particularly challenging.

Abdominal Actinomycosis

The abdominal form involves the abdomen and frequently develops following appendicitis or bowel surgery. It may present as an abscess or tumor-like mass within the abdominal cavity.

Urogenital Actinomycosis

This form primarily affects women using an intrauterine device (IUD) and may involve the uterus, fallopian tubes, or pelvic organs.

Symptoms

Symptoms vary depending on the affected region, but common signs include:

Slowly enlarging, painless or mildly painful swellings
Sinus tracts that drain pus containing sulfur granules
Fever and general malaise
Weight loss and night sweats (especially in the pulmonary form)
Trismus (lockjaw) and difficulty swallowing (in the cervicofacial form)

Diagnosis

Diagnosing actinomycosis can be difficult because it is uncommon and can mimic other conditions. Diagnostic approaches include:

Microbiological culture: Detection of Actinomyces bacteria from swab or tissue samples under anaerobic conditions
Histological examination: Identification of characteristic sulfur granules in tissue specimens
Imaging: Ultrasound, CT, or MRI to locate abscesses and sinus tracts
PCR diagnostics: Molecular detection of the pathogen in unclear cases

Treatment

Actinomycosis responds well to long-term antibiotic therapy. The first-line treatment is penicillin G or oral amoxicillin. Because the bacteria reside deep within tissue, prolonged treatment is essential:

High-dose intravenous penicillin G for 2-6 weeks, followed by
Oral antibiotic therapy (e.g., amoxicillin) for a further 6-12 months
For penicillin allergy: doxycycline or clindamycin as alternatives
Surgical drainage of abscesses and removal of sinus tracts when necessary

With early diagnosis and consistent treatment, the prognosis for actinomycosis is generally favorable. Left untreated, however, the infection can spread to adjacent structures and lead to serious complications, including sepsis.

References

Smego R.A., Foglia G. - Actinomycosis. Clinical Infectious Diseases, 26(6):1255-1263 (1998). Oxford University Press.
Wong V.K. et al. - Actinomycosis: a forgotten disease. Medical Journal of Australia, 2011;194(12):735.
Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 9th Edition. Elsevier, 2019.

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