Actinomycosis

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Actinomycosis
Introduction
Actinomycosis is a rare type of bacterial infection caused by a group of bacteria called
actinomycetaceae.
Most bacterial infections are confined to one part of the body because the bacteria are unable
to penetrate the body's tissue.
However, actinomycosis is unusual in that the infection is able to move slowly but steadily
through body tissue.
Symptoms of actinomycosis vary depending on the type of infection, but can include:
 Swelling and inflammation of affected tissue
 Tissue damage that results in scar tissue
 Formation of abscesses (pus-filled swellings)
 Small holes or tunnels that develop in tissue and leak a type of lumpy pus
Causative agent
Actinomycosis is caused by a family of bacteria known as actinomycetaceae. In most cases,
the bacteria live harmlessly on the lining of the mouth, throat, digestive system and vagina (in
women).
The bacteria only pose a problem if the tissue lining becomes damaged by injury or disease,
allowing the bacteria to penetrate deeper into the body.
This is potentially serious because these are anaerobic bacteria, which means they thrive in
parts of the body where there isn't much oxygen, such as deep inside body tissues.
However, an advantage of actinomyces bacteria being anaerobic is that they can't survive
outside the human body. This means that actinomycosis isn't a contagious condition.
Types of actinomycosis
In theory, actinomycosis can develop almost anywhere inside the tissue of the human body.
But the condition tends to affect certain areas of the body and can be classified into four main
types.
They are:
 Oral cervicofacial actinomycosis

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 Thoracic actinomycosis
 Abdominal actinomycosis
 Pelvic actinomycosis
Causes of actinomycosis
Actinomycosis is caused by a group of bacteria called actinomycetaceae.
Actinomycetaceae are found in many body cavities, such as inside the mouth and, less
commonly, the bowel.
In women, they can also be found in the womb and fallopian tubes (the tubes eggs are
released through into the womb).
How actinomycosis spreads
Actinomycetaceae are anaerobic bacteria, which means they can't survive in oxygen-rich
environments. They therefore don't cause illness when they're in the mouth or intestinal tract.
However, if the bacteria break through the protective lining (mucous membrane) surrounding
the cavities, they can penetrate deep into body tissue.
As the deep layers of human tissue are low in oxygen, the bacteria are able to reproduce
quickly and infect healthy tissue.
Abscesses
In an attempt to combat the infection, your immune system (the body's natural defence
against infection and illness) will send infection-fighting cells to the source of the
infection. But these cells are unable to kill the bacteria and will quickly die.
As the infection-fighting cells die, they accumulate into a yellowish-colored liquid (pus).
Having failed to kill the infection, your immune system will attempt to limit its spread by
using healthy tissue to form a protective barrier around the pus. This is how an abscess (pus-
filled swelling) develops.
Actinomycetaceae are able to penetrate the protective barrier of an abscess and move into
more healthy tissue. Your immune system will attempt to counter the infection by producing
more abscesses.
Sinus tracts
Your body will eventually need to get rid of the accumulation of pus. To do this, small
channels called sinus tracts will develop that lead from the abscesses to the surface of your
skin.

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The sinus tracts will leak pus, as well as lumps of bacteria. This takes the form of a yellow
powdery substance sometimes referred to as "Sulphur granules".
Opportunistic infection
Actinomycosis is an opportunistic infection that doesn't cause symptoms unless the chance
arises for it to penetrate body tissue.
Oral cervicofacial actinomycosis
Oral cervicofacial actinomycosis is where the infection develops inside the neck, jaw or
mouth. In the past, if the condition developed in the jaw it was known as lumpy jaw.
Most cases of oral cervicofacial actinomycosis are caused by dental problems, such as tooth
decay or a jaw injury.
Oral cervicofacial actinomycosis is the most common type of actinomycosis, accounting for
50-70% of all cases.
Symptoms of Oral cervicofacial actinomycosis
The symptoms of oral cervicofacial actinomycosis include:
 Swollen lumps on your cheek or neck, which can gradually increase in size and
number
 Reddish or bluish-colored skin over the lumps
 A high temperature (fever) of 38c (100.4f) or above may also occasionally develop
During the initial stages of oral cervicofacial actinomycosis, the lumps may be tender before
later becoming painless and hard to the touch. Your jaw muscles may also be affected, which
can make chewing difficult.
Oral cervicofacial actinomycosis can also cause narrow passages called sinus tracts to open in
the surface of your skin in the affected areas. These shouldn't be confused with sinuses,
which are the cavities in your face and nose.
The sinus tracts leak pus, which may contain a yellow, granular, lumpy material.
Causes of Oral cervicofacialactinomycosis
Opportunities for oral cervicofacial actinomycosis include:
 Tooth decay, particularly if the decay is left untreated for years
 Gum disease

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 Dental abscess
 Tonsillitis
 Middle ear infection (otitis media)
 Dental surgery, such as a tooth extraction, or root canal treatment
 Jaw surgery or trauma
Thoracic actinomycosis
Thoracic actinomycosis is where the infection develops inside the lungs or associated
airways.
Most cases of thoracic actinomycosis are thought to be caused by people accidentally
inhaling droplets of contaminated fluid into their lungs.
Thoracic actinomycosis accounts for an estimated 15-20% of cases.
Symptoms of Thoracic actinomycosis
The symptoms of thoracic actinomycosis may include:
 A high temperature (fever) of 38C (100.4F) or above
 Weight loss
 Tiredness (fatigue)
 Loss of appetite
 Shortness of breath
 Chest pain
 The appearance of sinus tracts on the surface of your chest
You may also develop a dry cough or a cough that produces phlegm. You may bring up drops
of blood when you cough, or if you produce phlegm it may be bloodstained.
Causes of Thoracic actinomycosis
Most cases of thoracic actinomycosis are thought to be caused by small food particles or
other ingested material that gets mixed up with the actinomycosis bacteria.
Rather than passing harmlessly down into the stomach, the particles are mistakenly passed
down into the windpipe and the airways of the lungs.
People with long-term drug or alcohol problems are particularly at risk of developing thoracic
actinomycosis.

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This is because being drunk or intoxicated increases the risk of material being accidentally
ingested into your lungs. Long-term alcohol misuse and drug misuse also weakens your
immune system, making you more vulnerable to developing an infection.
Abdominal actinomycosis
Abdominal actinomycosis is where the infection develops inside the abdomen (tummy).
This type of actinomycosis can have a range of potential causes. It can develop as a
secondary complication of a more common infection, such as appendicitis, or after
accidentally swallowing a foreign object, such as a chicken bone.
Abdominal actinomycosis accounts for an estimated 20% of all cases.
Symptoms of Abdominal actinomycosis
The symptoms of abdominal actinomycosis may include:
 Mild fever – usually a temperature that's no higher than 38C (100.4F)
 Weight loss
 Tiredness (fatigue)
 A change in your bowel habits, such as constipation or diarrhea
 Abdominal (tummy) pain
 Nausea and vomiting
 A noticeable mass or lump in your lower abdomen
 The appearance of sinus tracts on the surface of your abdomen
Causes of Abdominal actinomycosis
Abdominal actinomycosis occurs when something tears the wall of the intestine (bowel),
allowing the bacteria to penetrate into deep tissue.
The intestine can tear as the result of an infection, such as a burst appendix that damages
the intestine wall. It can also be damaged through injury – for example, if you were to
mistakenly swallow a fish bone.
There have also been some reported cases of abdominal actinomycosis occurring as a
complication of bowel or abdominal surgery.

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Pelvic actinomycosis
Pelvic actinomycosis is where the infection develops inside the pelvis.
It usually only occurs in women because most cases are caused when the actinomyces
bacteria are spread from the female genitals into the pelvis.
Most cases of pelvic actinomycosis are thought to be associated with the long-term use
of an intrauterine device (IUD). This type of contraceptive is often known as the coil.
Pelvic actinomycosis usually only occurs if the coil is left in for longer than the manufacturer
recommends.
Pelvic actinomycosis accounts for an estimated 10% of all cases.
Symptoms of Pelvic actinomycosis
The symptoms of pelvic actinomycosis may include:
 Lower abdominal pain
 Irregular or abnormal vaginal bleeding or vaginal discharge
 Loss of appetite
 Tiredness (fatigue)
 Mild fever
 A noticeable mass or lump in your pelvis
Causes of Pelvic actinomycosis
Most cases of pelvic actinomycosis have been recorded in women who were
using an intrauterine device (IUD) form of contraception.
An IUD is a small, T-shaped contraceptive device made from plastic and copper that fits
inside the womb. The women affected by the condition tend to be long-term users of an IUD
(eight years or more).
One explanation for cases of pelvic actinomycosis in women who are using an IUD is that,
over time, it may damage the womb lining, allowing bacteria to penetrate deep tissue.
However, no research has been carried out to find out whether or not this is the case.
It's important to note that it's very rare to develop pelvic actinomycosis as a result of
using an IUD. For example, in England, millions of women use the device and there have
only been a handful of reported cases of pelvic actinomycosis. It only tends to occur if an
IUD is left in place longer than the manufacturer recommends.

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Diagnosing actinomycosis
In its initial stages, actinomycosis can be a challenging condition to diagnose correctly
because it shares symptoms with other more common conditions. It's often only
discovered during tests or surgery to check for other conditions.
For example, many cases of actinomycosis are detected when biopsies are carried out to
check for cancer. A biopsy is where a small tissue sample is removed so it can be examined
under a microscope.
Actinomycosis can usually be more confidently diagnosed in its later stages, after the sinus
tracts have appeared in the surface of the skin.
This is because the Sulphur granules produced by the sinus tracts during an actinomycosis
infection have a distinctive shape that can be identified under a microscope.
Treating actinomycosis
Actinomycosis usually responds well to treatment, which involves taking a long-term course
of antibiotics.
Antibiotics
An initial course of antibiotic injections is usually recommended for 2 to 6 weeks, followed
by antibiotic tablets for another 6 to 12 months.
The preferred antibiotics for treating actinomycosis are benzylpenicillin, which is used for the
antibiotic injections, and amoxicillin tablets.
In some cases, other bacteria are also present and more than one antibiotic or other antibiotics
will need to be given.
Side effects of these antibiotics include:
 Diarrhea
 Nausea (feeling sick)
 Skin rash
 Increased vulnerability to fungal infections, such as oral thrush (a fungal infection that
occurs in the mouth)
If you're allergic to penicillin, alternative antibiotics such as tetracycline or erythromycin can
be used.

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Surgery
In some cases, minor surgery may be required to repair the damaged tissue and drain pus out
of the abscesses.
Complications of actinomycosis
Abscesses that develop as a result of actinomycosis may form in many parts of your body,
including your lungs. They can spread easily from one part of your body to another.
If the original site of the infection is located in the skin of your face, it may spread to nearby
parts of your body, such as your scalp or ears.
If the original site of the infection is your mouth, it may spread to your tongue, larynx (voice
box), trachea (windpipe) and salivary glands, and the tubes that connect your throat to your
nose.
If the infection spreads to your brain, a brain abscess could develop.
Preventing actinomycosis
Most cases of oral actinomycosis occur as a result of poor dental hygiene. This means
practicing good dental hygiene is the best way to prevent actinomycosis.
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