ACTINOMYCOSIS

Courtesy Dr. Kaess
Actinomycosis


Actinomycosis is the infection by various species of Actinomycosis, especially A. israelii, a (gram-positive) commensal of the oropharyngeal flora. Precipitating factors include dental work, dental caries, and local trauma. It may also cause draining fistulas with underlying infection of the abdominal (e.g., cecum, appendix, gall bladder) or thoracic (e.g., lung) area. Bone radiographs are recommended as periostitis and posttraumatic osteomyelitis may occur. A. turicensis is a distinct Actinomycetes species usually found in infections of the lower part of the body, especially in the anorectal and urogenital regions.

Clinical

Painless, "woody" swelling of the jaw (lumpy jaw) that may break down and drain occurs in cervicofacial actinomycosis. Fluctuant nodules, sinuses and chronic drainage with characteristic yellow "sulfur granules" occur. Cervicofacial actinomycosis may mimic lymphangioma circumscriptum [Indian J Dermatol 2011;56:321-3].

Diagnosis

Visualization of sulphur granules in the pus, histological findings, and positive culture are all ways to confirm the diagnosis. Actinomyces however is a fastidious organism and may be difficult to culture.

Treatment

Consultation with an infectious disease specialist is indicated. In the past, IV Penicillin for 2-6 weeks followed by oral PCN with probenecid has been used. Dapsone has also been reported to work well. Chronic scarring and fibrosis may impede antibiotic treatment. In such cases, surgery may be considered.

References

Actinomycosis presenting as a large facial mass Dermatology Online Journal 12 (2): 20

Primary cutaneous actinomycosis over right gluteal region. Indian Dermatol Online J 2016;7:217-9

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