Actinomycosis
Actinomycosis is a chronic infection caused mainly by Actinomyces israelii, an anaerobic bacterium present on the gums, teeth, and tonsils.
Actinomycosis occurs in four forms, all of which cause abscesses (collections of pus). Adult men are affected most often, but the infection occasionally develops in women who use an intrauterine device (IUD).
The abdominal form is caused by swallowing saliva contaminated with the bacteria. The infection affects the intestines and the lining of the abdominal cavity (peritoneum). Pain, fever, vomiting, diarrhea or constipation, and severe weight loss are common symptoms. If an abscess develops in the abdomen, pus may drain through the skin by way of channels connecting the abscess to the abdominal wall.
The cervicofacial form (lumpy jaw) usually begins as small, flat, hard, sometimes painful swellings in the mouth, on the skin of the neck, or below the jaw. These swellings may soften and discharge pus that contains small, round, yellowish granules. Because of their resemblance to sulfur, these granules are sometimes called sulfur granules: they do not, however, contain sulfur. The infection may extend to the cheek, tongue, throat, salivary glands, skull, facial bones, brain, or the tissues covering the brain (meninges).
The thoracic form causes chest pain, fever, and a cough that brings up sputum. These symptoms, however, may not appear until the lungs are severely infected. If an abscess develops in the chest, pus may drain through the skin by way of channels connecting the abscess to the chest wall.
The generalized form of actinomycosis results when the bacteria are carried in the blood to the skin, vertebrae, brain, liver, kidneys, ureters, and, in women, the uterus and ovaries.
Diagnosis, Prognosis, and Treatment
The symptoms, x-ray findings, and isolation of Actinomyces israelii in samples of pus, sputum, or tissue help the doctor make the diagnosis. With some intestinal infections, a sample cannot be obtained, and surgery is needed to make the diagnosis.
Lumpy jaw is the most easily treated form of actinomycosis and has the best prognosis. The thoracic, abdominal, and generalized forms are harder to treat and have a worse prognosis. More than 50% of people with actinomycosis of the brain and spinal cord have persisting neurologic damage, and more than 25% die.
To treat actinomycosis, doctors drain abscesses and give high doses of antibiotics such as penicillin or tetracycline. To prevent relapse, antibiotics are taken for as long as 6 to 12 months.
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