Actinomycosis

Actinomycosis is an infection characterised by the formation of painful abscesses in the mouth , lungs , or digestive organs caused mainly by Actinomyces bacteria. It occurs normally in the mouth and tonsils. Actinomycetes are prominent among the normal flora of the oral cavity but less prominent in the lower gastrointestinal tract and female genital tract. Fifty percent of actinomycosis cases are of the head and neck region (also called "lumpy jaw" and "cervicofacial actinomycosis"), 15% are in the chest, 20% are in the abdomen, and the rest are in the pelvis, heart, and brain. Men are three times more likely to develop actinomycosis than women.

Actinomycosis have been described as causative organisms in conjunctivitis, blepharitis, dacryocystitis, postsurgical endophthalmitis, and infected porous orbital implant. Cervico-facial actinomycosis has also been reported. Men are three times more likely to develop actinomycosis than women. Actinomyces infection is commonest between the ages of 25 and 50. Ultimately, the infection produces draining sinus tracts. Hematogenous dissemination to distant organs may occur in any stage of the infection, whereas lymphatic dissemination is unusual.

Infection of Actinomycosis is mainly caused via a breach in the mucous membrane. A common cause is dental abscess or oral surgery. Once in the tissue, it forms an abscess, producing a hard, red-to-reddish-purple lump, often on the jaw, from which comes the condition's common name, "lumpy jaw." It is not virulent and requires a break in the mucous membranes and devitalized tissue to invade deeper body structures and cause illness. It is often part of a mixed infection with several species of actinomyces and other bacteria. The most common clinical forms of actinomycosis are cervicofacial (ie, lumpy jaw), thoracic, and abdominal. In women, pelvic actinomycosis is possible. Because of the bacterium's normal location in the nose and throat, actinomycosis most commonly appears in the face and neck. And since it is normal for people to carry this organism, the infection is not contagious.

Causes of Actinomycosis

Here are the list of some of the possible causes of Actinomycosis:

• History of aspiration (Risk factors include seizure disorder, alcoholisms, and poor dental hygiene.)
• Dry or productive cough, occasionally blood-streaked sputum, shortness of breath, chest pain
• Fever, weight loss, fatigue, anorexia
• caused by the bacterium Actinomyces israelii
• may penetrate the surrounding bone and muscle to the skin, where they break open and leak large amounts of pus.
• Tooth extraction , tooth disease, root canal treatment ,jaw surgery, or poor dental hygiene.

Symptoms of Actinomycosis

Some sign and symptoms related to Actinomycosis are as follows:

• Fever, dry or productive cough, occasionally haemoptysis
• Shortness of breath, chest pain
• Weight loss, fatigue, anorexia
• hard lump on the face or neck.
• Fever, cachexia, abnormal breath sounds, haemoptysis
• Sinus tracts draining from the chest wall
• Pain is minimal to absent
• Draining sores in the skin, particularly those on the chest wall resulting from lung infection with Actinomyces

The main symptom of cervicofacial actinomycosis is the presence of a hard lump on the face or neck. The lump may or may not be red. Fever occurs in some cases.

Treatment of Actinomycosis

Treatment may include:

• Treatment for actinomycosis is long-term, with 1 to 2 months of penicillin given through a vein, followed by 6 to 12 months of penicillin taken by mouth. Other drugs have also been effective.
• The antibiotic therapy must be completed to insure that the infection does not return. Hyperbaric oxygen (oxygen under high pressure) therapy in combination with the antibiotic therapy has been successful.
• Surgical therapy may include incision and drainage of abscesses, excision of sinus tracts and recalcitrant fibrotic lesions, decompression
• Maintain good oral hygiene .
• Penicillin G is the drug of choice for treating an infection caused by actinomycetes.
• kill the bacteria, large doses of penicillin are given through a vein daily for two to six weeks followed by six to twelve months of penicillin taken by mouth.
• surgical excision and drainage of abscesses may be necessary.
• Tetracycline, clindamycin, or erythromycin may be used instead of penicillin. The antibiotic therapy must be completed to insure that the infection does not return.

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