Introduction:
Actinomycosis is a hematogenous or localized infection caused by Actinomyces israelii and other actinomyces species. It comprises the normal flora of the oral cavity and is also present in the lower digestive tract and female genital tract. However, these bacterias themselves are non-virulent. Actinomycosis results when there is a breach in the mucous membrane, and these bacterias reach the deeper tissues and cause infection.
Actinomycosis usually involves multiple bacterias, which along with actinomycetes species, cause the infection. These bacterias produce enzymes or toxins that affect the host's defense mechanism. Actinomycosis infection causes inflammation and may lead to fibrosis. The infection reaches the adjacent tissues and can spread hematogenously to distant organs. However, lymphatic spread is uncommon.
What Is Actinomycosis?
Actinomycosis is a rare chronic inflammatory bacterial infection affecting the cervicofacial region and lowering the gastrointestinal and urogenital tract. The causative organisms are anaerobic, gram-positive, Filamentous bacilli, Actinomyces israelli, and other Actinomyces species.
These bacterias are present harmlessly in the human body and become virulent once there is an injury in the underlying mucous membrane, invading the tissues and causing the disease.
What Causes Actinomycosis?
Actinomycosis is caused by the bacteria known as Actinomyces israelii and other species of Actinomyces. Since this bacteria is present in the nose and oral cavity, actinomycosis usually affects the face and neck region. Sometimes the injection disseminates to other parts of the body through blood, causing infections in that region.
How Is Actinomycosis Transmitted?
Actinomycosisis non-infectious and is not transmitted from one person to another. The causative organisms are already present in the normal flora of all humans. Therefore the disease is caused when these bacterias reach the submucosal region in case of an injury.
What Are the Types of Actinomycosis?
Actinomycosis can be of various types depending on the region of the body where the infection occurs.
1) Cervicofacial Actinomycosis:
It is the most common clinical form of actinomycosis and is also known as lumpy jaw syndrome, caused by odontogenic infections. Most cases of cervicofacial infections are caused by Actinomyces israelli and Actinomyces gerencseriae.
Cervicofacial actinomycosis leads to large abscesses, often involving the bone with or without the formation of the sinus tract.
The predisposing factors that can lead to cervicofacial lesions are:
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Dental caries.
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Dental extractions.
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Trauma to the oral mucous membrane.
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Radiation therapy.
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Cervicofacial surgery.
2) Pulmonary Actinomycosis:
Thoracic actinomycosis infection involves the respiratory tract affecting the pulmonary, laryngeal, and bronchial regions. It results from the spread of disease through the oropharynx or gastrointestinal routes.
Pulmonary actinomycosis is commonly seen in people with poor oral hygiene or untreated dental disease. Alcoholism has also been associated with the infection of thoracic actinomycosis.
Individuals with chronic lung diseases are also at risk of developing pulmonary actinomycosis.
An individual’s immune response also plays an essential role in the spread of this infection.
The major risk factors are:
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Human immunodeficiency virus infection.
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Steroid use.
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Infliximab treatment.
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Lung and renal transplantation.
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Acute leukemia.
3) Abdominal Actinomycosis:
Abdominal actinomycosis is commonly confused with abdominal malignancy due to its varied presentations.
Individuals who are at immense risk involve:
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Patients who underwent appendectomy.
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Patients who have missed perforated appendicitis.
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Women using the intrauterine contraceptive device.
Abdominal actinomycosis leads to abscess and fistula formation, followed by fibrosis of the surrounding tissues.
4) Pelvic Actinomycosis:
Pelvic actinomycosis is more common in females and can occur at any age. The patient feels lower abdominal discomfort and vaginal bleeding or discharge.
The common risk factors are:
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The presence of tumors.
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The use of IUDs.
What Are the Symptoms of Actinomycosis?
The symptoms of the actinomycosis infection differ according to the region affected:
1) Cervicofacial Form: The infection starts with the formation of a small raised lesion beneath the oral mucosa or the skin of the neck. Swelling in the jaw indicates subperiosteal involvement of the actinomycosis infection. These lesions may or may not be painful. This infection can further form sinuses and fistulas that lead to the discharge of sulfur granules.
2) Pulmonary Form: Involvement of the lungs may cause chest pain and fever. Draining sinuses are also formed in cases of severe infections.
3) Abdominal Form: The abdominal form of the infectioncauses pain, fever, diarrhea or constipation, vomiting, and makes the individual weak. The infection usually involves the intestine and the peritoneum leading to intestinal obstruction. There is the formation of sinuses and fistulas extending up to the abdominal wall.
4) Pelvic Form: In this form of infection, there is a pain in the pelvic or lower abdomen accompanied by vaginal discharge.
5) Generalized Form: This form of infection may also occur that disseminates to multiple regions hematogenously like the skin, brain, spinal cord, liver, kidneys, ureters, and pelvic organs (especially in women). Symptoms such as backache, headache, and lower abdominal pain may occur depending on the sites involved.
What Is the Treatment for Actinomycosis?
The administration of antibiotics results in the successful treatment of actinomycosis infection. Antibiotics commonly used are:
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Penicillin G.
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Doxycycline.
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Clindamycin.
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Amoxycillin + Clavulanic acid.
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Ceftriaxone.
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Imipenem.
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In the case of sinuses and fistulas, surgical drainage or removal can be done.
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In the case of pelvic actinomycosis due to intrauterine devices, the device should be removed.
What Is the Prognosis of Actinomycosis Infection?
Early diagnosis and proper antibiotic therapy can result in an excellent prognosis.
Can Actinomycosis be Prevented?
In order to prevent actinomycosis infection,
- Good oral hygiene should be maintained.
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Regular visits to the dentist should be made for early diagnosis and treatment of dental problems.
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People should be educated about the risk of intrauterine contraceptive devices that may cause pelvic actinomycosis infection.
Conclusion
Actinomycosis is a rare chronic inflammatory disease caused by anaerobic gram-positive bacteria, Actinomyces israelii, and other species that are commensals to the human oral cavity, digestive and genital tract. Different forms of actinomycosis, like craniofacial, pulmonary, abdominal, and pelvic actinomycosis, show different clinical features that need to be identified and treated accordingly.
Actinomycosis is a non-transmissible disease and is caused by bacteria that are usually present in the human body that causes infection when it reaches the submucous membrane in case of an injury. Antibiotic therapy results in the successful treatment of the infection. Maintenance of good oral hygiene is vital to prevent the occurrence of actinomycosis infection.
