Introduction
Greek words aktino, which describes a sulfur granule's radiating look, and mykos, which designates the illness as a mycotic sickness, were combined to create the English word actinomycosis. Actinomyces spp., a Gram-positive, anaerobic, or microaerophilic bacilli, is the unusual cause of actinomycosis, a subacute or chronic bacterial illness.
These are higher prokaryotic organisms from the Actinomycetaceae family. Primary cutaneous actinomycosis is an uncommon condition that frequently results from trauma. The pathogenic organism Actinomycosis israelii, was discovered in 1891. Males are more likely than females to get diseases between 20 and 60.
What Is Actinomycosis?
A chronic or slowly progressing illness called actinomycosis is brought on by several bacterial species of the Actinomyces genus, most frequently Actinomyces israelii. Actinomyces are typical mouth, gastrointestinal system, and female vaginal tract occupants. Unless there is a rupture in the skin or mucosa, they do not often cause an illness. Actinomyces also need the presence of other bacterial companions to be pathogenic.
A sinus tract (a tiny tube that opens onto the skin's or mucous membranes' surface and drains pus) and the development of an abscess are the disease's defining features. Yellow sulfur particles are seen in the draining pus.
It is important to distinguish between actinomycosis and actinomycetoma, a persistent skin and subcutaneous tissue infection that often affects the foot. Different species of Actinomyces, which are present in soil and plant matter in tropical climates, are responsible for actinomycetoma.
Who Is at Risk of Actinomycosis?
Although actinomycosis is very uncommon, the following things make infection more likely:
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Having poor oral health and then having dental surgery or trauma.
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Impaired immunity, such as from immunosuppressive drugs or chronic diseases like diabetes mellitus.
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Malnutrition.
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Living in tropical nations.
What Is Cervicofacial Actinomycosis?
The most frequent infection affecting 50 to 70 percent of patients is cervicofacial (neck and head) actinomycosis. Infection is frequently preceded by dental surgery, oral or face trauma, localized cancer- or radiation-induced tissue damage, or infection.
A hard lump in the cheek or around the jaw that grows steadily over time is typically the first sign of an infection. Abscesses and sinus drainage tracts result from this. A systemic infection can occasionally cause fever and other symptoms. Trismus (prolonged spasm of the jaw muscles) can result from actinomycosis around the jaw.
Unless nearby tissues are squeezed, lymph nodes are often not swollen, and discomfort is rarely severe. The tissues and organs of the infection gradually spread to the scalp, eyes, ears, tongue, larynx, and trachea. On rare occasions, the neighboring bone will invaded by infection. Meningitis may result from an infection spreading to the meninges, the membranes surrounding the brain and spinal cord.
What Is Cutaneous Actinomycosis?
Skin's deep subcutaneous tissue is impacted by the chronic condition known as cutaneous actinomycosis. Actinomyces invasion of the soft tissue results in aberrant sinus tracts that release light yellow sulfur granules caused by anaerobic, gram-positive, filamentous bacteria.
The most typical signs of cutaneous actinomycosis include progressive skin and soft-tissue inflammation that can develop into an abscess or cold mass, as well as nodular lesions with fistulas that need to be distinguished from sporotrichosis, cutaneous mycobacterial infections, and chronic inflammatory skin disease.
How to Diagnose Cutaneous Actinomycosis?
The following tests and examinations are mostly used to determine the diagnosis of cutaneous actinomycosis:
i) A complete physical examination and symptom evaluation.
ii) Examining the affected person's medical background.
iii) Microscopical examination of pus or tissue samples to look for sulfur granules, which are spherical and yellow and are so named due to their distinctive appearance but do not contain sulfur. Surgical procedures can be required to collect the tissue samples.
iv) The fluid or tissue from the infected location is cultured. Because these bacteria grow slowly in culture, it may take more than three weeks to get a (positive) culture result.
v) Scans using an X-ray machine, a CT scanner, or a magnetic resonance imaging machine to determine the position and number of abscesses and to distinguish between tumors and inflammatory masses resulting from infection.
What Is the Treatment for Cutaneous Actinomycosis?
Antimicrobial therapy is the mainstay of treatment for lower extremities cutaneous actinomycosis.
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Penicillin G is the preferred medication. Following oral Amoxicillin, Ampicillin, or Penicillin V over an extended length of time (between six months and a year), high-dose Penicillin G (12 to 24 million U/d intravenous via continuous infusion or in split doses) is given.
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If the patient is allergic to Penicillin or the causing organisms are penicillin-resistant, several antibiotics can be used instead of Penicillins, including Ceftriaxone, Imipenem/Cilastatin, Clindamycin, Amoxycillin/Clavulanic Acid, Doxycycline, Tetracycline, Lincomycin, and Macrolides (erythromycin, Carbomycin, Spiramycin, and Oleandomycin).
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Surgery is recommended primarily to take a biopsy sample, drain abscesses, and remove a fibrotic sinus tract or a refractory fistulous tract that is not responding to conservative medicinal therapy.
What Is the Prognosis of Cutaneous Actinomycosis?
The prognosis is often favorable, particularly when it is discovered early and treated with the right antibiotic medication. Therefore, the follow-up should be thorough and diligent to have a complete cure for the condition.
Conclusion
Actinomycosis is a subacute or chronic suppurative bacterial infection that is largely caused by the genus Actinomyces of filamentous, gram-positive, anaerobic to microaerophilic, nonacid rapid bacilli, which often colonize the mouth, colon, and vagina. The condition known as actinomyosis is uncommon. Men are more likely than women to get actinomycosis. Skin edema, nodules, and soft tissue inflammations characterized it. Actinomycosis is often diagnosed with CT and X-rays. Antifungal and antibiotic use is the mainstay of the therapy. One must follow up regularly.
