Actinomycosis

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Actinomycosis
Actinomycosis PHIL 2856 lores.jpg
A man with actinomycosis on the right side of his face
Specialty Infectious disease

Actinomycosis is a rare infectious bacterial disease caused by the gram-positive Actinomyces species. [1] The name refers to ray-like appearance of the organisms in the granules. About 70% of infections are due to either Actinomyces israelii or A. gerencseriae . [1] Infection can also be caused by Streptomyces somaliensis and Propionibacterium propionicus . The condition is likely to be a polymicrobial anaerobic infection. [2]

Contents

Signs and symptoms

The disease is characterised by the formation of painful abscesses in the mouth, lungs, [3] [4] breast, [5] or gastrointestinal tract. [2] Actinomycosis abscesses grow larger as the disease progresses, often over months. In severe cases, they may penetrate the surrounding bone and muscle to the skin, where they break open and leak large amounts of pus, which often contains characteristic granules filled with progeny bacteria. These granules are often called "sulfur granules" due to their yellow appearance, although they may also be white, gray or brown. [6]

Causes

Actinomycosis Grocott's stain Actinomycosis GROCOTT'S.JPG
Actinomycosis Grocott's stain
Actinomycosis Gram stain Actinomycosis GRAM'S.JPG
Actinomycosis Gram stain

Actinomycosis is primarily caused by any of several members of the bacterial genus Actinomyces . These bacteria are generally anaerobes. [7] In animals, they normally live in the small spaces between the teeth and gums, causing infection only when they can multiply freely in anoxic environments. An affected human often has recently had dental work, poor oral hygiene, periodontal disease, radiation therapy, or trauma (broken jaw) causing local tissue damage to the oral mucosa, all of which predispose the person to developing actinomycosis. A. israelii is a normal commensal species part of the microbiota species of the lower reproductive tract of women. [8] They are also normal commensals among the gut flora of the caecum; thus, abdominal actinomycosis can occur following removal of the appendix. The three most common sites of infection are decayed teeth, the lungs, and the intestines. Actinomycosis infections are typically polymicrobial, containing additional bacterial species; as Actinomyces itself has little invasive ability, these other species often aid in the infection process. [9]

Diagnosis

The diagnosis of actinomycosis can be a difficult one to make. In addition to microbiological examinations, magnetic resonance imaging and immunoassays may be helpful. [10]

Treatment

Actinomyces bacteria are generally sensitive to penicillin, which is frequently used to treat actinomycosis. In cases of penicillin allergy, doxycycline is used. Sulfonamides such as sulfamethoxazole may be used as an alternative regimen at a total daily dosage of 2–4 grams. Response to therapy is slow and may take months. Hyperbaric oxygen therapy may also be used as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment. [11] [12]

Epidemiology

Disease incidence is greater in males between the ages of 20 and 60 years than in females. [13] Before antibiotic treatments became available, the incidence in the Netherlands and Germany was one per 100,000 people/year. Incidence in the U.S. in the 1970s was one per 300,000 people/year, while in Germany in 1984, it was estimated to be one per 40,000 people/year. [13] The use of intrauterine devices (IUDs) has increased incidence of genitourinary actinomycosis in females. Incidence of oral actinomycosis, which is harder to diagnose, has increased. [13]

History

In 1877, pathologist Otto Bollinger described the presence of A. bovis in cattle, and shortly afterwards, James Israel discovered A. israelii in humans. In 1890, Eugen Bostroem isolated the causative organism from a culture of grain, grasses, and soil. After Bostroem's discovery, a general misconception existed that actinomycosis was a mycosis that affected individuals who chewed grass or straw. The pathogen is still known as the “great masquerader". [14] Bergey's Manual of Systematic Bacteriology classified the organism as bacterial in 1939, [15] but the disease remained classified as a fungus in the 1955 edition of the Control of Communicable Diseases in Man . [16]

Violinist Joseph Joachim died of actinomycosis on 15 August 1907. The Norwegian painter Halfdan Egedius died from actinomycosis on 2 February 1899.

Other animals

Actinomycosis occurs rarely in humans, but rather frequently in cattle as a disease called "lumpy jaw". This name refers to the large abscesses that grow on the head and neck of the infected animal. It can also rarely affect sheep, swine, horses, dogs, and other mammals. [17]

Related Research Articles

<span class="mw-page-title-main">Abscess</span> Localized collection of pus that has built up within the tissue of the body

An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends beyond the swelling. Carbuncles and boils are types of abscess that often involve hair follicles, with carbuncles being larger. A cyst is related to an abscess, but it contains a material other than pus, and a cyst has a clearly defined wall.

<span class="mw-page-title-main">Brain abscess</span> Medical condition

Brain abscess is an abscess within the brain tissue caused by inflammation and collection of infected material coming from local or remote infectious sources. The infection may also be introduced through a skull fracture following a head trauma or surgical procedures. Brain abscess is usually associated with congenital heart disease in young children. It may occur at any age but is most frequent in the third decade of life.

<span class="mw-page-title-main">Lemierre's syndrome</span> Medical condition

Lemierre's syndrome is infectious thrombophlebitis of the internal jugular vein. It most often develops as a complication of a bacterial sore throat infection in young, otherwise healthy adults. The thrombophlebitis is a serious condition and may lead to further systemic complications such as bacteria in the blood or septic emboli.

Bloodstream infections (BSIs) are infections of blood caused by blood-borne pathogens. Blood is normally a sterile environment, so the detection of microbes in the blood is always abnormal. A bloodstream infection is different from sepsis, which is characterized by severe inflammatory or immune responses of the host organism to pathogens.

<span class="mw-page-title-main">Melioidosis</span> Human disease

Melioidosis is an infectious disease caused by a gram-negative bacterium called Burkholderia pseudomallei. Most people exposed to B. pseudomallei experience no symptoms; however, those who do experience symptoms have signs and symptoms that range from mild, such as fever and skin changes, to severe with pneumonia, abscesses, and septic shock that could cause death. Approximately 10% of people with melioidosis develop symptoms that last longer than two months, termed "chronic melioidosis".

<span class="mw-page-title-main">Osteomyelitis</span> Infection of the bones

Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the feet, spine, and hips are most commonly involved in adults.

<span class="mw-page-title-main">Cellulitis</span> Bacterial infection of the inner layers of the skin called the dermis

Cellulitis is usually a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Signs and symptoms include an area of redness which increases in size over a few days. The borders of the area of redness are generally not sharp and the skin may be swollen. While the redness often turns white when pressure is applied, this is not always the case. The area of infection is usually painful. Lymphatic vessels may occasionally be involved, and the person may have a fever and feel tired.

<i>Actinomyces naeslundii</i> Species of bacterium

Actinomyces naeslundii is a Gram-positive, rod-shaped bacterium found in the mouth of humans. The species has been implicated in periodontal disease, as well as various tooth cavities. In other cases, A. naeslundii is associated with good oral health. It is one of the first bacteria to occupy the oral cavity and colonize the tooth's surface. It has also been isolated from women with bacterial vaginosis.

<i>Actinomyces</i> Genus of bacteria

Actinomyces is a genus of the Actinomycetia class of bacteria. They all are gram-positive and facultatively anaerobic, growing best under anaerobic conditions. Actinomyces species may form endospores, and while individual bacteria are rod-shaped, Actinomyces colonies form fungus-like branched networks of hyphae. The aspect of these colonies initially led to the incorrect assumption that the organism was a fungus and to the name Actinomyces, "ray fungus".

<span class="mw-page-title-main">Mastoiditis</span> Middle ear disease

Mastoiditis is the result of an infection that extends to the air cells of the skull behind the ear. Specifically, it is an inflammation of the mucosal lining of the mastoid antrum and mastoid air cell system inside the mastoid process. The mastoid process is the portion of the temporal bone of the skull that is behind the ear. The mastoid process contains open, air-containing spaces. Mastoiditis is usually caused by untreated acute otitis media and used to be a leading cause of child mortality. With the development of antibiotics, however, mastoiditis has become quite rare in developed countries where surgical treatment is now much less frequent and more conservative, unlike former times.

<span class="mw-page-title-main">Gas gangrene</span> Human bacterial infection

Gas gangrene is a bacterial infection that produces tissue gas in gangrene. This deadly form of gangrene usually is caused by Clostridium perfringens bacteria. About 1,000 cases of gas gangrene are reported yearly in the United States.

<i>Peptostreptococcus</i> Genus of bacteria

Peptostreptococcus is a genus of anaerobic, Gram-positive, non-spore forming bacteria. The cells are small, spherical, and can occur in short chains, in pairs or individually. They typically move using cilia. Peptostreptococcus are slow-growing bacteria with increasing resistance to antimicrobial drugs. Peptostreptococcus is a normal inhabitant of the healthy lower reproductive tract of women.

<span class="mw-page-title-main">Pathogenic bacteria</span> Disease-causing bacteria

Pathogenic bacteria are bacteria that can cause disease. This article focuses on the bacteria that are pathogenic to humans. Most species of bacteria are harmless and are often beneficial but others can cause infectious diseases. The number of these pathogenic species in humans is estimated to be fewer than a hundred. By contrast, several thousand species are part of the gut flora present in the digestive tract.

<span class="mw-page-title-main">Actinomycosis in animals</span> Bacterial disease mostly affecting cattle

Actinomycosis is an infection caused by a bacterium of the genus Actinomyces, usually Actinomyces bovis; the disease it causes has several common names. When it is a moveable tumour or lump on the jaw area, it is referred to as lump jaw; when it spreads into the hard bone of the jaw, it is referred to as big jaw; and when it affects the tongue, it is referred to as wooden tongue.

<span class="mw-page-title-main">Pus</span> Phenomenon of inflammatory infection

Pus is an exudate, typically white-yellow, yellow, or yellow-brown, formed at the site of inflammation during bacterial or fungal infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection of pus within or beneath the epidermis is known as a pustule, pimple or spot.

<i>Actinomyces israelii</i> Species of bacterium

Actinomyces israelii is a species of Gram-positive, rod-shaped bacteria within the genus Actinomyces. Known to live commensally on and within humans, A. israelii is an opportunistic pathogen and a cause of actinomycosis. Many physiologically diverse strains of the species are known to exist, though not all are strict anaerobes. It was named after the German surgeon James Adolf Israel (1848–1926), who studied the organism for the first time in 1878.

Perianal cellulitis, also known as perianitis or perianal streptococcal dermatitis, is a bacterial infection affecting the lower layers of the skin (cellulitis) around the anus. It presents as bright redness in the skin and can be accompanied by pain, difficulty defecating, itching, and bleeding. This disease is considered a complicated skin and soft tissue infection (cSSTI) because of the involvement of the deeper soft tissues.

Anaerobic infections are caused by anaerobic bacteria. Obligately anaerobic bacteria do not grow on solid media in room air ; facultatively anaerobic bacteria can grow in the presence or absence of air. Microaerophilic bacteria do not grow at all aerobically or grow poorly, but grow better under 10% carbon dioxide or anaerobically. Anaerobic bacteria can be divided into strict anaerobes that can not grow in the presence of more than 0.5% oxygen and moderate anaerobic bacteria that are able of growing between 2 and 8% oxygen. Anaerobic bacteria usually do not possess catalase, but some can generate superoxide dismutase which protects them from oxygen.

<i>Actinomyces bovis</i> Species of bacterium

Actinomyces bovis is a branching, Gram-positive, rod-shaped bacterium of the genus Actinomyces. It is the causative agent of lumpy jaw in cattle, and occasionally causes actinomycosis infections in humans. A. bovis normally populates the gastrointestinal tract of healthy ruminants, but is opportunistic in nature and will move into tissues through ulcerations or abrasions of the mucosa to cause infection. The disease occurs when there is physical damage to the tissue of the mouth, allowing the bacteria to colonize the deep tissue and bone, typically affecting the mandible and maxilla. Actinomycosis is pathognomonic for abscesses containing "sulfur" granules, and its colonies appear basophilic with club-shaped reaction products on a histological preparation. Lumpy jaw is commonly treated with broad-spectrum antibiotics with varying success, and can be a major economic loss for producers in countries where it is endemic. Because this organism is zoonotic, it is a human health concern and can cause granulomas, abscesses, skin lesions, and bronchopneumonia.

Actinomyces viscosus is a human and animal pathogen/pathobiont which colonises the mouths of 70% of adult humans. A. viscosus has a low level of virulence and is often mistaken with other actinomycetes.

References

  1. 1 2 Valour F, Sénéchal A, Dupieux C, Karsenty J, Lustig S, Breton P, Gleizal A, Boussel L, Laurent F, Braun E, Chidiac C, Ader F, Ferry T (2014). "Actinomycosis: etiology, clinical features, diagnosis, treatment, and management". Infect Drug Resist. 7: 183–97. doi: 10.2147/IDR.S39601 . PMC   4094581 . PMID   25045274.
  2. 1 2 Bowden GHW (1996). Baron S; et al. (eds.). Actinomycosis in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN   978-0-9631172-1-2. (via NCBI Bookshelf).
  3. ↑ Brook, I (Oct 2008). "Actinomycosis: diagnosis and management". Southern Medical Journal. 101 (10): 1019–23. doi:10.1097/SMJ.0b013e3181864c1f. PMID   18791528. S2CID   19554893.
  4. ↑ Mabeza, GF; Macfarlane J (March 2003). "Pulmonary actinomycosis". European Respiratory Journal. 21 (3): 545–551. doi: 10.1183/09031936.03.00089103 . PMID   12662015.
  5. ↑ Abdulrahman, Ganiy Opeyemi; Gateley, Christopher Alan (1 January 2015). "Primary actinomycosis of the breast caused by Actinomyces turicensis with associated Peptoniphilus harei". Breast Disease. 35 (1): 45–47. doi:10.3233/BD-140381. PMID   25095985.
  6. ↑ Kliegman, Robert M.; St. Geme, Joseph W., III (2019). Nelson Textbook of Pediatrics. Elsevier Health Sciences. p. 1466. ISBN   9780323568883.{{cite book}}: CS1 maint: multiple names: authors list (link)
  7. ↑ Ryan KJ; Ray CG, eds. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN   978-0-8385-8529-0.
  8. ↑ Hoffman, Barbara (2012). Williams gynecology (2nd ed.). New York: McGraw-Hill Medical. p. 42. ISBN   978-0071716727.
  9. ↑ Schaal, Klaus P.; Yassin, Atteyet F.; Stackebrandt, E. R. K. O. (2006). "The Family Actinomycetaceae: The Genera Actinomyces, Actinobaculum, Arcanobacterium, Varibaculum, and Mobiluncus". Prokaryotes. Vol. 3. p. 485. doi:10.1007/0-387-30743-5_21. ISBN   9780387254937.
  10. ↑ Böhm, Ingrid; Willinek, Winfried; Schild, Hans H. (October 2006). "Magnetic Resonance Imaging Meets Immunology: An Unusual Combination of Diagnostic Tools Leads to the Diagnosis Actinomycosis". The American Journal of Gastroenterology. 101 (10): 2439–2440. doi:10.1111/j.1572-0241.2006.00742_7.x. PMID   17032212. S2CID   2491012.
  11. ↑ "Bone Infections". MedlinePlus. US National Library of Medicine. Retrieved 16 August 2015.
  12. ↑ "Osteomyelitis (Refractory)". Undersea and Hyperbaric Medical Society. Retrieved 16 August 2015.
  13. 1 2 3 Wolff K, Goldsmith LA, Katz S, Gilchrist BA, Paller A, Leffell DJ (2007). Fitzpatrick's Dermatology in General Medicine (7th ed.). McGraw Hill.
  14. ↑ Sullivan, D. C.; Chapman, S. W. (12 May 2010). "Bacteria That Masquerade as Fungi: Actinomycosis/Nocardia". Proceedings of the American Thoracic Society. 7 (3): 216–221. doi:10.1513/pats.200907-077AL. PMID   20463251.
  15. ↑ Strong, Richard (1944). Stitt's Diagnosis, Prevention and Treatment of Tropical Diseases (7th ed.). p. 1182.
  16. ↑ Control of Communicable Diseases in Man (8th ed.). American Public Health Association. 1955.
  17. ↑ Smith GW (July 2020). "Actinomycosis in Cattle, Swine, and Other Animals". MSD Manual. Retrieved 6 November 2022.

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