Actinomycosis
Encyclopedia
Actinomycosis is an infectious
bacteria
l disease caused by Actinomyces
species such as Actinomyces israelii
or A. gerencseriae. It can also be caused by Propionibacterium propionicus
, and the condition is likely to be polymicrobial aerobic anaerobic infection
.
Actinomycosis occurs rarely in humans but rather frequently in cattle
as a disease called lumpy jaw. This name refers to the large abscess
es that grow on the head and neck of the infected animal. It can also affect swine, horses, and dogs, and less often wild animals and sheep. See: Actinomycosis in animals
.
es in the mouth
, lungs, or gastrointestinal tract
. 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
. The purulent leakage via the sinus cavities contains "sulfur granules," not actually sulfur-containing but resembling such particles. These granules contain progeny bacteria.
Actinomyces
. These bacteria are generally anaerobes
. 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
, or radiation therapy
causing local tissue damage to the oral mucosa
, all of which predispose the person to developing actinomycosis. They are also normal commensals in 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. It is important to note that actinomycosis does not occur in isolation from other bacteria. This infection depends on other bacteria (gram positive, gram negative, and cocci) to aid in invasion of tissue.
, which is frequently used to treat actinomycosis. In cases of penicillin allergy, doxycyclin 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.
described the presence of Actinomyces bovis in cattle, and shortly afterwards, James Israel
discovered Actinomyces israelii in humans. In 1890, Eugen Bostroem
isolated the causative organism from a culture of grain, grasses, and soil. After Bostroem's discovery there was a general misconception that actinomycosis was a mycosis
that affected individuals who chewed grass or straw.
Violinist Joseph Joachim
died of actinomycosis.
Infectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...
bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
l disease caused by Actinomyces
Actinomyces
Actinomyces from Greek "actino" that means mucus and fungus, is a genus of the actinobacteria class of bacteria. They are all Gram-positive and are characterized by contiguous spread, suppurative and granulomatous inflammation, and formation of multiple abscesses and sinus tracts that may...
species such as Actinomyces israelii
Actinomyces israelii
Actinomyces israelii is a species of Actinomyces.Actinomycosis is most frequently caused by Actinomyces israelii and is sometimes known as the "most misdiagnosed disease," as it is frequently confused with neoplasms. A. israelii is a normal colonizer of the vagina, colon, and mouth...
or A. gerencseriae. It can also be caused by Propionibacterium propionicus
Propionibacterium propionicus
Propionibacterium propionicus is a Gram positive, aerotolerant anaerobic species of Propionibacterium, found as part of the normal human oral flora....
, and the condition is likely to be polymicrobial aerobic anaerobic infection
Anaerobic infection
Anaerobic infections are caused by anaerobic bacteria. Anaerobic bacteria do not grow on solid media in room air ; facultative anaerobic bacteria can grow in the presence as well as in the absence of air. Microaerophilic bacteria do not grow at all aerobically or grow poorly, but grow better under...
.
Actinomycosis occurs rarely in humans but rather frequently in cattle
Cattle
Cattle are the most common type of large domesticated ungulates. They are a prominent modern member of the subfamily Bovinae, are the most widespread species of the genus Bos, and are most commonly classified collectively as Bos primigenius...
as a disease called lumpy jaw. This name refers to the large abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
es that grow on the head and neck of the infected animal. It can also affect swine, horses, and dogs, and less often wild animals and sheep. See: Actinomycosis in animals
Actinomycosis in animals
Actinomycosis in animals is caused by Actinomyces bovis .It is a quite common condition in cattle, where it is referred to as lumpy jaw or senfed ....
.
Signs and symptoms
The disease is characterized by the formation of painful abscessAbscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
es in the mouth
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....
, lungs, or gastrointestinal tract
Gastrointestinal tract
The human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. ....
. 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
Pus
Pus is a viscous exudate, typically whitish-yellow, yellow, or yellow-brown, formed at the site of inflammatory during 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 or...
. The purulent leakage via the sinus cavities contains "sulfur granules," not actually sulfur-containing but resembling such particles. These granules contain progeny bacteria.
Causes
Actinomycosis is primarily caused by any of several members of the bacterial genusGenus
In biology, a genus is a low-level taxonomic rank used in the biological classification of living and fossil organisms, which is an example of definition by genus and differentia...
Actinomyces
Actinomyces
Actinomyces from Greek "actino" that means mucus and fungus, is a genus of the actinobacteria class of bacteria. They are all Gram-positive and are characterized by contiguous spread, suppurative and granulomatous inflammation, and formation of multiple abscesses and sinus tracts that may...
. These bacteria are generally anaerobes
Anaerobic organism
An anaerobic organism or anaerobe is any organism that does not require oxygen for growth. It could possibly react negatively and may even die if oxygen is present...
. In animals, they normally live in the small spaces between the teeth and gums, causing infection only when they can multiply freely in anoxic
Hypoxia (medical)
Hypoxia, or hypoxiation, is a pathological condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise...
environments. An affected human often has recently had dental work
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
, poor oral hygiene
Oral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...
, periodontal disease
Periodontal disease
Periodontitis is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth...
, or radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
causing local tissue damage to the oral mucosa
Oral mucosa
The oral mucosa is the mucous membrane epithelium of the mouth. It can be divided into three categories.*Masticatory mucosa, para-keratinized stratified squamous epithelium, found on the dorsum of the tongue, hard palate and attached gingiva....
, all of which predispose the person to developing actinomycosis. They are also normal commensals in the caecum; thus, abdominal actinomycosis can occur following removal of the appendix
Vermiform appendix
The appendix is a blind-ended tube connected to the cecum , from which it develops embryologically. The cecum is a pouchlike structure of the colon...
. The three most common sites of infection are decayed teeth, the lungs, and the intestines. It is important to note that actinomycosis does not occur in isolation from other bacteria. This infection depends on other bacteria (gram positive, gram negative, and cocci) to aid in invasion of tissue.
Treatment
Actinomyces bacteria are generally sensitive to penicillinPenicillin
Penicillin is a group of antibiotics derived from Penicillium fungi. They include penicillin G, procaine penicillin, benzathine penicillin, and penicillin V....
, which is frequently used to treat actinomycosis. In cases of penicillin allergy, doxycyclin is used.
Sulfonamides
Sulfonamide (medicine)
Sulfonamide or sulphonamide is the basis of several groups of drugs. The original antibacterial sulfonamides are synthetic antimicrobial agents that contain the sulfonamide group. Some sulfonamides are also devoid of antibacterial activity, e.g., the anticonvulsant sultiame...
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.
Epidemiology
There is a greater disease incidence in males between the ages of 20 and 60 years than in females. Before antibiotic treatments became available, the incidence in the Netherlands and Germany was 1 per 100,000 people/year. Incidence in the U.S. in the 1970s was 1 per 300,000 people/year, while in Germany in 1984, it was estimated to be 1 per 40,000 people/year. 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.History
In 1877, pathologist Otto BollingerOtto Bollinger
Otto Bollinger was a German pathologist born in Altenkirchen, Kusel, Rhineland-Palatinate.In 1868, he obtained his doctorate at Berlin, receiving his habilitation two years later...
described the presence of Actinomyces bovis in cattle, and shortly afterwards, James Israel
James Israel
James Adolf Israel was a German surgeon who was a native of Berlin. In 1870 he received his medical doctorate from Friedrich-Wilhelms-Universität. He studied under von Bernhard Rudolf Konrad von Langenbeck and Ludwig Traube...
discovered Actinomyces israelii in humans. In 1890, Eugen Bostroem
Eugen Bostroem
Eugen Woldemar Bostroem was a German pathologist. He was a native of Fellin , Livonia). He studied medicine in Leipzig and Erlangen, receiving his degree in 1876. Afterwards he was an assistant to Friedrich Albert von Zenker at the pathology institute in Erlangen...
isolated the causative organism from a culture of grain, grasses, and soil. After Bostroem's discovery there was a general misconception that actinomycosis was a mycosis
Mycosis
A mycosis is a fungal infection of animals, including humans. Mycoses are common, and a variety of environmental and physiological conditions can contribute to the development of fungal diseases...
that affected individuals who chewed grass or straw.
Violinist Joseph Joachim
Joseph Joachim
Joseph Joachim was a Hungarian violinist, conductor, composer and teacher. A close collaborator of Johannes Brahms, he is widely regarded as one of the most significant violinists of the 19th century.-Origins:...
died of actinomycosis.