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Chapter 156. Actinomycosis

Actinomycosis is an indolent, slowly progressive infection caused by anaerobic or microaerophilic bacteria, primarily of the genus Actinomyces, that colonize the mouth, colon, and vagina. Mucosal disruption may lead to infection at virtually any site in the body. In vivo growth of actinomycetes usually results in the formation of characteristic clumps called grains or sulfur granules. The clinical presentations of actinomycosis are myriad. Common in the preantibiotic era, actinomycosis has diminished in incidence, as has its timely recognition. . | Chapter 156. Actinomycosis Actinomycosis is an indolent slowly progressive infection caused by anaerobic or microaerophilic bacteria primarily of the genus Actinomyces that colonize the mouth colon and vagina. Mucosal disruption may lead to infection at virtually any site in the body. In vivo growth of actinomycetes usually results in the formation of characteristic clumps called grains or sulfur granules. The clinical presentations of actinomycosis are myriad. Common in the preantibiotic era actinomycosis has diminished in incidence as has its timely recognition. Actinomycosis has been called the most misdiagnosed disease and it has been said that no disease is so often missed by experienced clinicians. Thus this entity remains a diagnostic challenge. Three clinical presentations that should prompt consideration of this unique infection are 1 the combination of chronicity progression across tissue boundaries and mass-like features mimicking malignancy with which it is often confused 2 the development of a sinus tract which may spontaneously resolve and recur and 3 a refractory or relapsing infection after a short course of therapy since cure of established actinomycosis requires prolonged treatment. An awareness of the full spectrum of the disease will expedite its diagnosis and treatment and will minimize the unnecessary surgical interventions morbidity and mortality that are reported all too often. Etiologic Agents Actinomycosis is most commonly caused by A. israelii. A. naeslundii A. odontolyticus A. viscosus A. meyeri A. gerencseriae and Propionibacterium propionicum are established but less common causes. Most if not all actinomycotic infections are polymicrobial. Actinobacillus actinomycetemcomitans Eikenella corrodens Enterobacteriaceae and species of Fusobacterium Bacteroides Capnocytophaga Staphylococcus and Streptococcus are commonly isolated with actinomycetes in various combinations depending on the site of infection. The contribution of these other .