Actinomycosis: Causes, Symptoms and Treatment

Actinomycosis is an infection caused by a bacterium called Actinomyces israelii (A. israelii).

Actinomycosis (also known as Rivalta disease, big jaw, clams, lumpy jaw or wooden tongue) is an infection, commonly of the face and neck, that produces abscesses (collections of pus) and open-draining sinuses (tracts in the skin).

Actinomycosis is caused by a bacterium called Actinomyces israelii (A. israelii). It occurs normally in the mouth and tonsils. This bacterium may cause infection when it is introduced into the soft tissues by trauma, surgery or another infection. Once in the tissues, it may form an abscess that develops into a hard red to reddish purple lump. When the abscess breaks through the skin, it forms pus-discharging lesions.

Causes of Actinomycosis

Actinomycosis is caused by a strain of bacteria called actinomycetales. Actinomycetales are found in many of the body’s cavities, such as inside the mouth and less commonly the bowel.

In women, they can also be found in the womb and the fallopian tubes (through which eggs are released into the womb).

How actinomycosis spreads

Actinomycetales are anaerobic bacteria, which means they cannot survive in oxygen-rich environments. Therefore, they do not present a problem when they are in one of the body’s cavities, such as the mouth or the intestinal tract.

However, if actinomycetales break through the protective lining (mucus membrane) that surrounds the cavities, they can penetrate deep into your body’s tissue. As the deep layers of human tissue are low in oxygen, the bacteria are able to reproduce quickly and infect healthy tissue.

Abscesses

In an attempt to combat the infection, your immune system (the body’s natural defence against infection and illness) will send infection-fighting cells to the source of the infection. However, these cells do not have the ability to kill the bacteria and will quickly die.

Actinomycosis (lumpy jaw)

As the infection-fighting cells die, they accumulate into a yellowish-coloured liquid called pus. Having failed to kill the infection, your immune system will attempt to limit its spread by using healthy tissue to form a protective barrier around the pus. This is how a pus-filled swelling, known as an abscess, is formed.

Unfortunately, the actinomycetales strain of bacteria has the ability to penetrate the protective barrier of an abscess and move into more healthy tissue. Your immune system will attempt to counter the infection by producing more abscesses.

Sinus tracts

Your body will eventually need to get rid of the accumulation of pus. To do this, small channels called sinus tracts will develop that lead from the abscesses to the surface of your skin.

The sinus tracts will leak pus, as well as ‘sulphur granules’, which are a yellow, powdery substance. The sulphur granules are actually made up of lumps of bacteria, but they are known as sulphur granules as they are the same colour as the chemical sulphur.

Opportunistic infection

Actinomycosis is an opportunistic infection that does not cause any symptoms unless an opportunity arises for it to penetrate into the body‘s tissue.

Oral cervicofacial actinomycosis

Opportunities for oral cervicofacial actinomycosis include:

  • tooth decay – particularly if the decay is left untreated for many years
  • gum disease
  • dental abscess
  • tonsillitis
  • inner ear infection
  • dental surgery, such as a tooth extraction, or root canal treatment
  • jaw surgery

Thoracic actinomycosis

Most cases of thoracic actinomycosis are thought to be caused by small particles of food or other ingested material that get mixed up with the actinomycosis bacteria. Rather than passing harmlessly down into the stomach, the particles are mistakenly passed down into the windpipe and the airways of the lungs.

People with long-term drug or alcohol problems are particularly at risk of developing thoracic actinomycosis for two reasons:

  • being drunk or intoxicated increases your risk of accidentally ingesting material into your lungs
  • long-term drug and alcohol misuse weakens the immune system, which makes a person more vulnerable to developing an infection

Abdominal actinomycosis

Abdominal actinomycosis occurs when something tears the wall of the intestine (bowel), allowing the bacteria to penetrate into deep tissue.

The intestine can tear as a result of an infection, such as a burst appendix that damages the wall of the intestine. Or it can be damaged through injury – for example, when someone mistakenly swallows a fish bone.

There have also been some reported cases of abdominal actinomycosis occurring as a complication of bowel or abdominal surgery.

Pelvic actinomycosis

Most cases of pelvic actinomycosis have been recorded in women who were using the intrauterine device (IUD) form of contraception. The IUD is a small, T-shaped contraceptive device made from plastic and copper that fits inside the womb. The women affected tend to be long-term users of the IUD (eight years or more).

One explanation for the high number of cases of pelvic actinomycosis in women who are using the IUD is that over time the IUD may damage the womb lining, allowing bacteria to penetrate into deep tissue. However, no research has yet been done to find out whether or not this is the case.

It should be stressed that developing pelvic actinomycosis as a result of using an IUD is very unlikely. In England, millions of women use the IUD device and there have only been a handful of reported cases of pelvic actinomycosis.

Actinomycosis Symptoms

The list of signs and symptoms mentioned in various sources for Actinomycosis includes the 17 symptoms listed below:

* Symptoms of facial actinomycosis:
o Swollen jaw
o Jaw pain
o Tooth pain
o Pus in the mouth
* Symptoms of other abscesses:
o Pain
o Fever
o Weight loss
* Varies depending on site
* Commonly includes the mouth
* Rectum and vagina
* Fever
* Pain
* Abscess formation
* Weight loss
* Abnormal vaginal bleeding and vaginal discharge

Actinomycosis Treatment

Medical Care

In most cases of actinomycosis, antimicrobial therapy is the only treatment required, although surgery can be adjunctive in selected cases. Penicillin G is the drug of choice for treating infections caused by actinomycetes.

Surgical Care

Attempt to cure actinomycosis, including extensive disease, with aggressive antimicrobial therapy alone initially. Surgical therapy may include incision and drainage of abscesses, excision of sinus tracts and recalcitrant fibrotic lesions, decompression of closed-space infections, and interventions aimed at relieving obstruction (eg, when actinomycotic lesions compress the ureter).

Consultations

* Interventional radiologist
* Surgeon
* Infectious diseases specialist

Diet

No specific dietary precautions are indicated in patients with actinomycosis.

Activity

Patients with actinomycosis may be active to the degree tolerated.


Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

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