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Actinomycoses 

Actinomycoses

Chapter:
Actinomycoses
Author(s):

K.P. Schaal

DOI:
10.1093/med/9780199204854.003.070629_update_001

Update:

Chapter reviewed, minor changes made, further reading added.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 24 March 2017

Human actinomycoses are always synergistic polymicrobial infections in which fermentative actinomycetes—predominantly Actinomyces israelii, A. gerencseriae, or Propionibacterium propionicum—are the principal pathogens, usually needing the assistance of so-called concomitant microbes to produce disease. Nearly all of the members of the mixed actinomycotic microflora belong to the indigenous microbial community of human mucous membranes, hence actinomycoses present as sporadic endogenous infections which are not transmissible.

Clinical features—the initial actinomycotic lesion usually develops in tissue adjacent to a mucous membrane as a subacute to chronic process that is granulomatous as well as suppurative, typically giving rise to multiple abscesses and draining sinus tracts that are preferentially located in the cervicofacial region, thorax or abdomen. These characteristically progress slowly, penetrate tissues without regard to natural organ borders, and spread haematogenously, with symptoms remitting and exacerbating with and without antimicrobial treatment.

Diagnosis—this can be difficult as clinical symptoms, radiographic, or histopathological signs, and the results of serological tests may all be misleading. The finding of so-called sulphur granules is pathognomonic: these are macroscopically visible, yellowish or reddish to brownish particles that exhibit a cauliflower-like appearance under the microscope at low magnifications, and which may be found as free structures in pus or embedded in affected tissue. Reliable diagnosis chiefly rests on bacteriological culture.

Treatment and prognosis—antibacterial drugs used for treatment should be active against both the causative actinomycetes and all concomitant bacteria. For cervicofacial actinomycoses, the rare cutaneous processes, and most thoracic forms of the disease, this requirement is best fulfilled by amoxicillin plus clavulanic acid in medium to high doses: abdominal cases and the presence of unusually resistant concomitant bacteria may require the addition of further antimicrobials (e.g. an aminoglycoside plus either metronidazole or clindamycin). The prognosis of cervicofacial and cutaneous actinomycoses is good provided that treatment is adequate; thoracic and abdominal forms are more serious, with grave prognosis without proper treatment.

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