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Actinomycosis

Mohanad N. Saleh 6th year meical student Supervisor: Dr. Anas Muhanna

About 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 Characteristic:clumps called grains or sulfur granules under microscopy

ETIOLOGIC AGENTS
most commonly caused by A. israelii. A. naeslundii, A. odontolyticus, A. viscosus, A. meyeri Most if not all actinomycotic infections are polymicrobial.

EPIDEMIOLOGY
peak incidence in the middle decades Males have a threefold higher incidence of infection than females(possibly poor dental hygiene) Individuals who do not seek or have access to health care are undoubtedly at higher risk.

PATHOGENESIS AND PATHOLOGY


normal oral flora and are often cultured from the bronchi, the gastrointestinal tract, and female genital tract disruption of the mucosal barrier. Local infection may consequently ensue. spreads contiguously in a slow progressive manner, ignoring tissue planes

Indulent Phase: manifested by lesions that usually appear as single or multiple indurations. Central necrosis consisting of neutrophils and sulfur granules develops and is virtually diagnostic of this disease fibrotic walls of the mass are typically described as wooden

Foreign bodies as IUCDs can raise the risk. HIV and immunocompromised patients have a higher chance. Ulcerative mucosal infections (e.g., by herpes simplex virus or cytomegalovirus)

Oral-Cervicofacial Disease
most frequently at an oral, cervical, or facial site, usually as a soft tissue swelling, abscess, or mass lesion that is often mistaken for a neoplasm. Pain, fever, and leukocytosis are variably reported. extension to the cranium, cervical spine, or thorax is a potential sequela

Thoracic Disease
involvement of the pulmonary parenchyma and/or the pleural space Sx: Chest pain, fever, and weight loss are common. A cough, when present, is variably productive. CXR: a mass lesion or pneumonia CT: central areas of low attenuation and ringlike rim enhancement may be seen

FIGURE147-1 Harrisons text book of Internal medicine

Thoracic actinomycosis 50% of cases include pleural thickening, effusion, or empyema( empty arrow)

Abdominal Disease
Months or years usually pass from the inciting event (e.g., appendicitis, diverticulitis, peptic ulcer disease, foreign-body perforation, bowel surgery, or ascension from IUCDassociated pelvic disease) Peritoneal fliud >> any abdominal organ, region, or space can be involved

disease usually presents as an abscess, a mass, or a mixed lesion that is often fixed to underlying tissue and mistaken for a tumor CT: enhancement is most often heterogeneous and adjacent bowel is thickened. Sinus tracts to the abdominal wall, to the perianal region, or between the bowel and other organs may develop and mimic inflammatory bowel disease.

Musculoskeletal and Soft Tissue Infection


due to adjacent soft-tissue infection but may be associated with trauma Cutaneous sinus tracts frequently develop.

Disseminated Disease
multiple-organ involvement. The lungs and liver are most commonly affected, with the presentation

DIAGNOSIS
Clinically, and raiology Aspirations and biopsies (with or without CT or ultrasound guidance) microscopic identification of sulfur granules

TREATMENT
High doses of antimicrobials for a prolonged period ( table) CT and MRI should be used to monitor the response to therapy. In most cases, either surgery can be avoided or a less extensive procedure can be used except when medical Tx fails

Reference: Harrisons principles of internal medicine. 16th edition.

Thank you