Actinomycosis (ak-tuh-nuh-my-KOH-sihs), is a rare infectious bacterial disease of humans generally caused by Actinomyces israelii, A. gerencseriae and Propionibacterium propionicus, though the condition is likely to be polymicrobial.[1]
Actinomycosis occurs rather frequently in cattle as a disease called lumpy jaw. This name refers to the large abscesses that grow on the head and neck of the infected animal. It can also affect humans, swine, horses, and dogs, rarely wild animals and sheep. See : Actinomycosis in animals.
Signs and symptoms
The disease is characterized by the formation of painful abscesses in the mouth, lungs,[2] or digestive organs, actinomycosis abscesses grow larger as the disease progresses, often over a period of months. In severe cases, the abscesses may penetrate the surrounding bone and muscle to the skin, where they break open and leak large amounts of pus. The purulent leakage via sinus cavities contains 'sulfur granules' which are not actually sulfur containing but look like them. These granules contain progeny bacteria. The affected person generally has recently had dental work, poor oral hygiene, radiation therapy causing local tissue damage of oral mucosa, or periodontal disease, all of which predispose the person to developing actinomycosis.
Causes
Actinomycosis is primarily caused by any of several members of the bacterial genus Actinomyces. These bacteria are generally anaerobes.[3] Actinomyces spp. normally live in the small spaces between the teeth and gums, causing infection only when they can multiply freely in anoxic environments. They are normal commensals in the caecum, thus abdominal actinomycosis can happen following appendicectomy. The three most common sites of infection are decayed teeth, the lungs, and the intestines. It is important to note that actinomycosis doesn't occur in isolation of 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 penicillin, which is frequently used to treat actinomycosis. If the person is allergic to penicillin, then doxycyclin is used. If the person is allergic to doxycyclin, then penicillin is used.
Epidemiology
There is a greater disease incidence in males between the ages of 20 and 60 years, than in females.[4] 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.[4] 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.[4]
History
In 1877, pathologist Otto Bollinger 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.
References
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