Expired CME Article

Actinomycosis: Diagnosis and Management

Authors: Itzhak Brook, MD, MSc


Actinomycosis is an uncommon, chronic bacterial infection that induces both suppurative and granulomatous inflammation. Localized swelling with suppuration, abscess formation, tissue fibrosis, and sinus drainage characterizes this disease. The infection spreads contiguously, often forming draining sinuses that extrude characteristic but not pathognomonic “sulfur granules.” Infections of the oral and cervicofacial regions are most common; however, any site in the body can be infected and it often mimics malignancy. Other regions that are often affected are the thoracic and abdominopelvic, as well as the central nervous system. Musculoskeletal and disseminated disease can also be seen, albeit rarely. Prolonged antimicrobial therapy with penicillin has typically been recommended for patients with all clinical forms of actinomycosis to prevent disease recrudescence.

Key Points

* Actinomycosis spreads contiguously, forming draining sinuses that extrude characteristic “sulfur granules.”

* It can cause localized swelling with suppuration, abscesses, tissue fibrosis, draining sinuses, and often mimics malignancy.

* The regions commonly affected are the oral and cervicofacial, thoracic, and abdominopelvic, as well as the central nervous system.

* Proper drainage is needed if abscesses are present, and prolonged therapy with penicillin is the treatment of choice.

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1. Smego RA Jr, Foglia G. Actinomycosis. Clin Infect Dis 1998;26:1255–1261.
2. Hall V, Talbot PR, Stubbs SL, et al. Identification of clinical isolates of actinomyces species by amplified 16S ribosomal DNA restriction analysis. J Clin Microbiol 2001;39:3555–3562.
3. Lippes J. Pelvic actinomycosis: a review and preliminary look at prevalence. Am J Obstet Gynecol 1999;180:265–269.
4. Clarridge JE III, Zhang Q. Genotypic diversity of clinical actinomyces species: phenotype, source, and disease correlation among genospecies. J Clin Microbiol 2002;40:3442–3448.
5. Oostman O, Smego RA. Cervicofacial actinomycosis: diagnosis and management. Curr Infect Dis Rep 2005;7:170–174.
6. Pulverer G, Schutt-Gerowitt H, Schaal KP. Human cervicofacial actinomycoses: microbiological data for 1997 cases. Clin Infect Dis 2003;37:490–497.
7. Curi MM, Dib LL, Kowalski LP, et al. Opportunistic actinomycosis in osteoradionecrosis of the jaws in patients affected by head and neck cancer: incidence and clinical significance. Oral Oncol 2000;36:294–299.
8. Chouabe S, Perdu D, Deslee G, et al. Endobronchial actinomycosis associated with foreign body: four cases and a review of the literature. Chest 2002;121:2069–2072.
9. Mabeza GF, Macfarlane J. Pulmonary actinomycosis. Eur Respir J 2003;21:545–551.
10. de Montpreville VT, Nashashibi N, Dulmet EM. Actinomycosis and other bronchopulmonary infections with bacterial granules. Ann Diagn Pathol 1999;3:67–74.
11. Fife TD, Finegold SM, Grennan T. Pericardial actinomycosis: case report and review. Rev Infect Dis 1991;13:120–126.
12. Hsieh MJ, Liu HP, Chang JP, et al. Thoracic actinomycosis. Chest 1993;104:366–370.
13. Kim TS, Han J, Koh WJ, et al. Thoracic actinomycosis: CT features with histopathologic correlation. AJR Am J Roentgenol 2006;186:225–231.
14. Cintron JR, Del Pino A, Duarte B, et al. Abdominal actinomycosis. Dis Colon Rectum 1996;39:105–108.
15. Wagenlehner FM, Mohren B, Naber KG, et al. Abdominal actinomycosis. Clin Microbiol Infect 2003;9:881–885.
16. Cayley J, Fotherby K, Guillebaud J, et al. Recommendations for clinical practice: actinomyces like organisms and intrauterine contraceptives. The Clinical and Scientific Committee. Br J Fam Plann 1998;23:137–138.
17. Taga S. Diagnosis and therapy of pelvic actinomycosis. J Obstet Gynaecol Res 2007;33:882–885.
18. Goldberg MH. Diagnosis and treatment of cervicofacial actinomycosis. Oral Maxillofac Surg Clin North Am 2003;15:51–58.
19. Smego RA Jr. Actinomycosis of the central nervous system. Rev Infect Dis 1987;9:855–865.
20. Choi J, Koh WJ, Kim TS, et al. Optimal duration of IV and oral antibiotics in the treatment of thoracic actinomycosis. Chest 2005;128:2211–2217.
21. Hamid D, Baldauf JJ, Cuenin C, et al. Treatment strategy for pelvic actinomycosis: case report and review of the literature. Eur J Obstet Gynecol Reprod Biol 2000;89:197–200.
22. Sudhakar SS, Ross JJ. Short-term treatment of actinomycosis: two cases and a review. Clin Infect Dis 2004;38:444–447.
23. Trutnovsky G, Tamussino K, Reich O. Short-term antibiotic treatment of pelvic actinomycosis. Int J Gynaecol Obstet 2008;101:203–204.
24. Brook I. Beta-lactamase-producing bacteria and their role in infection. Rev Med Microbiol 2005;16:91–99.
25. Smith AJ, Hall V, Thakker B, et al. Antimicrobial susceptibility testing of actinomyces species with 12 antimicrobial agents. J Antimicrob Chemother 2005;56:407–409.