II. Pathophysiology
- Chronic local or systemic Bacterial, Granulomatous disease
- Organisms: Actinomycetes (Gram Positive Rods with fungal-like growth)
- Actinomyces bovis
- Actinomyces israeli (most common)
- Gram Positive Rods, beaded, filamentous Anaerobes
- Normal oral flora
III. Symptoms
- Weight loss
- Weakness
IV. Signs
- Fever
- Disseminated organ involvement
- Head and neck (Cervicofacial) lumps, abscess and fistula tracts after facial Trauma
- Abdominal mass after surgery (with fistula in some cases)
- Pelvic from Tuboovarian Abscess (and PID), often related to IUD
- Lung Mass
- Skin
- Multiple sinus tracts draining pustular discharge
- Pus contains "sulfur granules" (actinomyces colonies)
V. Lab
-
Gram Stain of "sulfur granules"
- Gram Positive Rods with fungal-like growth
- Anaerobic Blood Culture
VI. Management
- First-Line
- FIRST: Ampicillin 16.5 mg/kg IV tid (or penicllin G 2.5 to 5 MU IV qid) for 4-6 weeks
- THEN: Penicillin VK 2-4g/day divided qid for 3-6 months
- Alternative agents
- Doxycycline 100 mg oral or IV twice daily
- Clindamycin 600-900 mg IV every 8 hours
- Adjunctive
- Surgical drainage
VII. Resources
- EMedicine: Actinomycosis
VIII. References
- (2015) Sanford Guide to Antibiotics, IOS App accessed 4/21/2016