Actinomycosis

Aka: Actinomycosis, Actinomyces israeli

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II. Pathophysiology

  1. Chronic local or systemic Bacterial, Granulomatous disease
  2. Organisms: Actinomycetes (Gram Positive Rods with fungal-like growth)
    1. Actinomyces bovis
    2. Actinomyces israeli (most common)
      1. Gram Positive Rods, beaded, filamentous Anaerobes
      2. Normal oral flora

III. Symptoms

  1. Weight loss
  2. Weakness

IV. Signs

  1. Fever
  2. Disseminated organ involvement
    1. Head and neck (Cervicofacial) lumps, abscess and fistula tracts after facial Trauma
    2. Abdominal mass after surgery (with fistula in some cases)
    3. Pelvic from Tuboovarian Abscess (and PID), often related to IUD
    4. Lung Mass
  3. Skin
    1. Multiple sinus tracts draining pustular discharge
    2. Pus contains "sulfur granules" (actinomyces colonies)

V. Lab

  1. Gram Stain of "sulfur granules"
    1. Gram Positive Rods with fungal-like growth
  2. Anaerobic Blood Culture

VI. Management

  1. First-Line
    1. FIRST: Ampicillin 16.5 mg/kg IV tid (or penicllin G 2.5 to 5 MU IV qid) for 4-6 weeks
    2. THEN: Penicillin VK 2-4g/day divided qid for 3-6 months
  2. Alternative agents
    1. Doxycycline 100 mg oral or IV twice daily
    2. Clindamycin 600-900 mg IV every 8 hours
  3. Adjunctive
    1. Surgical drainage

VII. Resources

  1. EMedicine: Actinomycosis
    1. http://emedicine.medscape.com/article/211587-overview#showall

VIII. References

  1. (2015) Sanford Guide to Antibiotics, IOS App accessed 4/21/2016

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