II. Etiologies

  1. Actinomycosis israeli (most common)
  2. Actinomycosis bovis

III. Pathophysiology

  1. Chronic local or systemic Bacterial, Granulomatous disease

IV. Symptoms

  1. Weight loss
  2. Weakness

V. Signs

  1. Fever
  2. Disseminated organ involvement
    1. Head and neck (Cervicofacial) lumps 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

VI. Lab

  1. Gram Stain of sulfur granules
    1. Gram Positive fungi
  2. Anaerobic Blood Culture

VII. 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

VIII. Resources

IX. References

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

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