What is Actinomycosis?

Chronic purulent granulomatous disease caused by actinomycetes. Lesions occur in the face, neck, chest, and abdomen, and are characterized by expansion into surrounding tissues to form fistulas and discharge of pus with sulfur-like particles. Large-dose, long-term penicillin treatment is effective in most cases. Tetracycline, erythromycin, lincomycin, and cephalosporin antibiotics can also be used. At the same time, surgical drainage of pus and surgical removal of fistulas are required. The disease is not contagious. Pay attention to oral hygiene to prevent the disease.

Basic Information

English name

actinomycosis

Visiting department

surgical

Common locations

Face, neck, chest and abdomen

Common causes

Actinomyces isidii

Common symptoms

Face and neck abscesses, local plate-like hard, abscesses puncture into many abscess sinus tracts, "sulfur particles" are common in discharged pus

Causes of actinomycosis

Actinomycetes is the most common pathogen. These pathogenic bacteria are anaerobic or microaerobic, which is usually a normal flora in the human body, especially in the oral cavity. If there is trauma, infection can occur after surgery. After infection, bacterial infections are often associated, and the damage gradually spreads from the center to the surroundings through the sinus, invading the skin, subcutaneous tissues, muscles, fascia, bones and internal organs. It can be transmitted through the digestive tract and trachea, and rarely through blood.

Clinical manifestations of actinomycosis

Facial and neck actinomycosis

It is most common and can begin with parasitic infections in the mouth. Pathogens can invade from dental caries or periodontal abscesses, tonsil lesions, etc., and they occur at the junction of the face and neck. The surface is dark red or brown red. Later, an abscess is formed, the local plate is hard, and the abscess penetrates into many pus sinus tracts. "Sulfur particles" are common in discharged pus. The lesions can extend to the skull, neck, shoulders, and chest, etc. When the masticatory muscles are involved, the teeth can be closed tightly, and the periostitis and osteomyelitis can be caused later.

2. Abdominal actinomycosis

Pathogens are caused by ingestion of the intestinal mucosa by oral ingestion, and can also be directly affected by chest lesions. Occurs in the ileocecal area, such as acute, subacute or chronic appendicitis manifestations, plate-like hardness of the local mass, and then piercing the abdominal wall to form a fistula. "Sulfur particles" can be seen in the pus, which can be accompanied by fever, night sweats, fatigue, weight loss, etc Symptoms can also affect other abdominal organs, such as the stomach, liver, kidneys, etc., or the spine, ovary, bladder, and chest cavity, or the spread of blood to the central nervous system.

3. Chest Actinomycosis

Pathogens enter the lungs through the respiratory tract and become pathogenic. They can also be directly affected by actinomycosis in adjacent areas. They often invade the hilar or base of the lungs and show acute or chronic infections, such as irregular fever, chest pain, cough, sputum with blood, Night sweats, weight loss, etc. The pleura can cause pleurisy, empyema, and can form pus drainage fistula. There are "sulfur particles" in the pus. X-rays show consolidation of the lung lobes, which can have translucent areas, which can be associated with pleural adhesions and pleural effusions. Causes pericarditis.

4. Cerebral actinomycosis

(1) The limited types include thick-walled abscesses and granulomas, which are more common in the brain, and can also involve the third ventricle and the posterior cranial fossa, causing elevated intracranial pressure. Cerebral nerve involvement can cause headaches, nausea, vomiting, diplopia, and disc bleeding.

(2) Diffuse type showed simple meningitis or brain abscess, but also showed epidural abscess and skull osteomyelitis.

5.Skin type actinomycosis

It is caused by direct skin contact with pathogenic bacteria and can be located in various parts of the body. It is a subcutaneous nodule from the beginning. After softening, it ruptures into a sinus tract. After the fistula was broken, there were "sulfur particles" in the pus. The disease is chronic. It can also invade deep tissues and become locally hard due to fibrosis and scar formation.

Actinomycosis check

1. Pathogen inspection

(1) Direct microscopic examination of the granules for tablet compression and Gram staining showed blue mycelial masses and rods. Pus smears may also find small, short branch-like hyphae, negative for acid-fast staining. Note that Nocardia is positive for acid-fast staining and that Streptomyces has spores.

(2) The culture is difficult. The particles must be washed with sterile saline several times to remove bacteria, and then crushed with a sterilized glass rod, streaked and inoculated on blood agar of brain heart infusion, into a CO ₂ anaerobic bacteria tank, Only at 37 ° C.

2. Histopathology

In the early stage, there was local infiltration of white blood cells, forming small abscesses, and penetrating to form sinus tracts, which could communicate with each other. The fascia, pleura, diaphragm, and bones in the body cannot prevent its development. There may be chronic granulation tissue hyperplasia near the purulent area, which may be infiltrated with lymphoid cells, plasma cells, histiocytes, and fibroblasts, and the local tissue may also be glass-like degeneration, causing a hard plate-like, "sulfur particles" can be seen in the abscess The center of HE staining was homogeneous, with fence-like short rod-shaped cells around it.

Actinomycosis diagnosis

Typical clinical manifestations, special imaging findings, sulfur particles found in the pus, the diagnosis is not difficult. In addition, the diagnosis can be further confirmed by combining the pathogenic examination and histopathology.

Actinomycosis treatment

Systemic treatment

Large-dose, long-range penicillin treatment is effective for this disease, intramuscularly or intravenously. Others such as lincomycin, tetracycline, chloramphenicol, streptomycin, sulfonamides, and rifampicin have certain effects. Antifungals such as polyenes and azoles are not effective for this disease.

Local treatment

All superficial lesions and sinus abscesses should be excised or drained.