Actinomycosis is a chronic bacterial infection which, commonly, affects the face and neck. It usually does not cause disease and is not contagious.
Actinomycosis It is usually caused by a bacterium called Actinomyces israelii. It is a common organism normally found in the nose and throat.
When it penetrates the facial tissues due to trauma, surgery or infection, the bacteria causes an abscess and produces a hard bump from deep red to purple red. It often occurs with dental abscesses or oral surgery.
Actinomycosis most commonly affects the face and neck; However, the infection can sometimes also occur in the chest, abdomen, pelvis, or other areas of the body.
On the other hand, the infection can also affect certain women who have had an intrauterine device (IUD) to prevent pregnancy.
Types of actinomycosis
Actinomycosis appears more frequently in adult men and it can manifest itself in several ways:
- Cervicofacial: It presents with mandibular swelling. The most frequent origin is usually tooth decay.
- Thoracic: Lung disease is secondary to the aspiration of buccal secretions.
- Abdominal: it may be due to the rupture of the mucous membrane of a diverticulum or appendix, or to trauma.
- Uterine: It appears in women who have an IUD. Its symptoms are vaginal discharge and pelvic or hypogastric pain.
- Generalized: The infection spreads through the bloodstream to numerous areas of the body. Various symptoms may appear such as back pain, headache or abdominal pain.
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The diagnosis is confirmed by the identification of A. israelii by microscopy and culture of sputum, pus or a biopsy. Imaging is often done based on the results.
The lesions can simulate malignant proliferations. The lung lesions should be distinguished from those of tuberculosis and cancer. Most abdominal injuries are difficult to diagnose, except for laparotomy.
The disease progresses slowly. The prognosis is directly related to early diagnosis. In addition, the prognosis is more favorable in the cervicofacial form.
However, Actinomycosis progressively worsens in the thoracic, abdominal and generalized forms, especially if it affects the central nervous system.
Treatment of actinomycosis
The treatment of actinomycosis can be pharmacological and surgical type:
The treatment of actinomycosis usually requires antibiotics for several months, even up to a year.
The antibiotics of first choice are:
- Betalactamic antibiotics of the penicillin type, either parenterally or orally. However, in allergic patients it can be used:
- Macrolides: erythromycin and azithromycin.
- Lincosamines: clindamycin or lincomycin.
The duration of treatment with antibiotics should be prolonged from 2 to 6 weeks. However, in the first days it can be parenteral and later change orally, depending on the evolution. In some cases, there may be oral treatments for more than 12 months.
The recommended dose of Penicillin G is 20 million units in 24 hours. In cases of suspected infections, the use of antibiotics is not recommended until obtaining a sample for the purpose of isolation of the causative agent. Intravenous therapy is recommended for patients with more severe disease.
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For women with gynecological or pelvic actinomycosis, Surgical treatment consists of treating obstructive symptoms. To do this, a drain is made at the site of its location.
In addition, the treatment of obstructive complications should be followed by antibiotic treatment for a long time. This is intended to avoid serious complications of the disease.
In cases of thoracic actinomycosis, drainage is performed and obstructive complications are treated, followed by antibiotics. The bronchoscopic extraction of the foreign body is effective in all cases.