Actinomycosis is a bacterial infection that leads to abscess formation in deeper tissues. The cause of the infection is bacteria of the actinomyces species. Medication and, in some cases, surgical intervention are used to treat the disease.
What is actinomycosis?
Actinomycosis is a bacterial infection that leads to abscess formation in deeper tissues. The cause of the infection is bacteria of the actinomyces species. Actinomycetes are rod-shaped bacteria with gram-positive staining behavior. The anaerobes do not form spores and have microscopic appearance with radial-filamentous branching. There are numerous species of Actinomyces. Some of the human pathogenic species cause the so-called actinomycosis. Actinomycoses are characterized by abscess formation. The accumulation of pus in the tissues spreads to the surrounding tissue and is framed by connective and granulation tissue. Throughout Germany, the disease is also known as radiation mycosis. Through fistula formation, the bacterial pathogens enter the blood system, resulting in short-term bacteremia or, in immunodeficient patients, permanent bacteremia. A complication of bacteremia is sepsis, which corresponds to a systemic inflammatory reaction in the sense of blood poisoning and can assume life-threatening proportions in the context of septic shock. Actinomycoses include cervico-facial, thoracic, and abdominal actinomycoses, as well as cutaneous actinomycosis and various special forms, all caused by Actinomyces.
Causes
The cause of actinomycosis is a mixed bacterial anaerobic aerobic infection with Actinomyces. Predominantly, the infection is caused by the species Actinomyces israelii, but Actinomyces naeslundii, viscosus, and odontolyticus are also possible causative agents. For example, the species Actinomyces viscosus can colonize the female urogenital tract. Actinomyces israelii, on the other hand, are part of the normal oral flora of humans and bring an existence there as commensal. When the oral mucosa is injured, the bacteria penetrate into deeper tissues. In these deeper layers, they cause purulent inflammation associated with the formation of granulation tissue and duct-like fistulas. The occurrence of actinomycosis in the central nervous system is rather rare. The same is true for the occurrence in the lungs, which can take place only by aspiration of the bacteria. The disease is also observed less frequently on the skin than in the neck. Basically, any penetration of the bacteria from the oral flora into deeper tissues can result in actinomycosis. This means that not only inflammation but also fistulas can promote the disease. Nonetheless, invasive dental treatments are considered the most common trigger of actinomycosis.
Symptoms, complaints, and signs
Patients with actinomycosis are affected by abscess formation, with pus collections that extend to surrounding tissues and are located in connective and granulation tissues. The colonized tissue is of a coarse consistency, with pus consisting of inflammatory fused cells, immune components, and bacteria. Abscesses can spread further along the anatomic clefts, supporting the multiplication of pathogens.
- In cervico-facial actinomycosis, and thus the most common form of the disease, bacteria of the species Actinomyces israelii invade deeper tissues through an injury in the mouth and cause endogenous infection.
- Thoracic actinomycosis may result from salivary aspiration, is caused by rampant cervico-facial actinomycosis, or results from dissemination of the bacteria in the blood. In this form, the area of the chest and lungs are affected by the abscesses.
- Abscesses of abdominal actinomycosis affect the abdominal organs and occur in intestinal lesions or begin in the female genital area. Abscesses of the skin occur in the cutaneous variant, which develops after injuries involving saliva transfer. In some special forms of the disease, the liver and lacrimal ducts are affected by abscess formation, usually due to the spread of bacteria in the blood.
The infection may be accompanied by general signs of infection such as fatigue, fever and chills. If the central nervous system is involved, the abscesses can affect just about all bodily functions.
Diagnosis and course
In actinomycosis, drusen form that correspond to hard granules in the fistula ladder and appear microscopically as an accumulation of bacteria. These drusen allow the physician to develop an initial suspicion of actinomycosis in light of the patient’s history. Cultural detection is performed under anaerobic conditions, but is very laborious and takes several weeks. Due to the high recurrence rate, the prognosis is rather unfavorable. If left untreated, actinomycosis is a life-threatening phenomenon, especially in the thoracic region.
Complications
In most cases, actinomycosis does not present with complications. The symptom can be treated relatively well with no further problems, discomfort, or limitations. In most cases, actinomycosis occurs after operations in the oral cavity, during which the affected person does not pay attention to the necessary hygiene standards. Here, inflammation and transfer of the bacteria into the patient’s blood can occur. To prevent actinomycosis, antibiotics can be used prophylactically after oral surgery. The treatment is carried out without complications. For this purpose, in most cases, only medication is administered. However, the treatment itself can last up to a year. However, it hardly restricts the patient’s life. Treatment is also possible in the form of a three-month short therapy. In the further course of the disease, surgical intervention can also be performed. This also does not lead to any further complications. The only complication that can occur is acute blood poisoning. Actinomycosis can recur even after treatment. However, with good hygiene and prophylaxis, the probability is very low.
When should you go to the doctor?
In most cases, actinomycosis does not present any particular and characteristic symptoms or complaints. For this reason, early diagnosis is not possible in most cases. However, those affected always suffer from fever and chills as a result of the infection. In most cases, those affected also feel tired and weary and no longer take an active part in life. If these complaints occur, a doctor must usually be consulted. Especially in the case of long-lasting complaints, medical treatment is definitely necessary. Other bodily functions may also be impaired. If the affected person has previously had treatment in the oral cavity, the complaints may directly indicate an infection or inflammation. In this case, the attending physician can be consulted. As a rule, actinomycosis can be treated relatively quickly and easily, so that the complaints quickly disappear. However, if the symptoms do not directly indicate actinomycosis, a general practitioner can also be consulted in the first instance.
Treatment and therapy
The therapy of actinomycosis is medicinal, especially in the early stages. In most cases, treatment corresponds to the administration of aminopenicillin, which is optimally administered intravenously, especially in the early stages. The therapy can extend over an entire year. According to current studies, short-term therapy is also possible, for a maximum of three months. Drug alternatives to aminopenicillin include tetracycline and cephalosporin. In addition, high-dose iodine has shown beneficial effects on the course of the disease in the past. Often, combined drug and surgical therapy takes place in later stages of the disease. In surgical treatment of abscesses, the focus of inflammation is opened, and the physician removes the affected tissue. Since actinomycosis can lead to fistula formation, systemic sepsis is one of the most important complications. In cases of fistula, invasive treatment takes place to remove the ductal systems to prevent the abscess from spreading into the blood. The condition is associated with a high recurrence rate and, accordingly, may recur even after healing.
Outlook and prognosis
Actinomycosis causes a variety of symptoms. These complaints do not disappear on their own, so treatment by a doctor is always necessary. The affected person feels sick and tired, suffering from fatigue. A relatively high fever occurs, which significantly reduces the quality of life of the affected person. Chills also occur.Often, paralysis and other disorders of the nervous system can also occur, which can complicate the patient’s daily life. Inflammation and infections occur in the oral cavity, which can make it difficult to ingest food and liquids in the usual way. With treatment, the symptoms of actinomycosis can be relatively well limited and the disease can thus be completely controlled. In most cases, this does not result in reduced life expectancy or further symptoms. However, even with successful treatment, there is no guarantee that actinomycosis will not recur in the patient. Surgical treatment involves removal of the affected tissue. In most cases, however, the affected person must also take medication to prevent the disease from spreading.
Prevention
To prevent actinomycosis, patients usually receive antibiotic prophylaxis before and after oral surgery to prevent oral floral bacteria from passing into the blood.
Here’s what you can do yourself
In the case of actinomycosis, the most important action is to seek immediate medical evaluation and treatment of the condition. The bacterial infection is usually treated with medication. The patient can support the therapy with some measures and various remedies from the field of naturopathy. Initially, rest and bed rest are important. Since abscesses are often associated with fever, malaise and other complaints, the immune system must be supported above all. This is best achieved through a healthy lifestyle with sufficient exercise, a balanced diet and the avoidance of stress. If the disease has already spread to the oral mucosa, various caring ointments from natural medicine can be used. Mouth rinses are also useful for inflammation of the oral cavity. If the skin is affected, a number of natural ointments and other preparations are also available. In addition, strict personal hygiene should be observed in order to avoid complications as far as possible. If the above-mentioned measures do not have any effect or even cause further complaints, the responsible physician must be informed. In general, close medical monitoring is indicated in actinomycosis.
