Beyond the Lump :Understanding Actinomycosis From Cause to Cure

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                       ACTINOMYCOSIS

INTRODUCTION:

  • It is caused by actinomycosis Israeli
  • Gram positive fungal like bacteria ,anaerobic
  • Its also known as RAY FUNGUS -sun ray appearance
  • Present in :oral floral
  • Invade tissue in case of carious teeth ,trauma, poor oral hygiene 






CLINICAL TYPES:

A)CERVICOFACIAL

  • Commonest type
  • Lower jaw -commonly involved 
  • Site :Tonsil, trauma from infected tooth 
  • Gums (induration)
  • Nodules from with involvement of face and neck 
  • Softens ,burst through skin forming multiple tortuous sinuses
  • Discharge pus ,containing sulfur granules
  • Cervical lymph node not enlarged 

Differential diagnosis :

  • Carcinoma in floor of mouth 
  • Jaw tumor
  • Osteomyelitis of mandible





B)THORACIC :

  • Aspiration -lung and pleura gets infected later emphysema develop chest wall nodule -discharging sinuses






C)ABDOMINAL:

  • In Intestine the organism cross bowel wall -pericecal region causing inflammatory reaction ,adhere to abdominal wall enter right iliac fossa -multiple discharging sinuses 
  • From right iliac fossa through portal vein to liver and gets destroyed and thereby forming multiple abscess (honey comb liver).







PATHOGENESIS:

  • Organism -enter through deeper plane of tissue form sub -acute inflammation -induration and nodules formation ultimately resulting in discharging sinus 
  • Pus collected in swab show -SULFUR GRANULES






CLINICAL FEATURES:

  • Discharging sinus and induration 
  • Nodule
  • No lymph node involvement 
  • Through blood may cause pyemia and endanger life 

INVESTIGATION:

  • Pus under microscopy shows branching filaments
  • Grams staining -gram positive mycelia in center and a gram negative radiating filament 
  • Cultured in brain heart infusion agar and thioglycolate media






    DIFFERENTIAL DIAGNOSIS:

  • Chronic pyogenic osteomyelitis
  • Carcinomas a site
  • Tuberculosis disease

TREATMENT :

  • Injection crystalline penicillin 10 lakhs per day 

Tetracycline and lincomycin

Dapsone and iodine

  • Surgical debridement is occasionally required 





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