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Miscellaneous Respiratory Infections
Published in Adam T. Hill, F. X. Emmanuel, W.H.B. Wallace, Pulmonary Infection, 2004
Adam T. Hill, F. X. Emmanuel, W.H.B. Wallace
Actinomycosis is caused by filamentous, branching, slow- growing, Gram-positive anaerobic bacteria. By far the commonest species causing human infections is Actinomyces israelii. Other organisms, such as anaerobes and streptococci of the milleri group, are often found in association with this organism and may contribute to the pathogenesis. The organism is commonly found in the human mouth and pharynx, particularly when oral hygiene is poor. Most infections are derived from this endogenous source, and person-to-person transmission is rare. Infection usually presents as a slowly expanding, suppurating lump in the cervicofacial region (lumpy jaw). If untreated this often leads to sinus formation with drainage of pus containing particulate accretions (sulphur granules) which are composed of compacted bacterial filaments and debris from the host inflammatory response. Infection of intrathoracic structures is uncommon, and may result from aspiration, lymphatic extension from the oropharynx, or passage across
Actinomyces causing a brain abscess
Published in Baylor University Medical Center Proceedings, 2021
Alejandro Perez, Gaurav Syngal, Samreen Fathima, Uriel Sandkovsky
Diagnosis of actinomycosis is challenging due to its nonspecific symptoms and physical findings, unless the classic “lumpy jaw” is seen on clinical exam.2,5 CNS involvement is rare and usually results from hematogenous spread from distant sites such as lung, abdomen, or pelvis (infected intrauterine device) or contiguous foci like ear, sinus, and cervicofacial region.4,6 Our patient had evidence of poor dentition, which could have been the inciting event leading to aspiration and formation of a lung abscess with subsequent hematogenous spread to the CNS. Although bronchoalveolar cultures were obtained, it is not unusual to yield negative results given that they are usually not obtained under proper anaerobic conditions.7 Tissue biopsy would be more appropriate, but we did not feel it would be necessary in this case.