Actinomycosis
Firza Alexander Gronthoud in Practical Clinical Microbiology and Infectious Diseases, 2020
In the case of actinomycosis, it has been considered that a long duration of antimicrobial therapy with high doses is necessary, with treatment extending up to 1 year (or even longer). This concept is changing, and medications are now adjusted on the basis of individual treatment needs. The same is valid for surgery, which was previously used routinely for treatment of actinomycotic lesions; however, the current trend is to limit invasive procedures and to rely on a targeted antibiotic regimen instead. Treatment of abscesses usually requires drainage, whereas surgical resection may be indicated only in cases with extensive necrotic lesions or when antimicrobial therapy fails. Actinomycosis is often a polymicrobial infection. for severe infections an initial intravenous course of two weeks is recommended, followed by an oral stepdown. Intravenous options are amoxicillin/clavulanic acid or ceftriaxone with or without metronidazole. Oral options include amoxicillin/clavulanic acid, doxycycline or a macrolide with or without metronidazole. Clindamycin or quinolones should be avoided unless in vitro susceptible.
Cervicofacial Infections
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
Actinomycosis is caused by Gram-positive non-spore forming bacteria. The most common human pathogen is Actinomyces israelii but there are several other species which can rarely be pathogenic. Approximately 50% of cases are cervicofacial. Actinomyces are normal commensals in the oral cavity and infections arise from a breach of the mucosa (e.g. dental extraction). The most common presentation is a slow-growing painless mass near the mandible. Local lymph nodes may be involved and in a small number of cases metastasis of disease to liver or brain may occur. Untreated, the mass progresses to fibrosis and chronic suppuration with draining sinuses. A less common presentation is with an acute, warm, tender mass with fever. The presence of sulphur granules on pathological examination is suggestive but not diagnostic. If the diagnosis is suspected, special culture conditions increase the chance of culturing this organism. Most cases are treated by surgical excision followed by prolonged antibacterial therapy, usually penicillin for up to 6 months.
Penicillins
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
Penicillin G (aqueous) is administered intravenously for serious infections such as infective endocarditis, meningitis, septic arthritis, and pneumonia caused by S. pyogenes, viridans streptococci and penicillin-sensitive S. pneumoniae as well as susceptible staphylococci species. The drug is also the agent of choice for all forms of tertiary syphilis/neurosyphilis, fusospirochetal gingivostomatitis, and leptospirosis. Penicillin G is effective in treating serious skin and soft tissue infections such as necrotizing fasciitis due to group A streptococci, streptococcal impetigo, erysipelas, perianal streptococcal dermatitis, and cellulitis secondary to animal bites, and human bites; however, amoxicillin-clavulanate or ampicillin-sulbactam is preferable in most animal bites. Brain abscess, several odontogenic infections, and lung abscesses caused by susceptible anaerobic bacteria may be treated with penicillin G intravenously. All forms of actinomycosis can be effectively managed with high-dose penicillin G or ampicillin. Oral penicillin G or V still remains the drug of choice for most cases of streptococcal pharyngitis.
Actinomyces lymphadenitis
Published in Baylor University Medical Center Proceedings, 2020
John Kim, Christopher Wood, Uriel Sandkovsky, Haala Rokadia
Actinomycosis is a chronic disease caused by Actinomyces, an anaerobic gram-positive bacteria that normally colonizes in the human mouth, digestive tract, and urogenital tract.1–5 Typical clinical presentations include cervicofacial actinomycosis following dental procedures, pelvic actinomycosis in women with an intrauterine device, and pulmonary actinomycosis in smokers with poor dentition.5Actinomyces found in lymph nodes is uncommon, with only two reported cases.1,2 Due to the rarity, lymphadenopathy with Actinomyces is commonly misdiagnosed as malignancy, causing unnecessary surgical interventions when only antibiotics are warranted.2 The finding of Actinomyces in the subcarinal lymph node with concomitant cough and hemoptysis makes our case very rare.
The prediction of surgical intervention in patients with tubo-ovarian abscess
Published in Journal of Obstetrics and Gynaecology, 2022
Jong Ha Hwang, Bo Wook Kim, Soo Rim Kim, Jang Heub Kim
In the 32 patients comprising the surgical intervention group, laparoscopy and laparotomy were performed in 17 (53.1%) and 14 (43.8%) patients, respectively. One patient was treated with abscess drainage via culdotomy and pigtail insertion, 15 patients underwent unilateral salpingectomy or unilateral salpingo-oophorectomy, and 12 patients underwent bilateral salpingectomy or bilateral salpingo-oophorectomy. Four cases of total hysterectomy in addition to adnexal surgery were identified. Four patients underwent appendectomy because the TOA spread to the periappendiceal area. One patient underwent low anterior resection because the TOA resulted from colon cancer with perforation. Fistulectomy was performed in one patient with a fistula between the TOA and abdominal skin. Two patients were diagnosed with actinomycosis.
Actinomyces causing a brain abscess
Published in Baylor University Medical Center Proceedings, 2021
Alejandro Perez, Gaurav Syngal, Samreen Fathima, Uriel Sandkovsky
Diagnosis of actinomycosis requires the recovery of Actinomyces species from an abscess, fistula, or sinus tract; histologically, they appear as colonies of filamentous bacteria with a zone of granulation tissue known as sulfur granules.1,8 Due to the slow-growing nature of the organism, cultures should be held for at least 14 days in an anaerobic environment.9 The microbiology laboratory should be informed about suspected actinomycosis.6 Branching gram-positive bacilli may indicate either aerobic Nocardia, Actinomyces, or sometimes Rhodococcus species. Actinomyces species is indistinguishable from Nocardia on Gram stain,1 but can be differentiated by special cultures and by modified acid-fast stain: Nocardia stains partially acid-fast, while Actinomyces does not.2 Differentiation of actinomycosis from nocardiosis is crucial for the selection of appropriate antimicrobial therapy.4
Related Knowledge Centers
- Abscess
- Actinomyces Israelii
- Anaerobic Infection
- Bacteria
- Mouth
- Infection
- Actinomyces
- Actinomyces Gerencseriae
- Streptomyces Somaliensis
- Arachnia Propionica