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Actinomycosis

6 September 2012, by GAYRAUD A. & BERNARD Ph. & BOIRON P.

Actinomycosis, or actinobacteriosis is a rare and chronic infection. It is caused by bacteria that are normally present in the mouth and digestive system. These bacteria, Actinomyces, become pathogenic as a result of various factors, which can be

— local: damage to the mucous membrane, poor dental hygiene and foreign bodies (for instance, a hip prosthesis or prolonged use of an intrauterine device);

— systemic: immunosuppression, cancer, diabetes, alcoholism and smoking.

Actinomycosis can affect any of the organs and may sometimes mimic other diseases such as tuberculosis, lung cancer, bowel cancer, Crohn’s disease and gynaecological cancers, etc. Whatever its starting point, this infection has a tendency to spread, particularly to the skin.

Cervicofacial actinomycosis is the form most commonly encountered (55 %). The infection starts with a sore in the lining of the mouth, the gums or pharynx and is encouraged by poor dental hygiene or a mouth wound. The lesions present as painless, subcutaneous swellings, most often around the jaw line.

Abdominal actinomycosis accounts for 25% of all cases. This is most often a complication of appendicitis. Thoracic actinomycosis (15 to 20 %) most often arises subsequent to inhalation of Actinomyces. Pelvic involvement is reported in women fitted with an intrauterine device (coil).

 Skin becomes infected after the bacteria spreads through the circulation from the lungs or comes into direct contact with damaged skin (exceptional).

The positive diagnosis is based on isolation and identification of the bacterium causing the infection.

The treatment for actinomycosis is antibiotics, particularly penicillin G, administered at high doses for a prolonged period of time. A few weeks of oral treatment suffice for the uncomplicated cervicofacial forms. However, treatment lasting up to 18 months may be required for patients with pulmonary, abdominal or complicated infections. In some cases, surgery is necessary.

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