Actinomycosis

Actinomycosis is a chronic subacute infection caused by the bacterium genus Actinomyces. 

Infection is characterized by :

• Swelling concentrated somewhere.
• Pus formation due to inflammation (suppuration).
• Fibrosis.
• Abscess formation.
• Discharge of fluid containing sulfur granules from the pus (sinus) channel in the abscess.

Actinomycosis is uncommon and the infection is local in one place in the body. Actinomyces bacteria do not have the ability to penetrate body tissue, but can move even though very slowly.

Actinomycosis type :

• Cervicofacial oral actinomycosis ➡ occurs in the mouth, oral cavity, jaw, neck, facial area. Most cases are caused by problems with the jaw (jaw injury), tartar and tooth decay.
• Thoracic actinomycosis ➡ occurs in the lungs or other respiratory organs. Mostly due to inhalation of saliva or fluid splashes contaminated with actinomyces into the respiratory organs.
• Abdominal actinomycosis ➡ occurs in the abdomen. The cause of one of them is appendicitis.
• Pelvic actinomycosis ➡ occurs in the pelvis (pelvic region). Patients with this type of infection are women due to the spread of bacteria from the genital organs to the pelvis. Pelvic actinomycosis is often associated with the use of an IUD construct. If its use exceeds the recommended time limit.

Cause.

The cause of actinomycosis is bacterial actinomyces which is a normal flora that normally lives in the oral cavity, digestive tract and urinary tract. Actinomyces bacteria are facultative pathogenic bacteria that require the ability to penetrate the mucosal layer so that it can cause disease.

Actinomycosis can also be caused by several types of bacteria of the same genus Actinomyces or other bacteria. Actinomyces bacteria (israelii and actinomyces gerencseriae) are the two bacteria most often found in cases of actinomycosis in humans. In addition to the two types of bacteria, other types of Actinomyces bacteria that can be found in cases of actinomycosis are :

• actinomyces odontolyticus.
• viscous actinomyces.
• actinomyces meyeri.
• actinomyces turicensis.
• actinomyces radingae.

Infections that occur due to Actinomyces tend to appear in tissue adjacent to the mucous membrane.

Something that can increase the risk of actinomycosis is :

• Age (20-60 years).
• Men, except pelvic actinomycosis that occurs in women.
• Diabetes.
• HIV.
• Chemotherapy.
• Consumption of steroids.
• Bisphosphonates.
• Organ transplant.
• Consuming alcohol.
• Injury.
• Surgery.
• Radiotherapy.
• Tooth decay.
• Cleaning teeth that are not properly maintained.

The symptoms.

• Fever.
• Chronic swelling around the lower jaw.
• Lesions that feel hard.
• Lymphadeopathy appears when actinomycosis is chronic enough and goes into an advanced stage.
• Pus formed (sinus) which secretes yellow pus like sulfur.
• The skin color around the swelling turns reddish or bluish.
• Dry cough and cough with phlegm.
• Heamoptisis.
• Tired and tired.
• Hard to breathe.
• Chest pain.
• There is fluid in the lungs.
• Lumps appear on the lungs. Infection can spread to the lining of the lungs, the lining of the heart, the lining of the chest.
• Stomach ache.
• Swelling in the lower abdomen.
• Pus from the sinuses that form in the abdomen.
• Diarrhea.
• Constipation.
• Nausea.
• Irregular vaginal bleeding.
• Fluid out of the vagina.
• Loss of appetite.
• A bulge appears in the waist or hip area.

Diagnosis.

• Blood test.
• CT scan.
• MRI.
• Chest radiograph.
• Examination of body tissue through a microscope.
• Tissue sampling.
• Histopathological examination.
• Examination of pus fluid coming out of the organs.
• Molecular genetic analysis.

Methods that can be done :

• PCR.
• Bacterial RNA sequencing.
• Hybridization of situ spectrophotometryin.
• Mass spectrometry.

Treatment.

• Using beta-lactam antibiotics, such as penicillin G and penicillin V. The ability of actinomyces bacteria to be resistant to penicillin is quite low, so this class of antibiotics can be used as the main treatment for actinomycosis.
• The first stage of treatment can use Gintravena penicillin for 2-6 weeks, then proceed with Voral penicillin for 6-12 months.

Besides using penicillin, actinomycosis can also be treated with other antibiotics, such as :

• Benzylpenicillin.
• Amoxicillin.
• Ceftriaxone.
• Meropenem.
• Piperacillin and tazobactam.
• Doxycycline.
• Clindamycin.
• Erythromycin.
• Clarithromycin.

Conditions that cause actinomycosis need to be treated surgically :

• If extensive tissue damage occurs and tissue resection or other measures are needed.
• If there is a large abscess or empyema (abscesses containing pus) that cannot be drained by suction from the surface of the skin.
• If an abscess that appears obstructs the organ channels.
• If the patient does not recover with antibiotics.

Actinomycosis can cause death if infection with actinomyces spreads to the central nervous system, such as the brain and spinal cord. If you get good medical care, people with actinomycosis can recover fully.

Complications.

• Osteomyelitis of the jawbone, ribs and backbone.
• Brain abscess.
• Chronic meningitis.
• Cranial (head) and spinal (spinal) infections.
• Infection of the durameter space in the meninges membrane.
• Endocarditis.
• Disseminated actinomycosis.
• Heart abscess.