William Herring, M.D.

© 2002

Actinomycosis
Actinomycosis

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 Actinomycosis
Microbiology


Caused by actinomyces israeli

Gram+ pleomorphic anaerobic bacterium
 Related to morphology of fungus and
Mycobacterium

Not acid fast

Rod shaped form found “normally” in
dental caries, gingival margins, tonsillar
crypts and GI tract
 Actinomycosis
General


Once, most common pulmonary fungal
disease

People with very poor dental hygiene and
those that are immunosuppressed
predisposed

White or yellow “sulfur granules” in
exudate are really mycelial clumps
 Actinomycosis
Organ Systems Affected


Mandibulofacial area

Intestinal tract

Lung

In That Order
 Actinomycosis
Mandibulofacial


Osteomyelitis of the mandible

Soft tissue mass

“Lumpy jaw”
 Actinomycosis
Intestinal


Resembles Crohn’s disease

May produce rupture of a hollow viscus,
especially appendix

May produce fistula formation
 Actinomycosis
Pulmonary


Consolidation which extends through
fissure

Peripheral and lower lobe

Abscess

Empyema

If chronic  severe fibrosis
 Actinomycosis
Extends Through Pleura


Osteomyelitis of the rib

Wavy periosteal reaction

Rarely rib destruction

Draining chest wall sinuses
Differential Diagnosis
Consolidation  Chest Wall


Actinomycosis

Blastomycosis

TB

Crytococcosis