Actinomyces: Difference between revisions

Revision as of 20:16, 12 August 2020

Background

Microbiology

Weakly Gram-positive branching bacillus that looks fungal under microscopy
Molar tooth appearance of colonies
Member of oral and gut flora
Often part of polymicrobial infections
Spreads by direct invasion through tissue and creating fistulae

Clinical Manifestations

Cervicofacial actinomycosis

"Lumpy jaw syndrome" with painless jaw mass, trismus, and eventually pain
- Starts as mass or cold abscess in neck, jaw, or mouth
- Can invade bone
- Spreads contiguously
Often no systemic symptoms like fever
May have "sulfur granules" discharge
Most common form, accounting for ~50% of cases

Abdominal actinomycosis

Presents as an abdominal mass that fistulizes to skin

Pulmonary actinomycosis

Presents as a chronic, non-resolving pneumonia or as a lung cancer
Can spread directly to involve heart as well

Others

Endocarditis

Management

First-line is penicillin IV x4-6 weeks then penicillin PO x6-12 months
Alternatives include ceftriaxone, clindamycin, and doxycycline
May need surgery

@@ Line 1: / Line 1: @@
-== Microbiology ==
+== Background ==
+===Microbiology===
-* Weakly Gram-positive bacterium that looks fungal under microscopy
-* Oral and gut flora
-* Spreads by direct invasion through tissue and creating fistulae
+*Weakly [[Stain::Gram-positive]] branching [[Cellular shape::bacillus]] that looks fungal under microscopy
-== Syndromes ==
+*Molar tooth appearance of colonies
+*Member of oral and gut flora
+*Often part of polymicrobial infections
+*Spreads by direct invasion through tissue and creating fistulae
+==Clinical Manifestations==
-=== Cervicofacial actinomycosis ===
+===Cervicofacial actinomycosis===
-* "Lumpy jaw syndrome" with painless jaw mass, trismus, and eventually pain
-* Most common form, accounting for ~50% of cases
+*"Lumpy jaw syndrome" with painless jaw mass, trismus, and eventually pain
-=== Abdominal actinomycosis ===
+**Starts as mass or cold abscess in neck, jaw, or mouth
+**Can invade bone
+**Spreads contiguously
+*Often no systemic symptoms like fever
+*May have "sulfur granules" discharge
+*Most common form, accounting for ~50% of cases
+===Abdominal actinomycosis===
-* Presents as an abdominal mass that fistulizes to skin
+*Presents as an abdominal mass that fistulizes to skin
-=== Pulmonary actinomycosis ===
+===Pulmonary actinomycosis===
-* Presents as a chronic, non-resolving pneumonia or as a lung cancer
-* Can spread directly to involve heart as well
+*Presents as a chronic, non-resolving [[pneumonia]] or as a lung cancer
-=== Others ===
+*Can spread directly to involve heart as well
+===Others===
-* Endocarditis
+*[[Endocarditis]]
-== Management ==
+==Management==
-* IV [[penicillin]] x4-6 weeks then PO [[penicillin]] x6-12 months
-* Alternatives include [[ceftriaxone]], amox/clav
+*First-line is [[Is treated by::penicillin]] IV x4-6 weeks then [[penicillin]] PO x6-12 months
+*Alternatives include [[Is treated by::ceftriaxone]], [[Is treated by::clindamycin]], and [[Is treated by::doxycycline]]
+*May need surgery
 {{DISPLAYTITLE:''Actinomyces'' species}}