Actinomycosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]


Based on the organ system involved and duration of symptoms, differential diagnosis of actinomycosis consists of blastomycosis, brain abscess, colon cancer, crohn disease, diverticulitis, liver abscess, lung abscess, lymphoma, nocardiosis, pelvic inflammatory disease, pneumonia, tuberculosis and uterine cancer.

Differential Diagnosis

  • Actinomycosis is a chronic pyogenic bacterial infection caused by Actinomycesspecies and most commonly involves orocervicofacial region
  • It rarely infects other organ systems. If involved it has a wide variety of presentation.
  • Most common symptoms of actinomycosis includes abscess with draining sinus tracts.
  • Other symptoms are mostly non-specific for actinomycosis.
  • Based on the organ system involved and duration of symptoms it should be differentiated from other conditions:[1][2][3][4][5][6][7][8][9] [10]

System involved Disease Differentiating signs/symptoms Differentiating tests
Abdomen Abdominal Abscess Features of sepsis and signs of an acute abdomen are generally prominent Histology and culture for actinomycetes are negative.

Blood cultures positive for the causative organism.

Appendicitis Rapid onset of symptoms

Positive for signs of appendicitis

Ultrasound shows inflammation of appendix

Negative blood culture

Colon cancer Systemic findings like weight loss, night sweats present


Blood loss in stools

Colonoscopy identifies the lesions, histopathology confirms the presence of the malignant cells.
Whipple disease An acute GI illness, with fever, diarrhea, and weight loss

Malabsorption such as steatorrhea.

Abdominal lymphadenopathy and abdominal pain.

Joint problems


Anti-Tropheryma whipplei-positive macrophage (Tropheryma whipplei).

PCR testing of duodenal biopsies positive for T whipplei

Inflammatory bowel disease Dysentery

Weight loss

Colonoscopy identifies the ulcerative lesions
Pulmonary Nocardiosis Immunocompromised host

Predominant pulmonary

Modified acid-fast staining of biopsy tissue or other samples allows distinction between Nocardia and Actinomyces
Blastomycosis Self-limited

Cutaneous manifestations along with lung involvement.

Endemic to Mississippi and Ohio river valley

Sputum smear and culture using KOH preparations or specific stains can confirm diagnosis
Lung abscess Risk of aspiration

Cough with foul smelling sputum

Polymicrobial infection
Pulmonary tuberculosis Cough >2 weeks


Night sweats, weight loss

Acid fast bacilli positive on sputum examination

Tuberculin skin testing positive.

Uro-genital system Ovarian/Oviductal tumor Systemic findings like weight loss ,night sweats present

No leukorrhea

Histopathology shows malignancy.
Pelvic inflammatory disease History of recent sexual contact or a sexually transmitted infection in the partner,

Past history of PID.

Laparoscopy with biopsy sampling followed by histology.
Actinomycosis Nocardiosis
Gram positive anaerobic species Gram positive aerobe
Decreasing incidence Increasing incidence
Occurs primarily in immunocompetent host Occurs primarily in immunocompromised host
Predominant cervicofacial Predominant pulmonary
Chest wall involvement and bony erosions are common Chest wall involvement is uncommon
Granuloma formation and intense fibrosis are common. Form characteristic sulfur granules Granuloma formation and fibrosis are uncommon
Spread by direct invasion Metastatic spread is common (especially to brain)
Diagnosis is made through cytologic or histologic examination Diagnosis is made through bronchoalveolar lavage (BAL).

sputum, or pleural fluid culture

Treatment: Penicillin

Treatment with antibiotics alone

Treatment: Sulfonamides

Often need surgical drainage


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de:Aktinomykose gl:Actinomicose hr:Aktinomikoza nl:Actinomycose sr:Актиномикоза fi:Aktinomykoosi uk:Актиномікоз