Actinomycosis pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pathophysiology

  • Actinomycosis is caused by the bacteria Actinomyces which is a normal commensal of the human oral cavity but less common in the female genital tract and lower gastrointestinal tract.
  • The common clinical forms of are:
  • Cervicofacial actinomycosis (lumpy jaw)
  • Thoracic actinomycosis
  • Abdominal actinomycosis
  • Pelvic actinomycosis
  • Dermatologic actinomycosis
  • Pediatric actinomycosis
  • Opthalmological actinomycosis

Pathogenesis

  • Actinomyces does not grow in oxygen rich environment. When there is a break through the protective lining surrounding the cavities (from mouth to rectum), the actinomycetales penetrate through the deeper tissues where the bacteria grow rapidly due to low oxygen levels.
Types Site of Infection Source of infection Pathogenesis
Cervicofascial actinomycosis
  • Neck
  • Jaw
  • Mouth
  • Dental problems like tooth decay
  • Most common type of actinomycosis
  • 50% of cases
Thoracic actinomycosis
  • Lungs
  • Pleura
  • Chest wall
  • Mediastinum
  • Inhalation of droplets of contaminated fluid
  • Aspiration of oropharyngeal secretions or gastric contents
  • Direct extension of cervicofacial infection into the mediastinum
  • Transdiaphragmatic or retroperitoneal spread from the abdomen
  • Hematogenous spread
  • 15%-20% of cases
Abdominal actinomycosis Abdomen
  • Secondary to abdominal infections like appendicitis
  • Accidental swallowing of a foreign body such as, chicken bone containing the actinomycetes bacteria
  • Penetrating trauma
  • Perforation of the gut (e.g.,the colon or appendix)
  • Surgical manipulation of GI tract
  • 20% of cases
Pelvic actinomycosis Pelvis
  • Occurs most commonly in woman as the bacteria passes from the female genitals into the pelvis
  • Long term use of IUD type of contraceptive
  • 10% of cases
Central nervous system

actinomycosis

CNS
  • Secondary to hematogenous spread from primary infection in the lung, abdomen, or pelvis
  • Direct extension from paranasal sinuses, ears, and cervicofacial regions
Types of lesions

References

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