Actinomyces israelii

Snapshot

A 45-year-old man comes into urgent care for several months of lumps on his neck. Since he has not had any fevers or pain, he had ignored the lumps and had not sought treatment. He states that he has had multiple dental procedures but no other surgeries. On physical exam, he has multiple dental caries and 2 large, nontender masses under his chin. Yellow pus drains from these masses. He is counseled on oral hygiene and given antibiotics.

Introduction

Classification
- Actinomyces israelii
  - an anaerobic, branching, filamentous gram + rod
  - produces yellow, sulfur-colored granules
- transmission
  - direct contact with bacteria
Epidemiology
- demographics
  - male > female
- location
  - most commonly affects the face and neck
  - may also cause pelvic inflammatory disease
- risk factors
  - poor oral hygiene
    - dental caries
    - dental extraction or procedure
  - dental trauma
  - intrauterine device (IUD)
Pathogenesis
- anaerobic environment in abscess cavities allow the bacteria to flourish
Associated conditions
- cervicofacial actinomycosis
Prognosis
- slowly progresses over weeks to months
may relapse even after treatment

Presentation

Studies

Differential

Nocardiosis
- distinguishing factors
  - weakly acid fast and aerobic branching filamentous gram + rod
  - primarily causes pulmonary infections that can spread to central nervous system
SNAP = Sulfa for Nocardia; Actinomyces use Penicillin

Treatment

Complications