Clinical Review

Actinomycosis

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6099 (Published 11 October 2011) Cite this as: BMJ 2011;343:d6099
  1. V K Wong, specialist registrar in microbiology1,
  2. T D Turmezei, specialist registrar in radiology2,
  3. V C Weston, consultant in microbiology1
  1. 1Queen’s Medical Centre, Nottingham NG7 2UH, UK
  2. 2Addenbrooke’s Hospital, Cambridge, UK
  1. Correspondence to: V K Wong vanessawong{at}doctors.org.uk
  • Accepted 15 August 2011

Summary points

  • Although rare, a high level of clinical suspicion is needed to diagnose and cure actinomycosis in patients with indolent, unresolving, or relapsing chronic inflammatory disease

  • Actinomyces are commensals that become pathogenic when the mucosa is breached, and co-infection with other organisms is common

  • Disease is defined by anatomical location; orocervicofacial disease is the most common, followed by thoracic and abdominopelvic disease

  • A mass characteristically enlarges across tissue planes and local tissue invasion may lead to the formation of sinus tracts that can spontaneously heal and recur

  • Actinomycosis often mimics other infections and malignancy—clinically and radiologically

  • It is generally treated with long term antibiotics, usually penicillin, but surgery may be needed

Actinomycosis is a rare, chronic, and slowly progressive granulomatous disease caused by filamentous Gram positive anaerobic bacteria from the Actinomycetaceae family (genus Actinomyces).1 It is often misdiagnosed because it can mimic other conditions such as malignancy and tuberculosis,2 and a high level of clinical suspicion is needed for an early diagnosis. However, it is readily treatable and curable if the patient is appropriately managed. We review the clinical presentations of actinomycosis, its diagnosis, and approaches to treatment. Our review is based on the findings of randomised controlled trials, prospective analytical and retrospective studies, review articles, and case reports.

How is actinomycosis acquired?

Actinomyces are commensals of the human oropharynx, gastrointestinal tract, and urogenital tract. When tissue integrity is breached through a mucosal lesion they can invade local structures and organs and become pathogenic. Actinomycosis is therefore mainly an endogenous infection.3 Actinomyces are often isolated with other normal commensals, such as Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Eikenella corrodens, fusobacteria, bacteroides, capnocytophaga, staphylococci (including S aureus), streptococci (including β haemolytic streptococci and S pneumoniae), or Enterobacteriaceae, but the precise pattern of organisms depends on the site of infection.4 …

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