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Actinomycosis PHIL 2856 lores.jpg
A man with Actinomycosis on the right side of his face.
Classification and external resources
Specialty Infectious disease
ICD-10 A42
ICD-9-CM 039
DiseasesDB 145
MedlinePlus 000599
eMedicine med/31
Patient UK Actinomycosis
MeSH D000196

Actinomycosis is an infectious bacterial disease caused by Actinomyces species[1] such as Actinomyces israelii [2] or A. gerencseriae. It can also be caused by Propionibacterium propionicus, and the condition is likely to be polymicrobial aerobic anaerobic infection.[3]

Signs and symptoms[edit]

The disease is characterised by the formation of painful abscesses in the mouth, lungs,[4][5] or gastrointestinal tract.[3] Actinomycosis abscesses grow larger as the disease progresses, often over months. In severe cases, they may penetrate the surrounding bone and muscle to the skin, where they break open and leak large amounts of pus, which often contains characteristic granules (sulfur granules) filled with progeny bacteria. These granules are named due to their appearance but are not actual composed of sulfur. Sometimes there is difficulty in making the correct diagnosis. In addition to microbiological examinations magnetic resonance imaging and immunological blood analyses may also be helpful.[6]


Actinomycosis Grocott's stain
Actinomycosis Gram stain

Actinomycosis is primarily caused by any of several members of the bacterial genus Actinomyces. These bacteria are generally anaerobes.[7] In animals, they normally live in the small spaces between the teeth and gums, causing infection only when they can multiply freely in anoxic environments. An affected human often has recently had dental work, poor oral hygiene, periodontal disease, radiation therapy, or trauma (broken jaw) causing local tissue damage to the oral mucosa, all of which predispose the person to developing actinomycosis. Actinomyces israelii is a normal commensal species part of the microbiota species of the lower reproductive tract of women.[8] They are also normal commensals in the caecum; thus, abdominal actinomycosis can occur following removal of the appendix. The three most common sites of infection are decayed teeth, the lungs, and the intestines. It is important to note that actinomycosis does not occur in isolation from other bacteria. This infection depends on other bacteria (gram positive, gram negative, and cocci) to aid in invasion of tissue.


Actinomyces bacteria are generally sensitive to penicillin, which is frequently used to treat actinomycosis. In cases of penicillin allergy, doxycyclin is used. Sulfonamides such as sulfamethoxazole may be used as an alternative regimen at a total daily dosage of 2-4 grams. Response to therapy is slow and may take months. Hyperbaric oxygen therapy may also be used as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment.[9][10]


There is a greater disease incidence in males between the ages of 20 and 60 years than in females.[11] Before antibiotic treatments became available, the incidence in the Netherlands and Germany was 1 per 100,000 people/year. Incidence in the U.S. in the 1970s was 1 per 300,000 people/year, while in Germany in 1984, it was estimated to be 1 per 40,000 people/year.[11] The use of intrauterine devices (IUDs) has increased incidence of genitourinary actinomycosis in females. Incidence of oral actinomycosis, which is harder to diagnose, has increased.[11]


In 1877, pathologist Otto Bollinger described the presence of Actinomyces bovis in cattle, and shortly afterwards, James Israel discovered Actinomyces israelii in humans. In 1890, Eugen Bostroem isolated the causative organism from a culture of grain, grasses, and soil. After Bostroem's discovery there was a general misconception that actinomycosis was a mycosis that affected individuals who chewed grass or straw. The pathogen is still known as the “great masquerader".[12] Bergey classified the organism as bacterial in 1939,[13] but the disease remained classified as a fungus in the 1955 edition of the Control of Communicable Diseases in Man.[14]

Violinist Joseph Joachim died of actinomycosis on 15 August 1907.

Other animals[edit]

Actinomycosis occurs rarely in humans but rather frequently in cattle as a disease called lumpy jaw. This name refers to the large abscesses that grow on the head and neck of the infected animal. It can also affect swine, horses, and dogs, and less often wild animals and sheep.


  1. ^ "actinomycosis" at Dorland's Medical Dictionary
  2. ^ "Actinomycosis". A.D.A.M Medical Encyclopedia. pubMed Health. Retrieved 9 September 2012. 
  3. ^ a b Bowden GHW (1996). Actinomycosis in: Baron's Medical Microbiology (Baron S et al., eds.) (4th ed.). Univ of Texas Medical Branch. ISBN 0-9631172-1-1. (via NCBI Bookshelf). 
  4. ^ Brook, I (Oct 2008). "Actinomycosis: diagnosis and management.". Southern Medical Journal 101 (10): 1019–23. doi:10.1097/SMJ.0b013e3181864c1f. PMID 18791528. 
  5. ^ Mabeza, GF; Macfarlane J (March 2003). "Pulmonary actinomycosis". European Respiratory Journal (ERS Journals Ltd.) 21 (3): 545–551. doi:10.1183/09031936.03.00089103. PMID 12662015. Retrieved 2008-07-21. 
  6. ^ Böhm, Ingrid; Willinek, Winfried; Schild, Hans H. (October 2006). "Magnetic Resonance Imaging Meets Immunology: An Unusual Combination of Diagnostic Tools Leads to the Diagnosis Actinomycosis". The American Journal of Gastroenterology 101 (10): 2439–2440. doi:10.1111/j.1572-0241.2006.00742_7.x. PMID 17032212. 
  7. ^ Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 0-8385-8529-9. 
  8. ^ Hoffman, Barbara (2012). Williams gynecology, 2nd edition. New York: McGraw-Hill Medical. p. 42. ISBN 0071716726. 
  9. ^ "Bone Infections". MedlinePlus. US National Library of Medicine. Retrieved 16 August 2015. 
  10. ^ "Osteomyelitis (Refractory)". Undersea and Hyperbaric Medical Society. Retrieved 16 August 2015. 
  11. ^ a b c Wolff K, Goldsmith L A, Katz S, Gilchrist B A, Paller A, and Leffell D J (2007). Fitzpatrick's Dermatology in General Medicine, 7th Ed. McGraw Hill. 
  12. ^ Sullivan, D. C.; Chapman, S. W. (12 May 2010). "Bacteria That Masquerade as Fungi: Actinomycosis/Nocardia". Proceedings of the American Thoracic Society 7 (3): 216–221. doi:10.1513/pats.200907-077AL. 
  13. ^ Strong, Richard (1944). Stitt's Diagnosis, Prevention and Treatment of Tropical Diseases (7th ed.). p. 1182. 
  14. ^ Control of Communicable Diseases in Man (8th ed.). American Public Health Association. 1955. 

Further reading[edit]

  • Anderson, Clifton W.; Jenkins, Ralph H. (December 15, 1938). "Actinomycosis of the Scrotum". New England Journal of Medicine 219 (24): 953–954. doi:10.1056/NEJM193812152192403. 
  • Codman, E. A. (August 11, 1898). "A Case of Actinomycosis". The Boston Medical and Surgical Journal 139 (6): 134–135. doi:10.1056/NEJM189808111390606. 
  • Randolph HL Wong; Alan DL Sihoe; KH Thung; Innes YP Wan; Margaret BY Ip; Anthony PC Yim (June 2004). "Actinomycosis: an often forgotten diagnosis". Asian Cardiovasc Thorac Ann. 12 (2): 165–7.  Review
  • Munro, John C. (September 13, 1900). "Four Cases of Actinomycosis". The Boston Medical and Surgical Journal 143 (11): 255–256. doi:10.1056/NEJM190009131431103. 
  • Whitney, W. F. (June 5, 1884). "A Case of Actinomycosis in a Heifer". The Boston Medical and Surgical Journal 110 (23): 532–532. doi:10.1056/NEJM188406051102302. 

External links[edit]