Beruflich Dokumente
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Actinomycosis
Raymond A. Smego, Jr., and Ginamarie Foglia From the Department of Infectious Diseases and Clinical Microbiology,
University of the Witwatersrand, and the South African Institute for
Medical Research, Johannesburg, Republic of South Africa; and the
Section of Infectious Diseases, Robert C. Byrd Health Sciences Center,
West Virginia University, Morgantown, West Virginia, USA
Actinomycosis is a chronic disease characterized by abscess appear as molar-tooth colonies on agar or as bread-
formation, tissue fibrosis, and draining sinuses. It is caused crumb colonies suspended in broth media. Differentiation of
by non-spore-forming, anaerobic or microaerophilic bacterial the species is difficult, requiring assessment of several meta-
species of the genus Actinomyces, order Actinomycetales. Acti- bolic capabilities.
nomyces species and the closely related Nocardia species, Bacteria of the related species Propionibacterium propio-
which were once believed to be fungi because of their nicus (formerly Arachnia propionica and Actinomyces propio-
genic Actinomyces species [12, 13]. Actinomycosis in cattle, sis ranges from 11% [26] to 97% [27], with a mean frequency
horses, and other animals is caused by other species, usually of 55% [19]. Actinomyces species are normally present in high
Actinomyces bovis [14, 15]. concentrations in the tonsillar crypts and gingivodental crev-
ices, and many actinomyces infections are odontogenic in ori-
Pathogenesis and Pathology
gin. In addition to poor dentition and recent dental manipula-
Four clinical forms of actinomycosis, i.e., cervicofacial, tho- tion, chronic tonsillitis, otitis, and mastoiditis are important
racic, abdominopelvic, and cerebral, account for the majority risk factors for these infections. External trauma may result in
of infections in humans. Actinomycosis usually occurs in im- the introduction of Actinomyces species into head and neck
munocompetent persons but may occur in persons with dimin- tissues. Cervicofacial actinomycosis may take the form of
ished host defenses. In a previously cited study [3], several acute, painful pyogenic abscesses or indolent disease that re-
patients with abscesses, diabetic foot ulcers, cellulitis, and bac- sembles the lumpy jaw caused by A. bovis in cattle [14]. The
teremia due to A. neuii were immunosuppressed. Bacteria iso- latter process may evolve into a painless indurated mass in the
lated from gingival crevices and tonsillar crypts of healthy face or neck, often accompanied by one or more draining sinus
persons [16] and from dental caries in otherwise asymptomatic tracts that discharge sulfur granules. Lesions are frequently
persons [17] were initially classified as A. bovis but are now located at the angle of the jaw or in the submandibular region.
recognized as the Actinomyces species that are potential human Cervicofacial actinomycosis may extend to the underlying
pathogens. As saprophytes, Actinomyces species are generally mandible or facial bones, leading to the development of perios-
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