Actinomycosis, Definition, Symptoms, Causes, Diagnosis, Treatment, Prevention, Complications

What is Actinomycosis? is a very chronic subacute infection caused by the bacterium genus Actinomyces. This infection is characterized by swelling that is centralized or localized in a place, accompanied by pus formation due to inflammation (suppuration), fibrosis, the formation of abscesses, and discharge of fluid containing sulfur granules from the pus channel (sinus) in abscesses.

Actinomycosis is quite rare and the infection is local in one place in the body part. The reason is that Actinomyces bacteria do not have the ability to penetrate body tissues. But in some cases, Actinomyces bacteria can move through the body's tissues even though it is very slow.

The symptoms of actinomycosis vary greatly depending on the type of infection that occurs in the patient. Some of the types of actinomycosis that have been identified are:

• Oral cervicofacial actinomycosis. In this type of actinomycosis infection often occurs in the mouth, jaw, oral cavity, neck, and the area around the face. Most cases of oral actinomycosis are caused by problems that occur in the jaw (such as jaw injuries) or other problems such as teeth and gums (such as tartar and tooth decay).
• Thoracic actinomycosis. This is a type of actinomycosis infection that occurs in the lung organs or other respiratory organs in humans. Most of the pulmonary actinomycosis infections are thought to be caused by the inhalation of spit or liquid contaminated with Actinomyces into the respiratory organs.
• Abdominal actinomycosis. Actinomycosis infection that occurs in the abdomen. The causes of abdominal actinomycosis are very diverse, one of which is due to infection of the appendix (appendicitis).
• Pelvic actinomycosis. This is an actinomycosis infection that occurs in the pelvis (pelvic region). Some sufferers of this type of infection are women due to the spread of bacteria from the genital organs to the pelvis. Pelvic actinomycosis is often associated with the use of an IUD constructive device. Especially if the use exceeds the time limit recommended by the manufacturer.

Causes of Actinomycosis

The cause of actinomycosis is Actinomyces bacteria which is a normal flora that normally lives in the oral cavity, digestive tract, and urinary tract. Actinomyces bacteria are facultative pathogens commensal bacteria that require the ability to penetrate the mucous layer so that it can cause disease. Actinomycosis is often caused by several types of bacteria, both fellow genera of Actinomyces or other bacteria. The bacteria Actinomyces israelii and Actinomyces gerencseriae are two of the most common bacteria in cases of actinomycosis in humans. In addition to these two types of bacteria, other types of Actinomyces bacteria that can be found in cases of actinomycosis include Actinomyces odontolyticus, Actinomyces viscous, Actinomyces meyeri, Actinomyces turicensis, and Actinomyces radingae. Infection that occurs due to Actinomyces tends to appear on tissues adjacent to the mucous membrane. Some things that can increase a person's chances of getting actinomycosis to include:

• Age. Actinomycosis sufferers usually occur mostly between the ages of 20-60 years.
• Man. Actinomycosis often occurs in men, except for pelvic actinomycosis which tends to occur in women.
• Diabetes.
• Immunosuppression. The condition of a person's immune system is disrupted causing it to be more susceptible to actinomycosis. For example due to HIV infection, undergoing chemotherapy, taking steroids, bisphosphonates, kidney transplants, or lung transplants. Eating alcohol.
• Having tissue damage. For example due to injury, surgery, or radiotherapy.
• Tooth decay or dental hygiene that is not properly maintained.
• Have a history of surgery on the abdomen.

Actinomycosis symptoms

The symptoms of actinomycosis vary considerably depending on the location of the occurrence of this condition. Symptoms of oral cervicofacial actinomycosis that often appear are as follows:

• Fever.
• The appearance of chronic swelling around the lower jaw is not painful. But sometimes this swelling can also cause pain.
• The appearance of lesions that feel hard and often mistaken for malignant lesions (cancer).
• The appearance of lymphadenopathy if actinomycosis is chronic enough and enters an advanced stage.
• Formed pus channel (sinus), which emits yellow pus fluid like sulfur.
• The color of the skin around the swelling can turn red or bluish.
• Oral cervicofacial actinomycosis in some cases can also spread to the bones and muscles.

Whereas in the case of thoracic actinomycosis, the symptoms that often appear are as follows:

• Mild to moderate fever.
• Coughs that appear can be either a dry cough or a cough with phlegm. In some cases, blood coughs can also appear.
• Tired and tired.
• Hard to breathe.
• Chest pain.
• Coughing up blood (hemoptysis) and losing weight if an actinomycosis infection has been going on for a long time.
• There is fluid in the lungs which are sometimes followed by the appearance of lumps in the lung area.
• If left unchecked, the infection can spread to the lining of the lungs, the lining of the heart, the lining of the chest.

In cases of abdominal actinomycosis, the symptoms that can appear are as follows:

• Mild fever
• Losing weight.
• Tired and tired.
• Abdominal pain
• The appearance of a lump or swelling in the lower abdomen. Sometimes the lump is not felt during a physical examination using this palpation method.
• Pus will emerge from the sinuses that form on the abdomen of the patient.
• Diarrhea or constipation.
• Nausea and vomiting.

Whereas in the case of pelvic actinomycosis, the symptoms that can appear are as follows:

• Lower abdominal pain.
• Irregular vaginal bleeding or vaginal discharge such as vaginal discharge occurs.
• Loss of appetite.
• The appearance of a lump that can be felt in the waist or hip area.
• Mild fever
• Tired.

Actinomycosis diagnosis

Actinomycosis can be identified and diagnosed through investigation as follows:

• Blood test. Actinomycosis can cause an increase in erythrocyte sedimentation rate, alkaline phosphatase enzyme, and reactive C protein (CRP). In addition, actinomycosis can also cause anemia and mild leukocytosis.
• Imaging of internal organs. Imaging can be done using CT scans, MRI and chest X-rays. CT and MRI results in actinomycosis patients can show nonspecific abscesses in parts suspected of having actinomycosis. From chest X-ray photos, pneumonitis, lumps and other lesions in the chest cavity can be identified, especially in thoracic actinomycosis. Although unable to diagnose the presence of actinomycosis accurately, the results of imaging internal organs can be used to help examine body tissues through a microscope, especially during tissue sampling.
• Histopathological examination. Tissue samples suspected of having actinomycosis can be observed through a microscope to see tissue appearance. Samples for microscopic studies can also be obtained from pus fluid coming out of the organ that experiences actinomycosis. Fluid can be observed directly or through bacterial culture, although the risk of bacterial culture failure is quite high.
• Molecular Genetic Analysis. For the purposes of a faster and more accurate diagnosis, molecular genetic analysis methods can be used to confirm the existence of Actinomyces. The methods that can be done include PCR, bacterial RNA sequencing, in situ hybridizations of spectrophotometry, and mass spectrometry.

Actinomycosis Treatment

The main treatment for actinomycosis is to use antibiotics, especially beta-lactam groups, such as penicillin G and penicillin V. The ability of Actinomyces bacteria to be resistant to penicillin is quite low so this class of antibiotics can be used as the main treatment for actinomycosis. Treatment in the first stage can use intravenous penicillin G for 2-6 weeks, then followed by oral penicillin V for 6-12 months. But keep in mind that treatment for 6-12 months is not necessary for all sufferers of actinomycosis.

In addition to using penicillin, actinomycosis can also be treated using other antibiotics, such as:

• Benzylpenicillin.
• Amoxicillin.
• Ceftriaxone.
• Meropenem.
• Piperacillin and tazobactam.
• Doxycycline.
• Clindamycin.
• Erythromycin.
• Clarithromycin.

Often in patients with actinomycosis, not only the genus Actinomyces is found in the area of actinomycosis, but often there are also other bacteria, such as Staphylococcus aureus and anaerobic gram-negative bacteria. Therefore, when administering antibiotics at the beginning of the treatment period, antibiotics that have the ability to inhibit the beta-lactamase enzyme should also be given. This beta-lactamase can inhibit the performance of antibiotics given by doctors to kill Actinomyces. Examples of antibiotic drugs that also have the ability to inhibit beta-lactamase are tazobactam and clavulanate.

Especially for patients with abdominal actinomycosis, besides being given amoxicillin, metronidazole, clindamycin or clavulanate, aminoglycosides can also be given. The function of aminoglycosides is to eradicate Enterobacteriaceae family bacteria that are resistant to previous antibiotics and aggravate the actinomycosis that occurs.

Surgery can indeed be done on patients with actinomycosis, but keep in mind that the primary method of actinomycosis treatment is through antibiotics. Some conditions that cause actinomycosis need to be treated surgically include:

• If extensive tissue damage occurs and tissue removal or resection needs to be done or other actions. For example, if there is necrosis, sinus infection, and the appearance of a fistula.
• If there is a large abscess or empyema (abscess containing pus) that cannot be dried through suctioning from the surface of the skin.
• If an abscess appears to block the tracts of organs, for example, if an abscess in actinomycosis pelvis obstructs the urinary tract.
• If the patient does not recover with antibiotics.

Actinomycosis can cause death in sufferers especially if the Actinomyces infection has spread to the central nervous system such as the brain and spinal cord. The death rate due to actinomycosis can reach 28 percent, but the rate depends on the location of the first time the actinomycosis occurs. If you get good medical care and treatment, actinomycosis sufferers can recover optimally.

Actinomycosis Complications

Actinomycosis complications can occur especially if the infection that appears in the patient is not handled properly and spreads to other body organs. Some of the complications that usually occur due to actinomycosis are:

• Osteomyelitis, especially in the jawbone, ribs, and spine.
• Abscesses in the brain and chronic meningitis, including infection of the cranial nerves (head) and spinal (spinal cord), and infection of the parameter space in the membranes of the meninges.
• Endocarditis.
• Actinomycosis disseminated.
• Liver Abscess.