Actinomycosis natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

## Overview

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Once in the tissue, actinomyces multiply and forms an abscess, producing a hard, red to reddish-purple lump, most commonly on the jaw. Eventually, the abscess ruptures through the skin surface producing a draining sinus tract. If left untreated, patients with actinomycosis may progress to develop multiple abscesses which can heal and reappear. The prognosis is excellent with prompt and effective antimicrobial treatment. Complications that can develop as a result of actinomycosis are osteomyelitis, endocarditis, pericarditis and meningitis.

## Natural History

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* Once in the tissue, actinomyces multiply and forms an abscess, producing a hard, red to reddish-purple lump, often on the jaw.
* Eventually, the abscess ruptures through the skin surface to produce a draining sinus tract and are completely treatable.
* If left untreated, patients with actinomycosis may progress to develop focal organ involvement with mass-like features and multiple abscesses which can heal and reform.[1][2][3][4][5][6]

## Prognosis

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* The prognosis is excellent with prompt and effective antimicrobial treatment in patients with uncomplicated actinomycosis that does not affect the CNS.
* The factors that define the outcomes of the disease include:
* Site of infection
* The time to diagnose
* The time to the start of appropriate treatment
* Mortality range from 0% to 28% highest being in CNS.

## Complications

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Complications that can develop as a result of actinomycosis are [7]

* Extension of disease can result in osteomyelitis of the mandible, ribs, or vertebrae.
* Endocarditis
* Pericarditis
* Brain abscess
* Meningitis

## References

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1. ↑ Volante M, Contucci AM, Fantoni M, Ricci R, Galli J (2005). "Cervicofacial actinomycosis: still a difficult differential diagnosis". Acta Otorhinolaryngol Ital. 25 (2): 116–9. PMC 2639881. PMID 16116835.
2. ↑ Sharkawy AA (2007). "Cervicofacial actinomycosis and mandibular osteomyelitis". Infect. Dis. Clin. North Am. 21 (2): 543–56, viii. doi:10.1016/j.idc.2007.03.007. PMID 17561082.
3. ↑ Peipert, Jeffrey F. (2004). "Actinomyces: Normal Flora or Pathogen?". Obstetrics & Gynecology. 104 (Supplement): 1132–1133. doi:10.1097/01.AOG.0000145267.59208.e7. ISSN 0029-7844.
4. ↑ Higashi Y, Nakamura S, Ashizawa N, Oshima K, Tanaka A, Miyazaki T, Izumikawa K, Yanagihara K, Yamamoto Y, Miyazaki Y, Mukae H, Kohno S (2017). "Pulmonary Actinomycosis Mimicking Pulmonary Aspergilloma and a Brief Review of the Literature". Intern. Med. 56 (4): 449–453. doi:10.2169/internalmedicine.56.7620. PMID 28202870.
5. ↑ Schaal KP, Lee HJ (1992). "Actinomycete infections in humans--a review". Gene. 115 (1–2): 201–11. PMID 1612438.
6. ↑ Brown, James R. (1973). "Human actinomycosisA study of 181 subjects". Human Pathology. 4 (3): 319–330. doi:10.1016/S0046-8177(73)80097-8. ISSN 0046-8177.
7. ↑ Agrawal P, Vaiphei K (2014). "Renal actinomycosis". BMJ Case Rep. 2014. doi:10.1136/bcr-2014-205892. PMC 4244330. PMID 25406215.

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