Actinomycotic Infection, Lumpy Jaw
What is Actinomycosis?
Actinomycosis is an infection caused by the bacterium Actinomyces. The infection begins when the bacteria, which are normal inhabitants of the mouth and intestine, are introduced into injured tissues. Such infections commonly occur in the face and neck. Actinomycosis typically follows the extraction of a tooth. Actinomycotic infection can also originate in the gastrointestinal tract or lungs, and spread by direct extension or, uncommonly, through the bloodstream to other locations.
How is it diagnosed?
- History is of a painful swelling around the jaw, a week or more after a tooth extraction or oral surgery; symptoms may develop slowly. If the lungs are infected, there can be a productive cough and fever; night sweats, weight loss, and pain with breathing may also be present. Abdominal actinomycosis causes pain in the lower intestinal area, fever, vomiting, and weight loss.
- Physical exam of actinomycosis of the face may reveal a markedly hardened area, with the overlying skin reddish or purplish-blue. An abscess eventually forms and drains to the exterior. Spasm of the jaw muscles may be observed. An abdominal mass may be felt.
- Tests: The organism can be isolated from the pus, and correct identification is crucial to effective treatment; specialized cultures of the pus may be required. X-rays may show evidence of infection of the bone or lung.
How is it treated?
Actinomycosis is treated with two stages of antibiotic therapy, first by injection and then orally. Therapy may be continued for weeks or months after clinical symptoms disappear, to be sure of a cure. Surgical procedures may be needed to drain abscesses.
Cleocin (Clindamycin), Doryx (Doxycycline), Ilosone (Erythromycin)
What might complicate it?
Infection may occasionally result in brain abscess or meningitis. If lung infection occurs, it can extend through the diaphragm and result in an abscess above or in the liver. The involvement of deep abscesses with bone or the development of cellular masses within the intestines or lungs may require surgical intervention to clear the passages and restore normal function.
With antibiotic treatment and surgery, the prognosis is good. Without treatment or with delayed diagnosis, extensive tissue injury may occur. Partial loss of organ function or scarring may result.
Nocardia infections may have a similar history and symptoms with actinomycosis. Tetanus can also result in spasm of jaw muscles, but also involves other muscle groups and other neurologic signs. Abdominal actinomycosis can resemble acute appendicitis, cancer of the cecum, tuberculosis, or amebiasis.
Infectious disease specialist, general surgeon, oral surgeon, and pulmonary specialist.
Last updated 17 December 2011