Actinomycosis

Classification according to ICD-10
A42	Actinomycosis
ICD-10 online (WHO version 2019)

Cervicofacial actinomycosis

Actinomycosis on a deer lower jaw

Actinomycosis of the lungs on x-ray and computed tomography.

As actinomycosis or radiation fungal disease a disease is referred to in Germany under the term Ray fungus is known. It is caused as a mixed infection by bacteria from the group of actinomycetes , among others . It used to be assumed that it was a fungal infection (or mycosis) with the anaerobic "radiation fungus" Actinomyces Israeli (also called Actinomyces Wolff-Israeli and Actinomyces bovis ) (pseudomycosis).

Actinomycosis is a bacterial anaerobic and aerobic mixed infection that is caused primarily by Actinomyces israelii , but also by other actinomycetes. This is part of the normal human oral flora and penetrates deeper tissue layers if the mucous membrane is injured. Here a purulent inflammation occurs with the formation of granulation tissue and branched fistulas. The most common clinical presentation is cervicofacial actinomycosis (i.e. on the neck, face - for example as lacrimal canaliculitis , mostly in the mouth area), whereas it rarely occurs in the CNS , the lungs (through aspiration) and in the skin . Actinomycoses of the mammary gland and in the genital area, mostly in connection with long-lying intrauterine devices, are also described .

The diagnosis is made by examining the sputum or a lung biopsy. The pathogen must be cultivated for an exceptionally long time, i.e. at least two weeks, because actinomycetes multiply slowly. Since the direct detection of Actinomyces spp. is difficult in tissue samples, PCR has also been used to detect DNA for a number of years . Actinomycosis is not contagious. It is characterized by a chronic course with high recurrence . Therapy consists of the administration of aminopenicillin , initially intravenously . This therapy can last up to a year. Newer studies recommend a short therapy of up to three months. Alternatively, tetracycline or cephalosporin can also be used. High doses of iodine are also said to have beneficial effects. With surgical therapy (read: operation), the focus of inflammation is opened and the affected tissue is removed.

The main complication is the fistula formation that occurs in actinomycosis . This allows the pathogens to enter the bloodstream and the disease can become systemic (affecting the whole body). The prognosis is not good due to the high level of recurrence . The thoracic form of infection (English: thoracic actinomycosis) remains untreated with a high risk to the health and life of the patient. Extensive thoracic diseases also respond very well to antibiotic therapy. Surgical or interventional therapy (drainage) is currently carried out in about half of the cases, which is probably too often.

Epidemiology

The incidence of actinomycosis is given as 2–5 per 100,000 per year. Reliable data on the prevalence of actinomycosis are not available.

literature

• Eduard Neuber: Specific diagnosis and therapy of actinomycosis . In: Clinical weekly . tape 19 , no. 29 . Springer, 1940, p. 736-741 .
• VK Wong, TD Turmezei, VC Weston: Actinomycosis. In: BMJ (Clinical research ed.). Volume 343, 2011, p. D6099, PMID 21990282 (review).
• F. Valor et al .: Actinomycosis: etiology, clinical features, diagnosis, treatment, and management. In: Infection and drug resistance. Volume 7, 2014, pp. 183-197, doi: 10.2147 / IDR.S39601 , PMID 25045274 , PMC 4094581 (free full text) (review).
• Jae-Uk Song, Hye Yun Park, Kyeongman Jeon, Sang-Won Um, O Jung Kwon, Won-Jung Koh: Treatment of thoracic actinomycosis: A retrospective analysis of 40 patients. In: Annals of Thoracic Medicine Volume 5, 2010, Issue 2, pp. 80-85, doi: 10.4103 / 1817-1737.62470 , PMID 20582172 .
• Eija Könönen, William G. Wade: Actinomyces and Related Organisms in Human Infections. In: Clinical Microbiology Reviews, Volume 28, 2015, Issue 2, pages 419-442, doi: 10.1128 / CMR.00100-14 .

Individual evidence

1. ↑ Like the nocardiosis pathogens, the actinomycosis pathogens were formerly part of the family of Actinomycetaceae (radiation fungi). See for example Hans von Kress (ed.): Müller - Seifert . Pocket book of medical-clinical diagnostics. 69th edition. Published by JF Bergmann, Munich 1966, p. 1062.
2. ↑ Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid 1961, pp. 9-223, here: pp. 212 f.
3. ↑ Manfred Kaufmann , Serban-Dan Costa , Anton Scharl: Die Gynäkologie . Springer Verlag, Heidelberg 2005, ISBN 3-540-25664-4 , pp. 611 ff . ( online at: books.google.de ).
4. ↑ C. Zuchna, M. Hager, M. Hell: Pelvic abscessing actinomycosis as a complication of an IUD. In: Obstetrics, gynecology. 2008; 68 - P47, doi: 10.1055 / s-2008-1078334
5. ↑ Reischl, Udo: Actinomyces spp. (Actinomycetes) , Regensburg, 2012.
6. ↑ Kayser, Fritz H. et al .: Pocket Textbook Medical Microbiology , Thieme, 2014, doi: 10.1055 / b-0034-98724
7. ↑ RA Smego, G. Foglia: actinomycosis . In: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America . tape 26 , no. 6 , June 1998, ISSN  1058-4838 , pp. 1255-1261; quiz 1262-1263 , PMID 9636842 .

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !