What Is Actinomycosis?

Actinomycosis is a subacute chronic infection caused by the bacterium genus Actinmyces. This infection is characterized by a centralized or localized swelling in a site, accompanied by pus formation due to inflammation ( suppuration ), fibrosis, abscess formation, and discharge of sulphurous granules from pus ( sinus ) channels in the abscess.

Actinomycosis is quite rare and the infection is localized in one spot of the body. This is because Actinomyces bacteria do not have the ability to penetrate body tissues. However, in some cases, Actinomyces bacteria can move through the tissues of the body though very slowly.

The symptoms of actinomycosis vary considerably depending on the type of infection that occurs. Several types of actinomycosis that have been identified are:

• Cervicofacialal oral actinomycosis. This type of actinomycosis infection occurs in the mouth, oral cavity, jaw, neck, and facial area. Most cases of oral actinomycosis are caused by problems with the jaw (eg jaw injury) or problems with teeth and gums (eg tartar and tooth decay).
• Thoracic aktinomycosis. This is a type of actinomycosis infection that occurs in the lungs or other respiratory organs. Most pulmonary actinomycosis infections are thought to be caused by inhalation of saliva or Actinomyces contaminated fluids into the respiratory organs.
• Abdominal actinomycosis. Actinomycosis infection occurs in the abdomen. The cause of the appearance of abdominal actinomycosis is very diverse, one of which is the result of appendicitis infection (appendicitis) .
• Pelvic actinomycosis. This is an actinomycosis infection that occurs in the pelvic (pelvic area). Some people with 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 IUD constricting devices. Especially if its use exceeds the time limit recommended by the manufacturer.

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Causes of Actinomycosis
The cause of actinomycosis is Actinomyces bacteria which is a normal flora that normally lives in the oral cavity, gastrointestinal tract, and urinary tract. Bacterial Actinomyces is a facultative pathogenic commensal bacterium that requires the ability to penetrate the mucosal lining that can cause disease. Actinomycosis is often caused by several types of bacteria, either fellow genera Actinomyces or other bacteria. Bacteria Actinomyces israelii and Actinomyces gerencseriae are the two most common bacteria found in cases of actinomycosis in humans. In addition to these two types of bacteria, other types of Actinomyces bacteria can be found in cases of actinomycosis, including Actinomyces odontolyticus, Actinomyces viscous, Actinomyces meyeri, Actinomyces turicensis, and Actinomyces radingae. Infections caused by Actinomyces tend to appear on tissues adjacent to the mucous membranes. Some things that can increase the likelihood of a person exposed to actinomikosis include:

• Age. Actinomycosis occurs most often at the age of 20-60 years.
• Men. Actinomycosis often occurs in men, with the exception of pelvic actinomycosis that tends to occur in women.
• Diabetes.
• Immunosuppression. The condition of a person's immune system is disturbed to cause more easily affected by aktinomikosis. For example due to HIV infection, undergoing chemotherapy, steroid consumption, bisphosphonates, kidney transplant, or lung transplant.
• Consume alcohol.
• Experiencing network damage. For example due to injury, surgery, or radiotherapy.
• Tooth decay or dental hygiene is not well maintained.
• Have a history of abdominal surgery.

Symptoms of Actinomycosis
The symptoms of actinomycosis vary considerably depending on the location of the condition. Common symptoms of cervicofacial oral actinomycosis are as follows:

• Fever.
• The appearance of chronic swelling around the lower jaw that does not feel pain. But sometimes this swelling can also cause pain.
• The emergence of hard and often mistaken lesions as malignant lesions (cancer).
• The emergence of lymphadeopathy if actinomycosis is chronic enough and goes into an advanced stage.
• Formed pus (sinus) ducts, which secrete yellow fluid such as sulfur.
• The skin color around the swelling can turn redness or bluish.
• Cervicofacialal oral actinomycosis in some cases can also spread to bones and muscles.

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

• A mild to moderate fever.
• Cough that appears can be a dry cough or cough with phlegm. In some cases, it can also appear cough with blood.
• Tired and tired.
• Hard to breathe.
• Chest pain.
• Coughing up blood (haemoptysis) and losing weight if infection of actinomycosis has been ongoing for a long time.
• There is fluid in the lungs which is sometimes followed by the appearance of a lump in the lung area.
• If left unchecked, the infection may spread to the lining of the lungs, the heart membrane, the lining of the chest.

In the case of abdominal actinomycosis, symptoms that may arise are as follows:

• Low-grade fever.
• Losing weight.
• Tired and tired.
• Abdominal pain.
• The appearance of a lump or swelling of the lower abdomen. But sometimes the lump is not felt during the physical examination using the palpation method.
• The appearance of pus fluid from the sinuses that form in the abdomen.
• Diarrhea or constipation.
• Nausea and vomiting.

Whereas in the case of pelvic actinomycosis, symptoms that may arise are as follows:

• Lower abdominal pain.
• Vaginal bleeding occurs irregularly or discharge of vaginal discharge such as vaginal discharge.
• Loss of appetite.
• The appearance of a lump that can be felt in the area of ​​the waist or hip.
• Low-grade fever.
• Tired.

Diagnosis of Actinomycosis
Actinomycosis can be known and diagnosed by investigation as follows:

• Blood examination. Actinomycosis can lead to an increase in blood sedimentation rate, alkaline phosphatase enzyme, and reactive C protein (CRP). In addition, actinomycosis may also cause mild anemia and leukocytosis.
• Imaging of internal organs. Imaging can be done using CT scans, MRI and chest X-ray. CT scans and MRI results in actinomycosis patients may indicate a nonspecific abscess in the suspected part of an actinomycosis. From chest X-rays can be seen the existence of pneumonitis, lumps and other lesions in the chest cavity, especially on thoracic aktinomikosis. Although it can not accurately diagnose the actinomycosis, the results of internal organ imaging can be used to assist the examination of body tissues through a microscope, especially during tissue sampling.
• Histopathological examination. Samples of tissue suspected of having an actinomycosis can be observed through a microscope to see tissue appearance. Samples for microscopic studies can also be obtained from the secretion of pus coming out of organs with actinomycosis. Liquids can be observed directly or through bacterial culture, although the risk of bacterial culture failure is quite high.
• Analysis of Molecular Genetics. For more rapid and accurate diagnostic purposes, molecular genetic analysis methods may be used to confirm the presence of Actinomyces . Methods that can be performed include PCR, bacterial RNA sequencing, in situ spectrophotometric hybridization, and mass spectrometry.

Treatment of Actinomycosis
The most important treatment of actinomycosis is by using antibiotics, especially beta-lactam groups, such as penicillin G and penicillin V. The ability of Actinomyces bacteria to resist penicillin is low enough, so this class of antibiotics can be used as the main treatment of actinomycosis. Treatment in the first stage may use intravenous penicillin G for 2-6 weeks, followed by oral penicillin V for 6-12 months. But keep in mind that treatment for 6-12 months is not necessary for all patients with aktinomikosis.
In addition to using penicillin, actinomycosis can be treated with other antibiotics, such as:

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

Often in patients with actinomycosis, not only the bacteria of Actinomyces genus are present in the site of actinomycosis, but there are often other bacteria, such as Staphylococcus aureus and anaerobic gram-negative bacteria. Therefore, at the time of administration of antibiotics at the beginning of the treatment period, it should also be given antibiotics that have the ability to inhibit the beta-lactamase enzyme. Beta lactamase can inhibit the performance of antibiotics given to kill Actinomyces . Examples of antibiotics that also have the ability to inhibit beta-lactamase are clavulanate and tazobactam .
Especially for people with abdominal actinomycosis, in addition to amoxicillin , metronidazole, clindamycin , or clavulanate , may also be given aminoglycosides. The aminoglycoside function is to eradicate the bacterial Enterobacteriaceae family that is resistant to previous antibiotics and aggravate the actinomycosis that occurs.

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

• In case of extensive network damage and network resection or other action is required. For example if there is necrosis, sinus infection, and the appearance of fistulas.
• If there is a large abscess or empyema (abscess containing pus) that can not be drained by suctioning from the skin surface.
• If the abscess appears to block the organs of the organ, for example if the abscess of pelvic actinomycosis inhibits the urinary tract.
• If the patient does not heal with antibiotics.

Actinomycosis can cause death especially if Actinomyces infection spreads to the central nervous system such as the brain and spinal cord. The death rate from actinomycosis can be as high as 28 percent, but the rate depends on the initial site of actinomycosis. If you get good treatment and medical treatment, the patient can act on the maximum.


Complications of Actinomycosis
Complications of actinomycosis can occur especially if the infections that appear in the patient are not handled properly and spread to other organs. Some of the complications that can occur due to actinomycosis are:

• Osteomyelitis , especially in the jawbone, ribs, and backbone.
• Abscesses in the brain and chronic meningitis, including cranial nerve (head) and spinal (spine) infections, as well as infection of the durameter space of the meninges membranes.
• Endocarditis .
• Actinomycosis is disseminated.
• Liver abscess.

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