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Actinomycosis: Differential Diagnoses & Workup

Author: Talib Najjar, DMD, MDS, PhD, Professor of Oral and Maxillofacial Surgery and Pathology, University of Medicine and Dentistry of New Jersey
Contributor Information and Disclosures

Updated: Aug 13, 2008

Differential Diagnoses

Aspergillosis
Erysipelas
Leishmaniasis
Nocardiosis
Osteomyelitis

Other Problems to Be Considered

Brucellosis
Botryomycosis
Blastomycosis
Histoplasmosis
Toxoplasmosis
Osteomyelitis
Multiple myeloma
Central giant cell granuloma
Osteosarcoma
Fibrous dysplasia
Hodgkin lymphoma
Burkitt lymphoma
Bisphosphonate

Consider actinomycosis infection in the differential diagnosis of any acute, subacute, or chronic cutaneous or soft tissue swelling of the head, face, or neck. The Medscape Head and Neck Cancer Resource Center may be of interest.

Workup

Laboratory Studies

  • Culture findings in actinomycosis
    • Cultures from the lesions of actinomycosis typically reveal a variety of accompanying bacteria.
    • The most common bacterium found in association with actinomycosis is appropriately called Actinobacillus actinomycetemcomitans, which is an oral commensal organism that is common in the cervicofacial form of the disease.
    • Other bacteria include anaerobic streptococci, fusiform bacilli, Haemophilus species, and gram-negative bacilli, which appear to interact synergistically with Actinomyces species.
    • The associated bacteria in actinomycosis may help to establish an anaerobic medium that enhances the growth and propagation of the Actinomyces species.
  • Performing cultures for actinomycosis
    • To culture the actinomycosis specimen, flush the sulfur granules with sodium chloride solution to remove accompanying bacteria.
    • Incubate in a brain-heart agar plate in a 5% carbon dioxide atmosphere at 37°C for 4-6 days.
    • After approximately 2 days of incubation, the characteristic loose branching filaments of actinomycosis appear.
    • The colonies develop into an opaque mass within 4-6 days.
    • A israelii may be subcultured in a thioglycollate broth, in which it subsequently develops into hard granules with irregular borders.
  • Hematologic study results in actinomycosis
    • White blood cell counts are increased in approximately one half of patients; however, the white blood cell count can also be in the reference range.
    • Anemia may not be present, but superinfection is associated with normocytic and normochromic anemia.
    • An elevated erythrocyte sedimentation rate may be an associated finding.

Imaging Studies

  • Radiographic studies are useful in analyzing osseous involvement in actinomycosis because osteolysis is a common feature in patients with actinomycosis.
  • The radiographic appearance of actinomycosis lesions can range from that of a minor subperiosteal reaction and minimal rarefaction to that of classic osteomyelitis, with total lytic destruction or thickening and sclerosis that may be confused findings of a bone tumor.
    • Bone is actively invaded by the infection, which results in localized areas of lytic bone destruction surrounded by areas of increased bone density.
    • The sinus tracts may interconnect bony foci.

Other Tests

  • CT scanning and MRI are very helpful for detecting osseous and soft tissue involvement with persistent actinomycosis.18

Histologic Findings

  • The histologic feature of actinomycosis sulfur granules is pathognomic, which could be used as a tool to confirm the microbiologic findings.

More on Actinomycosis

Overview: Actinomycosis
Differential Diagnoses & Workup: Actinomycosis
Treatment & Medication: Actinomycosis
Follow-up: Actinomycosis
Multimedia: Actinomycosis
References
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References

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Further Reading

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Keywords

actinomycosis, Actinomyces israelii, A israelii, inflammatory disease, bacterial infection, Actinomyces naeslundii, A naeslundii, Actinomyces viscosus, A viscosus, Actinomyces odontolyticus, A odontolyticus

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Contributor Information and Disclosures

Author

Talib Najjar, DMD, MDS, PhD, Professor of Oral and Maxillofacial Surgery and Pathology, University of Medicine and Dentistry of New Jersey
Disclosure: Nothing to disclose.

Medical Editor

Janet Fairley, MD, Professor and Head, Department of Dermatology, University of Iowa
Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Federation for Medical Research, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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