Actinomycosis Workup

  • Author: Jason F Okulicz, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Aug 2, 2011
 

Laboratory Studies

  • CBC count: Anemia and mild leukocytosis are common.
  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are often elevated.
  • Chemistry results usually are normal, with the exception of a frequently elevated alkaline phosphatase level in hepatic actinomycosis.
  • Organism cultures
    • Because actinomycosis is difficult to diagnose based on the typical clinical features, direct identification and/or isolation of the infecting organism from a clinical specimen or from sulfur granules is necessary for definitive diagnosis in most cases.
    • Acceptable specimen material is obtained from draining sinuses, deep needle aspirate, or biopsy specimens; swabs, sputum, and urine specimens are unacceptable or inappropriate.
    • Prompt transport of the specimens to the microbiology laboratory is necessary for optimal isolation of actinomycetes, preferably in an anaerobic transport device.
    • A Gram-stained smear of the specimen may demonstrate the presence of beaded, branched, gram-positive filamentous rods, suggesting the diagnosis of actinomycosis.
    • Cultures should be placed immediately under anaerobic conditions and incubated for 48 hours or longer; the isolation and definitive identification of actinomycetes may require 2-3 weeks.
    • Nucleic acid probes and polymerase chain reaction (PCR) methods are being developed for more rapid and more accurate identification.
    • Antimicrobial susceptibility testing is not indicated in the management of actinomycosis, partly because of their predictable antibiogram.
  • The preliminary diagnosis of actinomycosis also can be made by examining sulfur granules. Granules should be crushed between 2 slides, stained with 1% methylene-blue solution, and examined microscopically for features characteristic of actinomycetes.
  • Serologic diagnosis: Current serologic tests have no role in diagnosing actinomycosis.
  • Papanicolaou test:
    • The relationship between a Papanicolaou test that is positive for actinomycetelike organisms and the eventual development of pelvic actinomycosis is unclear.
    • The prevalence of smears positive for Actinomyces organisms in women who use IUCDs is approximately 7%.[5]
    • Because of the lack of sensitivity and specificity and low positive predictive value, the prognostic significance of detecting Actinomyces organisms is minimal in the absence of concomitant symptoms.[5]
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Imaging Studies

  • Chest radiography
    • A chest radiograph may reveal a poorly defined mass or pneumonitis or cavitary lesion, with or without pleural involvement. Hilar adenopathy is uncommon.
    • The presence of a masslike lesion that extends across fissures or pleura, invades into the adjacent chest wall or thoracic vertebrae, or causes local destruction of the ribs or sternum suggests thoracic actinomycosis.
  • CT scanning (irrespective of the anatomic area of involvement) usually reveals an infiltrative mass with focal areas of decreased attenuation that enhance with contrast. This infiltrative mass tends to invade surrounding tissues. Surrounding lymphadenopathy is uncommon.
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Procedures

  • CT scan or ultrasound-guided fine-needle aspiration and/or biopsy have been used successfully to obtain clinical material for diagnosis of actinomycosis.
  • Surgery (eg, thoracotomy with open lung biopsy, exploratory laparotomy) may be required for diagnostic purposes.
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Histologic Findings

Actinomycosis is characterized by mixed suppurative and granulomatous inflammatory reactions, connective-tissue proliferation, and the presence of sulfur granules. The sulfur granules are nearly pathognomonic for actinomycosis, although similar findings have been reported with infections caused by Nocardia brasiliensis, Streptomyces madurae, and Staphylococcus aureus presenting as botryomycosis. The granules are approximately 0.1-1 mm in diameter and may be seen with the naked eye as yellowish particles.

Microscopically, the granules manifest a cauliflowerlike shape at low magnification; at higher magnification (X100), when the particle has been pressed between slide and cover slip, a clump of filamentous actinomycete microcolonies surrounded by polymorphonuclear neutrophils (PMNs) can be observed. Gram stain renders these microcolonies visible as gram-positive, intertwined branching filaments, with radially arranged, peripheral hyphae. Coexisting with them are the companion bacteria, which are gram-positive and gram-negative cocci and rods. The images below are representative photomicrographs.

Actinomycosis in the endometrial tissue, low-powerActinomycosis in the endometrial tissue, low-power view. Image courtesy of Paul Gibbs, MD. Actinomycosis in the endometrial tissue, high-poweActinomycosis in the endometrial tissue, high-power view. Image courtesy of Paul Gibbs, MD.
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Contributor Information and Disclosures
Author

Jason F Okulicz, MD  Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center

Jason F Okulicz, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Hari Polenakovik, MD  Assistant Professor of Medicine, Wright State University, Boonshoft School of Medicine

Hari Polenakovik, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Sylvia Polenakovik, MD  Clinical Instructor, Internist, Department of Internal Medicine, Wayne Hospital, Wright State University, Boonshoft School of Medicine

Sylvia Polenakovik, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel R Lucey, MD, MPH  Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences

Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Hall V. Actinomyces--gathering evidence of human colonization and infection. Anaerobe. Feb 2008;14(1):1-7. [Medline].

  2. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. May 2004;62(5):527-34. [Medline].

  3. Markiewicz MR, Margarone JE 3rd, Campbell JH, Aguirre A. Bisphosphonate-associated osteonecrosis of the jaws: a review of current knowledge. J Am Dent Assoc. Dec 2005;136(12):1669-74. [Medline].

  4. Hansen T, Kunkel M, Weber A, James Kirkpatrick C. Osteonecrosis of the jaws in patients treated with bisphosphonates - histomorphologic analysis in comparison with infected osteoradionecrosis. J Oral Pathol Med. Mar 2006;35(3):155-60. [Medline].

  5. Westhoff C. IUDs and colonization or infection with Actinomyces. Contraception. Jun 2007;75(6 Suppl):S48-50. [Medline].

  6. Sung HY, Lee IS, Kim SI, Jung SE, Kim SW, Kim SY. Clinical Features of Abdominal Actinomycosis: A 15-year Experience of A Single Institute. J Korean Med Sci. Jul 2011;26(7):932-7. [Medline].

  7. Sudhakar SS, Ross JJ. Short-term treatment of actinomycosis: two cases and a review. Clin Infect Dis. Feb 1 2004;38(3):444-7. [Medline].

  8. Macfarlane DJ, Tucker LG, Kemp RJ. Treatment of recalcitrant actinomycosis with ciprofloxacin. J Infect. Sep 1993;27(2):177-80. [Medline].

  9. Ferreira Dde F, Amado J, Neves S, Taveira N, Carvalho A, Nogueira R. Treatment of pulmonary actinomycosis with levofloxacin. J Bras Pneumol. Apr 2008;34(4):245-8. [Medline].

  10. Apotheloz C, Regamey C. Disseminated infection due to Actinomyces meyeri: case report and review. Clin Infect Dis. Apr 1996;22(4):621-5. [Medline].

  11. Arend SM, Oosterhof H, van Dissel JT. Actinomyces and the intrauterine device. Arch Intern Med. Jun 8 1998;158(11):1270. [Medline].

  12. Belmont MJ, Behar PM, Wax MK. Atypical presentations of actinomycosis. Head Neck. May 1999;21(3):264-8. [Medline].

  13. Brown JR. Human actinomycosis. A study of 181 subjects. Hum Pathol. Sep 1973;4(3):319-30. [Medline].

  14. Cayley J, Fotherby K, Guillebaud J, et al. Recommendations for clinical practice: actinomyces like organisms and intrauterine contraceptives. The Clinical and Scientific Committee. Br J Fam Plann. Jan 1998;23(4):137-8. [Medline].

  15. Chaudhry SI, Greenspan JS. Actinomycosis in HIV infection: a review of a rare complication. Int J STD AIDS. Jun 2000;11(6):349-55. [Medline].

  16. Choi J, Koh WJ, Kim TS, et al. Optimal duration of IV and oral antibiotics in the treatment of thoracic actinomycosis. Chest. Oct 2005;128(4):2211-7. [Medline].

  17. Chouabe S, Perdu D, Deslee G, et al. Endobronchial actinomycosis associated with foreign body: four cases and a review of the literature. Chest. Jun 2002;121(6):2069-72. [Medline].

  18. Cintron JR, Del Pino A, Duarte B, Wood D. Abdominal actinomycosis. Dis Colon Rectum. Jan 1996;39(1):105-8. [Medline].

  19. Clarridge JE, Zhang Q. Genotypic diversity of clinical Actinomyces species: phenotype, source, and disease correlation among genospecies. J Clin Microbiol. Sep 2002;40(9):3442-8. [Medline].

  20. Colmegna I, Rodriguez-Barradas M, Rauch R, Clarridge J, Young EJ. Disseminated Actinomyces meyeri infection resembling lung cancer with brain metastases. Am J Med Sci. Sep 2003;326(3):152-5. [Medline].

  21. Curi MM, Dib LL, Kowalski LP, et al. Opportunistic actinomycosis in osteoradionecrosis of the jaws in patients affected by head and neck cancer: incidence and clinical significance. Oral Oncol. May 2000;36(3):294-9. [Medline].

  22. de Montpreville VT, Nashashibi N, Dulmet EM. Actinomycosis and other bronchopulmonary infections with bacterial granules. Ann Diagn Pathol. Apr 1999;3(2):67-74. [Medline].

  23. Endo S, Murayama F, Yamaguchi T, et al. Surgical considerations for pulmonary actinomycosis. Ann Thorac Surg. Jul 2002;74(1):185-90. [Medline].

  24. Felekouras E, Menenakos C, Griniatsos J, et al. Liver resection in cases of isolated hepatic actinomycosis: case report and review of the literature. Scand J Infect Dis. 2004;36(6-7):535-8. [Medline].

  25. Fife TD, Finegold SM, Grennan T. Pericardial actinomycosis: case report and review. Rev Infect Dis. Jan-Feb 1991;13(1):120-6. [Medline].

  26. Hamid D, Baldauf JJ, Cuenin C, Ritter J. Treatment strategy for pelvic actinomycosis: case report and review of the literature. Eur J Obstet Gynecol Reprod Biol. Apr 2000;89(2):197-200. [Medline].

  27. Hansen T, Kunkel M, Kirkpatrick CJ, Weber A. Actinomyces in infected osteoradionecrosis--underestimated?. Hum Pathol. Jan 2006;37(1):61-7. [Medline].

  28. Hsieh MJ, Liu HP, Chang JP, Chang CH. Thoracic actinomycosis. Chest. Aug 1993;104(2):366-70. [Medline].

  29. Huang KL, Beutler SM, Wang C. Endocarditis due to Actinomyces meyeri. Clin Infect Dis. Oct 1998;27(4):909-10. [Medline].

  30. Kim JC, Ahn BY, Kim HC, et al. Efficiency of combined colonoscopy and computed tomography for diagnosis of colonic actinomycosis: a retrospective evaluation of eight consecutive patients. Int J Colorectal Dis. Aug 2000;15(4):236-42. [Medline].

  31. Kim TS, Han J, Koh WJ, et al. Thoracic Actinomycosis: CT Features with Histopathologic Correlation. AJR Am J Roentgenol. Jan 2006;186(1):225-31. [Medline].

  32. Kuijper EJ, Wiggerts HO, Jonker GJ, et al. Disseminated actinomycosis due to Actinomyces meyeri and Actinobacillus actinomycetemcomitans. Scand J Infect Dis. 1992;24(5):667-72. [Medline].

  33. Lequerre T, Nouvellon M, Kraznowska K, et al. Septic arthritis due to Actinomyces naeslundii: report of a case. Joint Bone Spine. Oct 2002;69(5):499-501. [Medline].

  34. Lippes J. Pelvic actinomycosis: a review and preliminary look at prevalence. Am J Obstet Gynecol. Feb 1999;180(2 Pt 1):265-9. [Medline].

  35. Litwin KA, Jadbabaie F, Villanueva M. Case of pleuropericardial disease caused by Actinomyces odontolyticus that resulted in cardiac tamponade. Clin Infect Dis. Jul 1999;29(1):219-20. [Medline].

  36. Mabeza GF, Macfarlane J. Pulmonary actinomycosis. Eur Respir J. Mar 2003;21(3):545-51. [Medline].

  37. Macfarlane DJ, Tucker LG, Kemp RJ. Treatment of recalcitrant actinomycosis with ciprofloxacin. J Infect. Sep 1993;27(2):177-80. [Medline].

  38. Oostman O, Smego RA. Cervicofacial Actinomycosis: Diagnosis and Management. Curr Infect Dis Rep. May 2005;7(3):170-174. [Medline].

  39. Pulverer G, Schutt-Gerowitt H, Schaal KP. Human cervicofacial actinomycoses: microbiological data for 1997 cases. Clin Infect Dis. Aug 15 2003;37(4):490-7. [Medline].

  40. Reddy I, Ferguson DA Jr, Sarubbi FA. Endocarditis due to Actinomyces pyogenes. Clin Infect Dis. Dec 1997;25(6):1476-7. [Medline].

  41. Rothschild B, Naples V, Barbian L. Bone manifestations of actinomycosis. Ann Diagn Pathol. Feb 2006;10(1):24-27. [Medline].

  42. Sabbe LJ, Van De Merwe D, Schouls L, et al. Clinical spectrum of infections due to the newly described Actinomyces species A. turicensis, A. radingae, and A. europaeus. J Clin Microbiol. Jan 1999;37(1):8-13. [Medline].

  43. Scarano FJ, Ruddat MS, Robinson A. Actinomyces viscosus postoperative endophthalmitis. Diagn Microbiol Infect Dis. Jun 1999;34(2):115-7. [Medline].

  44. Schaal KP, Lee HJ. Actinomycete infections in humans--a review. Gene. Jun 15 1992;115(1-2):201-11. [Medline].

  45. Schaal KP, Pape W. Special methodological problems in antibiotic susceptibility testing of fermentative actinomycetes. Infection. 1980;8 Suppl 2:S176-82. [Medline].

  46. Sharma M, Briski LE, Khatib R. Hepatic actinomycosis: an overview of salient features and outcome of therapy. Scand J Infect Dis. 2002;34(5):386-91. [Medline].

  47. Smego RA Jr, Foglia G. Actinomycosis. Clin Infect Dis. Jun 1998;26(6):1255-61; quiz 1262-3. [Medline].

  48. Smith AJ, Hall V, Thakker B, Gemmell CG. Antimicrobial susceptibility testing of Actinomyces species with 12 antimicrobial agents. J Antimicrob Chemother. Aug 2005;56(2):407-9. [Medline].

  49. Soria-Aledo V, Flores-Pastor B, Carrasco-Prats M, et al. Abdominopelvic actinomycosis: a serious complication in intrauterine device users. Acta Obstet Gynecol Scand. Sep 2004;83(9):863-5. [Medline].

  50. Wagenlehner FM, Mohren B, Naber KG, Mannl HF. Abdominal actinomycosis. Clin Microbiol Infect. Aug 2003;9(8):881-5. [Medline].

  51. Warren NG. Actinomycosis, nocardiosis, and actinomycetoma. Dermatol Clin. Jan 1996;14(1):85-95. [Medline].

  52. Weese WC, Smith IM. A study of 57 cases of actinomycosis over a 36-year period. A diagnostic 'failure' with good prognosis after treatment. Arch Intern Med. Dec 1975;135(12):1562-8. [Medline].

  53. Wust J, Steiger U, Vuong H, Zbinden R. Infection of a hip prosthesis by Actinomyces naeslundii. J Clin Microbiol. Feb 2000;38(2):929-30. [Medline].

  54. Xia T, Baumgartner JC. Occurrence of Actinomyces in infections of endodontic origin. J Endod. Sep 2003;29(9):549-52. [Medline].

  55. Yung BC, Cheng JC, Chan TT, et al. Aggressive thoracic actinomycosis complicated by vertebral osteomyelitis and epidural abscess leading to spinal cord compression. Spine. Mar 15 2000;25(6):745-8. [Medline].

 
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Actinomycosis in the endometrial tissue, low-power view. Image courtesy of Paul Gibbs, MD.
Actinomycosis in the endometrial tissue, high-power view. Image courtesy of Paul Gibbs, MD.
 
 
 
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