eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Actinomycosis: Differential Diagnoses & Workup

Author: Jorge M Quinonez, MD, Medical Director of Pediatrics, Chief Medical Officer, Family Health Centers of South West Florida, Inc
Contributor Information and Disclosures

Updated: Jun 27, 2008

Differential Diagnoses

Tuberculosis

Other Problems to Be Considered

Cervical actinomycosis

Bacterial abscess of oral cavity
Neoplasia
Bacterial osteomyelitis of mandible

Thoracic actinomycosis

Tuberculosis
Nocardiosis
Bronchogenic carcinoma
Mesothelioma
Lymphoma
Lung abscess
Histoplasmosis
Blastomycosis

Abdominal actinomycosis

Intestinal tuberculosis
Ameboma
Regional enteritis
Carcinoma of the cecum

CNS actinomycosis

Intracranial neoplasia
Tuberculous meningitis
Chronic meningitis
Histoplasma capsulatum
Cryptococcus neoformans
Blastomyces dermatitidis

Pelvic actinomycosis

Intrapelvic neoplasia
Endometriosis

Workup

Laboratory Studies

Microbiologic identifications of the organisms that cause actinomycosis are uncommon. Diagnosis usually relies on the clinical picture and the presence of sulfur granules either observed macroscopically or microscopically. No serologic test or skin test for actinomycosis is available. Actinomyces is usually part of the normal flora; its presence on sputum samples, bronchial washings, or cervicovaginal secretions is not enough to make the diagnosis. Polymerase chain reaction has been used for diagnosis in some research laboratories.

  • Gram stain
    • Gram stain is more sensitive than culture.
    • Actinomyces are identified as gram-positive rods that are non–acid fast in diphtheroidal arrangement.
  • Hematoxylin-eosin stain of sulfur granules - Basophilic masses with a radiating border of eosinophilic terminal clubs
  • Culture
    • Tissue, pus, or sulfur granules are ideal.
    • Use anaerobic transport media.
    • No prior use of antibiotics is imperative.
    • Brain and heart infusion blood agar is cultured anaerobically or enriched with carbon dioxide.
    • Growth is in 5-7 days and may take 2-4 weeks.
  • Other useful stains
    • Grocott-Gomori methenamine-silver nitrate stain
    • P-aminosalicylic acid
    • Goodpasture stain
    • Brown-Brenn stain

Imaging Studies

  • CT scanning of the involved area is useful in differentiating between an inflammatory mass and a tumor.4
  • Abdominal and pelvic ultrasonographic studies have been used for diagnosing masses that may be due to actinomycosis.
  • Chest radiography in thoracic actinomycosis may provide some idea of the degree of pulmonary and pleural involvement; however, diagnosing the disease on the basis of radiographic findings alone is impossible.

Procedures

  • Fine-needle aspiration, biopsy, CT scanning, or ultrasound-guided aspirations and biopsies can be successfully used to retrieve clinical materials for diagnosis.

Histologic Findings

  • Histologic diagnosis is difficult because many specimens contain only a few sulfur granules.
  • The use of a specific monoclonal antibody conjugated with fluorescein is a useful alternative that allows rapid identification by direct staining of clinical materials even after they have been fixed in formalin.

More on Actinomycosis

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

  1. Funke G, von Graevenitz A. Infections due to Actinomyces neuii (former "CDC coryneform group 1" bacteria). Infection. Mar-Apr 1995;23(2):73-5. [Medline].

  2. Siqueira JF, Rocas IN. Polymerase chain reaction detection of Propionibacterium propionicus and Actynomyces radicidentis in primary and persistent endodontic infections. Oral Surg oral Med Oral Pathol Oral Radiol Endod. 2003;96:215-222. [Medline].

  3. Perlow JH, Wigton T, Yordan EL, et al. Disseminated pelvic actinomycosis presenting as metastatic carcinoma: association with the progestasert intrauterine device. Rev Infect Dis. Nov-Dec 1991;13(6):1115-9. [Medline].

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

  5. Henderson SR. Pelvic actinomycosis associated with an intrauterine device. Obstet Gynecol. May 1973;41(5):726-32. [Medline].

  6. Koshi G, Lalitha MK, Samraj T, et al. Brain abscess and other protean manifestations of actinomycosis. Am J Trop Med Hyg. Jan 1981;30(1):139-44. [Medline].

  7. Maxon S, Jacobs R. Actinomycosis. In: Feigin R, Cherry J, Fletcher J, eds. Textbook of Pediatric Infectious Diseases. Philadelphia, Pa: WB Saunders and Co; 1998:1587-90.

  8. Robinson JL, Vaudry WL, Dobrovolsky W. Actinomycosis presenting as osteomyelitis in the pediatric population. Pediatr Infect Dis J. Apr 2005;24(4):365-9. [Medline].

  9. Russo T. Agents of Actinomycosis. In: Mandell G, Bennett J, Dolin R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingston; 1995:2280-8.

  10. Sakallioglu U, Acikgoz G, Kirtiloglu T, et al. Rare lesions of the oral cavity: case report of an actinomycotic lesion limited to the gingiva. J Oral Sci. Mar 2003;45(1):39-42. [Medline].

  11. Skoutelis A, Petrochilos J, Bassaris H. Successful treatment of thoracic actinomycosis with ceftriaxone. Clin Infect Dis. Jul 1994;19(1):161-2. [Medline].

  12. Smego RA Jr. Actinomycosis of the central nervous system. Rev Infect Dis. Sep-Oct 1987;9(5):855-65. [Medline].

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

  14. Snape PS. Thoracic actinomycosis: an unusual childhood infection. South Med J. Feb 1993;86(2):222-4. [Medline].

  15. Tanaka-Bandoh K, Watanabe K, Kato N, et al. Susceptibilities of Actinomyces species and Propionibacterium propionicus to antimicrobial agents. Clin Infect Dis. Sep 1997;25 Suppl 2:S262-3. [Medline].

  16. 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].

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Further Reading

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Keywords

actinomycosis, actinophytosis, lumpy jaw, Actinomyces, Actinomyces israelii, A israelii, Actinomyces naeslundii, A naeslundii, Actinomyces odontolyticus, A odontolyticus, Actinomyces viscosus, A viscosus, Actinomyces meyeri, A meyeri, infections of the oral region, infections of the cervicofacial region, cervicofacial actinomycosis, thoracic actinomycosis, abdominal actinomycosis, pelvic actinomycosis, Actinobacillus actinomycetemcomitans, Eikenella corrodens, Fusobacterium, Bacteroides, Capnocytophaga, Staphylococcus, Streptococcus, Enterococcus pulmonary infection, appendicitis, diverticulitis, tonsillitis, mastoiditis, otitis, periostitis, osteomyelitis, pneumonia, tuberculosis, tracheoesophageal fistulas, pericarditis, myocarditis, endocarditis, typhoid fever, amebic dysentery, intrauterine contraceptive device, pneumonitis, pleural effusion

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Contributor Information and Disclosures

Author

Jorge M Quinonez, MD, Medical Director of Pediatrics, Chief Medical Officer, Family Health Centers of South West Florida, Inc
Jorge M Quinonez, MD is a member of the following medical societies: American Academy of Pediatrics and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Itzhak Brook, MD, MSc, Professor, Department of Pediatrics, Georgetown University School of Medicine
Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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