Actinomycosis: The Disease and its Treatment

Abstract

The diagnosis of actinomycosis is often missed because anaerobic cultures are difficult to obtain and the clinical presentation of actinomycosis often resembles several other disease states. The presence of external draining sinuses and/or yellow sulfur granules upon microscopic examination should direct the clinician toward a correct diagnosis. Therapeutic measures usually consist of several weeks of high dose intravenous penicillin followed by weeks to months of oral penicillin, tetracycline, clindamycin, or erythromycin. Abscesses and empyemas require surgical drainage in addition to antibiotic therapy. The prognosis is usually favorable with early detection and proper treatment. A case of pulmonary actinomycosis is described in a patient who presented with fever, weight loss, and a painful mass on his lower anterior left rib cage. Gram-stain and culture and sensitivity tests performed on the fluid drawn off the chest wall mass revealed Actinomyces israelii as the infecting organism. The patient was successfully treated with long-term penicillin therapy. A review of this rare bacterial disease is presented, emphasizing its treatment and its similarities and differences to other bacterial and fungal diseases.