Actinomycosis is a rare infectious bacterial disease caused by Actinomyces species.[1] About 70% of infections are due to either Actinomyces israelii or A. gerencseriae.[1] Infection can also be caused by other Actinomyces species, as well as Propionibacterium propionicus, which presents similar symptoms. The condition is likely to be polymicrobial aerobic anaerobic infection.[2]

Actinomycosis PHIL 2856 lores
A man with actinomycosis on the right side of his face
SpecialtyInfectious disease

Signs and symptoms

The disease is characterised by the formation of painful abscesses in the mouth, lungs,[3][4] breast,[5] or gastrointestinal tract.[2] Actinomycosis abscesses grow larger as the disease progresses, often over months. In severe cases, they may penetrate the surrounding bone and muscle to the skin, where they break open and leak large amounts of pus, which often contains characteristic granules (sulfur granules) filled with progeny bacteria. These granules are named due to their appearance, but are not actually composed of sulfur.


Actinomycosis GROCOTT'S
Actinomycosis Grocott's stain
Actinomycosis GRAM'S
Actinomycosis Gram stain

Actinomycosis is primarily caused by any of several members of the bacterial genus Actinomyces. These bacteria are generally anaerobes.[6] In animals, they normally live in the small spaces between the teeth and gums, causing infection only when they can multiply freely in anoxic environments. An affected human often has recently had dental work, poor oral hygiene, periodontal disease, radiation therapy, or trauma (broken jaw) causing local tissue damage to the oral mucosa, all of which predispose the person to developing actinomycosis. A. israelii is a normal commensal species part of the microbiota species of the lower reproductive tract of women.[7] They are also normal commensals among the gut flora of the caecum; thus, abdominal actinomycosis can occur following removal of the appendix. The three most common sites of infection are decayed teeth, the lungs, and the intestines. Actinomycosis does not occur in isolation from other bacteria. This infection depends on other bacteria (Gram-positive, Gram-negative, and cocci) to aid in invasion of tissue.

Actinomycosis (5287304877)
Actinomycosis (5287905500)
Actinomycosis - Gram stain (5285453121)
Actinomycosis - Gram stain (5286050280)
Actinomycosis - Gram stain (5286050326)


The diagnosis of actinomycosis can be a difficult one to make. In addition to microbiological examinations, magnetic resonance imaging and immunoassays may be helpful.[8]


Actinomyces bacteria are generally sensitive to penicillin, which is frequently used to treat actinomycosis. In cases of penicillin allergy, doxycycline is used. Sulfonamides such as sulfamethoxazole may be used as an alternative regimen at a total daily dosage of 2-4 grams. Response to therapy is slow and may take months. Hyperbaric oxygen therapy may also be used as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment.[9][10]


Disease incidence is greater in males between the ages of 20 and 60 years than in females.[11] Before antibiotic treatments became available, the incidence in the Netherlands and Germany was one per 100,000 people/year. Incidence in the U.S. in the 1970s was one per 300,000 people/year, while in Germany in 1984, it was estimated to be one per 40,000 people/year.[11] The use of intrauterine devices (IUDs) has increased incidence of genitourinary actinomycosis in females. Incidence of oral actinomycosis, which is harder to diagnose, has increased.[11]


In 1877, pathologist Otto Bollinger described the presence of A. bovis in cattle, and shortly afterwards, James Israel discovered A. israelii in humans. In 1890, Eugen Bostroem isolated the causative organism from a culture of grain, grasses, and soil. After Bostroem's discovery, a general misconception existed that actinomycosis was a mycosis that affected individuals who chewed grass or straw. The pathogen is still known as the “great masquerader".[12] Bergey's Manual of Systematic Bacteriology classified the organism as bacterial in 1939,[13] but the disease remained classified as a fungus in the 1955 edition of the Control of Communicable Diseases in Man.[14]

Violinist Joseph Joachim died of actinomycosis on 15 August 1907. Painter Halfdan Egedius died from actinomcosis.

Other animals

Actinomycosis occurs rarely in humans, but rather frequently in cattle as a disease called "lumpy jaw". This name refers to the large abscesses that grow on the head and neck of the infected animal. It can also affect swine, horses, and dogs, and less often wild animals and sheep.


  1. ^ a b Valour F, Sénéchal A, Dupieux C, Karsenty J, Lustig S, Breton P, Gleizal A, Boussel L, Laurent F, Braun E, Chidiac C, Ader F, Ferry T (2014). "Actinomycosis: etiology, clinical features, diagnosis, treatment, and management". Infect Drug Resist. 7: 183–97. doi:10.2147/IDR.S39601. PMC 4094581. PMID 25045274.
  2. ^ a b Bowden GHW (1996). Baron S; et al., eds. Actinomycosis in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 978-0-9631172-1-2. (via NCBI Bookshelf).
  3. ^ Brook, I (Oct 2008). "Actinomycosis: diagnosis and management". Southern Medical Journal. 101 (10): 1019–23. doi:10.1097/SMJ.0b013e3181864c1f. PMID 18791528.
  4. ^ Mabeza, GF; Macfarlane J (March 2003). "Pulmonary actinomycosis". European Respiratory Journal. 21 (3): 545–551. doi:10.1183/09031936.03.00089103. PMID 12662015. Retrieved 2008-07-21.
  5. ^ Abdulrahman, Ganiy Opeyemi; Gateley, Christopher Alan (1 January 2015). "Primary actinomycosis of the breast caused by Actinomyces turicensis with associated Peptoniphilus harei". Breast Disease. 35 (1): 45–47. doi:10.3233/BD-140381. PMID 25095985.
  6. ^ Ryan KJ; Ray CG, eds. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 978-0-8385-8529-0.
  7. ^ Hoffman, Barbara (2012). Williams gynecology (2nd ed.). New York: McGraw-Hill Medical. p. 42. ISBN 978-0071716727.
  8. ^ Böhm, Ingrid; Willinek, Winfried; Schild, Hans H. (October 2006). "Magnetic Resonance Imaging Meets Immunology: An Unusual Combination of Diagnostic Tools Leads to the Diagnosis Actinomycosis". The American Journal of Gastroenterology. 101 (10): 2439–2440. doi:10.1111/j.1572-0241.2006.00742_7.x. PMID 17032212.
  9. ^ "Bone Infections". MedlinePlus. US National Library of Medicine. Retrieved 16 August 2015.
  10. ^ "Osteomyelitis (Refractory)". Undersea and Hyperbaric Medical Society. Retrieved 16 August 2015.
  11. ^ a b c Wolff K, Goldsmith LA, Katz S, Gilchrist BA, Paller A, Leffell DJ (2007). Fitzpatrick's Dermatology in General Medicine (7th ed.). McGraw Hill.
  12. ^ Sullivan, D. C.; Chapman, S. W. (12 May 2010). "Bacteria That Masquerade as Fungi: Actinomycosis/Nocardia". Proceedings of the American Thoracic Society. 7 (3): 216–221. doi:10.1513/pats.200907-077AL. PMID 20463251.
  13. ^ Strong, Richard (1944). Stitt's Diagnosis, Prevention and Treatment of Tropical Diseases (7th ed.). p. 1182.
  14. ^ Control of Communicable Diseases in Man (8th ed.). American Public Health Association. 1955.

Further reading

  • Anderson, Clifton W.; Jenkins, Ralph H. (December 15, 1938). "Actinomycosis of the Scrotum". New England Journal of Medicine. 219 (24): 953–954. doi:10.1056/NEJM193812152192403.
  • Codman, E. A. (August 11, 1898). "A Case of Actinomycosis". The Boston Medical and Surgical Journal. 139 (6): 134–135. doi:10.1056/NEJM189808111390606.
  • Randolph HL Wong; Alan DL Sihoe; KH Thung; Innes YP Wan; Margaret BY Ip; Anthony PC Yim (June 2004). "Actinomycosis: an often forgotten diagnosis". Asian Cardiovasc Thorac Ann. 12 (2): 165–7. doi:10.1177/021849230401200218. PMID 15213087. Review
  • Munro, John C. (September 13, 1900). "Four Cases of Actinomycosis". The Boston Medical and Surgical Journal. 143 (11): 255–256. doi:10.1056/NEJM190009131431103.
  • Whitney, W. F. (June 5, 1884). "A Case of Actinomycosis in a Heifer". The Boston Medical and Surgical Journal. 110 (23): 532. doi:10.1056/NEJM188406051102302.

External links

External resources

Actinobacillosis is a zoonotic disease caused by Actinobacillus.It is more commonly associated with animals than with humans.One of the most common forms seen by veterinarians is mouth actinobacillosis of cattle, due to Actinobacillus lignieresii. The most prominent symptom is the swelling of the tongue that protudes from the mouth and is very hard at palpation ("wooden tongue").

Actinobacillus suis is an important disease of pigs of all ages and can lead to severe morbidity and sudden death.


Actinomyces is a genus of the Actinobacteria class of bacteria. They are all gram-positive. Actinomyces species are facultatively anaerobic (except A. meyeri and A. israelii both obligate anaerobe), and they grow best under anaerobic conditions. Actinomyces species may form endospores, and, while individual bacteria are rod-shaped, Actinomyces colonies form fungus-like branched networks of hyphae. The aspect of these colonies initially led to the incorrect assumption that the organism was a fungus and to the name Actinomyces, "ray fungus" (from Greek actis, ray, beam and mykes, fungus).

Actinomyces species are ubiquitous, occurring in soil and in the microbiota of animals, including the human microbiota. They are known for the important role they play in soil ecology; they produce a number of enzymes that help degrade organic plant material, lignin, and chitin. Thus their presence is important in the formation of compost. Certain species are commensal in the skin flora, oral flora, gut flora, and vaginal flora of humans and livestock. They are also known for causing diseases in humans and livestock, usually when they get an opportunity to gain access to the body's interior through wounds. As with other opportunistic infections, people with immunodeficiency are at higher risk. In all of the preceding traits and in their branching filament formation, they bear similarities to Nocardia.Like various other anaerobes, Actinomyces species are fastidious and thus not easy to culture and isolate. Clinical laboratories do culture and isolate them, but a negative result does not rule out infection, because it may be due simply to reluctance to grow in vitro.

Actinomyces israelii

Actinomyces israelii is a species of Gram-positive, rod-shaped bacteria within the Actinomyces. Known to live commensally on and within humans, A. israelii is an opportunistic pathogen and a cause of actinomycosis. Many physiologically diverse strains of the species are known to exist, though all are strict anaerobes. It was named after the German Surgeon, James Adolf Israel (1848–1926), who studied the organism for the first time in 1878.

Actinomycosis in animals

Actinomycosis in animals is caused by Actinomyces bovis (whereas human infections are usually due to A. israelii).

Actinomycosis is a quite common condition in cattle, where it is referred to as lumpy jaw or senfed (moroccan arabic), but it can also occur in horses, swine, dogs and rarely in sheep. In all these species, actinomycosis results in cold abscess, with granulomatous formations on the fistulised place.

Alexander Bakulev

Aleksandr Nikolayevich Bakulev (Russian: Алекса́ндр Никола́евич Ба́кулев) (December 7 [O.S. November 25] 1890 - March 31, 1967) was a Soviet surgeon, one of the founders of cardiovascular surgery in the USSR.

Born in Nevenikovskaya (now in the Kirov oblast) into a peasant family which belonged to the old Vyatka clan of Bakulevs, Bakulev attended the medical faculty of Saratov University after graduating from high school. During the First World War he served as a regimental medical officer on the Western Front. In 1938 Bakulev conducted a successful lobectomy in a case of chronic lung abscess. In 1939 he earned the academic degree of Professor and the same year conducted a successful lobectomy in a case of pulmonary actinomycosis. In 1943 Bakulev became head of the surgery department of the 2nd Pirogov Moscow Institute of Medicine. On the Eastern Front of World War II, Bakulev was the chief surgeon of Moscow evacuation hospitals. In 1948 he pioneered the surgical treatment of congenital heart disorders in the Soviet Union. He was the President of the USSR Academy of Sciences from 1953 to 1960.

In 1955 he suggested the foundation of the Thoracic Surgery Institute (now the Bakulev Scientific Center of Cardiovascular Surgery) and then became its first head. In 1958 Bakulev was elected as a member of the Soviet Academy of Sciences.

Bakulev died in Moscow in 1967. A medical prize was named after him.

Arthur Stanley, 5th Baron Stanley of Alderley

Arthur Lyulph Stanley, 5th Baron Stanley of Alderley KCMG (14 September 1875 – 22 August 1931), also 5th Baron Sheffield and 4th Baron Eddisbury, was an English nobleman and Governor of Victoria from 1914 to 1920.

Stanley was the second child and first son of Edward Lyulph Stanley, 4th Baron Stanley and Mary Katherine Bell. On 29 August 1905 he married Margaret Evelyn Evans Gordon. They had five children:

Mary Katherine Adelaide Stanley (30 May 1906 – 1981)

Edward John Stanley (9 October 1907 – 3 March 1971), the 6th Baron

Pamela Margaret Stanley (6 September 1909-30 June 1991), the actress Pamela Stanley

Lyulph Henry Victor Owen Stanley (22 October 1915 – 23 June 1971), the 7th Baron

Victoria Venetia Stanley, the actress "Tordie" Woods (29 June 1917-2007)Stanley was educated at Eton and Balliol College, Oxford where obtained a BA in 1898. In 1902 he was called to the bar at the Inner Temple. In 1904 he became a London County Councillor and in 1906 became Liberal Member of Parliament for Eddisbury in Cheshire near the family seat. Whilst an MP he was Parliamentary Secretary to the Postmaster General serving under Sydney Buxton. His sister, Venetia Stanley, was a close correspondent of the Prime Minister and leader of the Liberal party, H. H. Asquith.

In 1913 he was serving as High Sheriff of Anglesey when he was appointed Governor of Victoria. He was made a Knight Commander of the Order of St Michael and St George (KCMG) and took up his post on 23 February 1914. He served a five-year term and an additional year until relinquishing the post on 30 January 1920, although he had returned to Britain the previous year due to ill health. In the 1923 General election he stood unsuccessfully as Liberal candidate for Knutsford, losing by 80 votes to Conservative, Sir Ernest Makins. From 1925 to 1928 he was Chairman of the Royal Colonial Institute and of the East Africa Joint Committee.

In 1925 he succeeded his father to the three baronies and was known by the Stanley title. He died in August 1931 of a bacterial infection, actinomycosis. He was succeeded by his son Edward.

In his capacity as former Governor of Victoria, he attended the Covent Garden farewell of the Australian soprano Nellie Melba, and made a speech thanking her for her artistry and war-work. HMV recorded several excerpts of the evening, including Lord Stanley's speech, all of which can be heard on CD today.


Botryomycosis; also known as bacterial pseudomycosis is a rare chronic granulomatous bacterial infection that affects the skin, and sometimes the viscera.Botryomycosis has been known to affect humans, horses, cattle, swine, dogs and cats.

Cutaneous actinomycosis

Cutaneous actinomycosis is a chronic disease that affects the deep subcutaneous tissue of the skin. Caused by an anaerobic, Gram-positive, filamentous type of bacteria in the genus Actinomyces, invasion of the soft tissue leads to the formation of abnormal channels leading to the skin surface (external sinus tracts) that discharge pale yellow sulfur granules.This disease is uncommon, and has non-specific clinical features, making it difficult to diagnose.Cervicofacial, pulmonary/thoracic and gastrointestinal forms exist, yet cervicofacial disease accounts for two-thirds of reported infections.

Emil Ponfick

Emil Ponfick (3 November 1844 – 3 November 1913) was a German pathologist born in Frankfurt am Main.

In 1867 he received his medical doctorate from the University of Heidelberg, and later was an assistant to Friedrich Daniel von Recklinghausen (1833–1910) at Würzburg, and to Rudolf Virchow (1821–1902) in Berlin. Afterwards, he succeeded Theodor Ackermann (1825–1896) as professor of pathology at Rostock (1873), followed by professorships at Göttingen (from 1876) Breslau (from 1878), where he replaced Julius Friedrich Cohnheim (1839–1884) as director of the pathological institute. He remained at the University of Breslau until his death in 1913.

Ponfick is remembered for his pioneer research of actinomycosis, and his recognition of the causative role Actinomyces played in human actinomycosis. He is credited with establishing the unity of human and bovine forms of the disease. In 1882 he published Die Actinomykose des Menschen, eine neue Infectionskrankheit (Actinomycosis of humans, a new infectious disease) in regards to the disease. He also made significant contributions in his research of myxedema, writing two articles on the disorder, Myxoedem und Hypophysis (Myxedema and hypophysis) and Zur Lehre vom Myxoedem (The doctrine of myxedema).In 1874, Ponfick warned the Association of Baltic Physicians about the dangers of animal-to-human blood transfusions (xenotransfusion). This warning was based on empirical experience: a patient had died after receiving blood from a sheep. The following year physiologist Leonard Landois (1837–1902) from the University of Greifswald backed up Ponfick's findings with statistical data on the dangers of xenotransfusion.

Eugen Bostroem

Eugen Woldemar Bostroem (October 13, 1850 – May 24, 1928) was a Baltic German pathologist. He was born in Fellin (today known as Viljandi), in the Livonian Governorate of the Russian Empire (present-day Estonia).

He studied medicine at the universities of Leipzig and Erlangen, receiving his degree in 1876. Afterwards he was an assistant to Friedrich Albert von Zenker (1825–1898) at the pathology institute in Erlangen. From 1883 to 1926 he was a professor of general pathology and pathological anatomy in Gießen.

In 1890 Bostroem reportedly isolated the causative organism of actinomycosis from a culture of grain, grasses, and soil. After Bostroem's discovery there was a general misconception that actinomycosis was a mycosis that affected individuals who chewed grass or straw. The agents of actinomycosis are now known to be endogenous organisms of the mucous membranes, in most cases Actinomyces israelii, a species named after surgeon James Israel, who first discovered its presence in humans in the late 1870s.

In 1883 Bostroem was the first to describe a rare condition known as splenogonadal fusion. Since his discovery, approximately only 150 cases have been documented.

Halfdan Egedius

Halfdan Egedius (May 5, 1877 – February 2, 1899) was a Norwegian painter and illustrator.

Heinrich Albert Johne

(Heinrich) Albert Johne (10 December 1839 – 5 December 1910) (pronounced YOH-ne) was a pathologist born in Dresden, Germany.

He contributed to the literature of actinomycosis and trichinosis and discovered a method of staining bacterial capsules.

He was instrumental in the introduction of meat inspection.

Johne's disease, a paratuberculosis disease of cattle he described in 1895, is named for him.

James Israel

James Adolf Israel (2 February 1848 – 2 February 1926) was a Jewish-German surgeon who was a native of Berlin.

Joseph Joachim

Joseph Joachim (Hungarian: Joachim József, 28 June 1831 – 15 August 1907) was a Hungarian violinist, conductor, composer and teacher. A close collaborator of Johannes Brahms, he is widely regarded as one of the most significant violinists of the 19th century.

Pathogenic bacteria

Pathogenic bacteria are bacteria that can cause disease. This article deals with human pathogenic bacteria. Although most bacteria are harmless or often beneficial, some are pathogenic, with the number of species estimated as fewer than a hundred that are seen to cause infectious diseases in humans. By contrast, several thousand species exist in the human digestive system.

One of the bacterial diseases with the highest disease burden is tuberculosis, caused by Mycobacterium tuberculosis bacteria, which kills about 2 million people a year, mostly in sub-Saharan Africa. Pathogenic bacteria contribute to other globally important diseases, such as pneumonia, which can be caused by bacteria such as Streptococcus and Pseudomonas, and foodborne illnesses, which can be caused by bacteria such as Shigella, Campylobacter, and Salmonella. Pathogenic bacteria also cause infections such as tetanus, typhoid fever, diphtheria, syphilis, and leprosy. Pathogenic bacteria are also the cause of high infant mortality rates in developing countries.Koch's postulates are the standard to establish a causative relationship between a microbe and a disease.

Rectal discharge

Rectal discharge is intermittent or continuous expression of liquid from the anus (per rectum). Normal rectal mucus is needed for proper excretion of waste. Otherwise, this is closely related to types of fecal incontinence (e.g. fecal leakage) but the term rectal discharge does not necessarily imply degrees of incontinence. Types of fecal incontinence that produce a liquid leakage could be thought of as a type of rectal discharge.

Sergey Spasokukotsky

Sergey Ivanovich Spasokukotsky (Russian: Серге́й Иванович Спасокукоцкий, June 10 [O.S. May 29] 1870, Kostroma—December 17, 1943, Moscow) was a Soviet surgeon and a member of the Soviet Academy of Sciences since 1942. He was awarded the State Prize of the USSR for his monography Lung actinomycosis, apart from other distinctions (Order of Lenin and Order of the Red Banner of Labour).

Streptomyces somaliensis

Streptomyces somaliensis is a protelytic bacterium species from the genus of Streptomyces which has been isolated from a mycetoma from the foot of a man in Somalia. Streptomyces somaliensis is a human pathogen and can cause actinomycosis.

Streptomyces sudanensis

Streptomyces sudanensis is a bacterium species from the genus of Streptomyces which has been isolated from patients with actinomycosis infections in Sudan.

Gram-positive bacterial infection: Actinobacteria (primarily A00–A79, 001–041, 080–109)

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