Actinomycosis
GENERAL PRINCIPLES
Actinomyces is a microaerophilic gram-positive bacillus that usually causes soft-tissue swelling of the oropharynx, face, or neck, typically over or underneath the mandible (orocervicofacial actinomycosis).
Pulmonary and gastrointestinal disease can also be seen. Classic infections are chronic, indurated soft- tissue lesions associated with draining fistulae that pass through tissue planes. Unlike Nocardia, infection due to Actinomyces is not limited to immunocompromised hosts.DIAGNOSIS
Clinical presentation varies depending on what site is affected. Orocervicofacial infection is the most common form. Rare sites include the CNS and bones. Diagnosis is made by histopathology (gram-positive branching bacilli) or observation of “sulfur granules” in drainage.40
TREATMENT
See Table 14-13.
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