Makindo Medical Notes.com

Notable for the formation of multiple abscesses and sinus tracts that may discharge sulfur granules

About

• James Adolf Israel a German surgeon first described it.
• Causes abscess formation
• Actinomyces israelii is commonly found in the oropharynx and is a commensal organism

Characteristics

• Gram Positive non-acid-fast anaerobic bacillus
• Both rods and branching filamentous forms
• Visible granules "sulfur granules"

Aetiology

• Normal commensals usually
• Infections with trauma and devitalised tissue
• Actinomyces israeli is major pathogen

Clinical: Abscesses with hard yellow colonies - sulfur granules

• Cervicofacial - lumpy jaw following tooth extraction or oral surgery with poor oral hygiene
• Thoracic - aspiration leads to abscess formation
• Brain Abscesses: focal neurological evidence.
• Abdominal/Pelvic - IUCD insertion. Pelvic pain. Mass.
• Chronic granulomatous appendicitis: Patients may develop inflammatory masses and fistulas that involve the colon. Fistulas can extend to the skin, where characteristic colonies of sulfur granules may be identified. Abdominal pain, weight loss, fever and, occasionally, a palpable mass that may mimic malignancy.

Investigations

• FBC: Elevated WCC, Anaemia and Raised ESR and CRP
• CXR may show a lesion
• Ultrasonography and CT may also reveal large inflammatory abdominopelvic masses
• Culture and sensitivities of any lesions

Management

• Prolonged course of Penicillin G and surgical management
• Doxycycline for those allergic and not pregnant. See BNF for guidance.
• Surgical management especially when cancer in the differential