Actinomycetales Infection

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is Actinomycetales (Actinomyces) infection?

Actinomycetales infections are caused by an order of bacteria known as Actinomycetales. This order contains several different groups of bacteria that are shaped like thin filaments or rods, including the Mycobacteria that are best known as the cause of tuberculosis. Bacteria from all of these groups cause a wide variety of diseases.

Actinomyces, one of the types of bacteria in the order Actinomycetales, is the focus of this article. Actinomyces bacteria cause actinomycosis, an infectious disease that can occur throughout the body. Actinomycosis is most commonly due to the species Actinomyces israelii, which causes infections that typically affect the face and neck but can involve other areas of the body as well. These bacteria normally reside in the nose, mouth and throat, where they do not cause problems. Disease may occur if they enter the skin or body as a result of injury or surgery, through a tooth abscess, by aspiration, if another infection is present, or if an intrauterine device (IUD) is present.

Actinomyces infections are sometimes called “lumpy jaw” because of their characteristic appearance of bumps on the face and neck. These bumps, which may or may not be painful, are caused by abscesses, or collections of pus, that form under the skin. As an abscess develops, the overlying skin forms a firm lump that turns red or reddish purple. The abscess eventually breaks through the skin and drains pus that typically contains yellowish crystals called sulfur granules.

Inside the body, Actinomyces infections can cause inflammation and abscesses that can create tracts that drain into nearby tissues. In the lungs, an Actinomyces infection can resemble tuberculosis. If infection occurs in the abdomen, it can cause symptoms such as vomiting and diarrhea. In the pelvis, Actinomyces infections can cause pelvic pain and irregular vaginal bleeding. Actinomyces infections can spread directly to nearby tissues and through the bloodstream to other parts of the body. These infections are not considered to be contagious.

Actinomyces infections of the skin rarely represent medical emergencies; however, serious infections can develop in the lungs, abdomen, pelvis, and other areas of the body. Seek immediate medical care (call 911) for serious symptoms, such as high fever, confusion, lethargy, loss of consciousness, rapid breathing or shortness of breath, rapid heart rate, seizure, severe headache, severe vomiting or diarrhea, or reduced urine production.

Seek prompt medical care if the infection is near the eye or interferes with eating or drinking, or if you are being treated for Actinomyces infections but symptoms recur, are persistent, or otherwise cause you concern.

What are the symptoms of Actinomyces infection?

Symptoms of an Actinomyces infection typically include lumps under the skin, most commonly on the face and neck, which turn red to reddish purple. The lumps eventually drain, producing a fluid containing yellowish crystals called sulfur granules. Fever may be present. At least half of Actinomyces infections involve the face and neck.

Actinomyces infections can also occur internally in the lungs, abdomen, pelvis, and other parts of the body. The specific symptoms depend on the site of the infection. Because Actinomyces infections tend to spread outward and can spread through the body wall, even internal infections can cause drainage of pus through the skin.

Common symptoms of skin and oral Actinomyces infections

Actinomyces infections most often affect the skin of the face and neck, although they can affect skin in any area of the body and the lining of the mouth. Common symptoms of skin and oral Actinomyces infections include:

  • Absent or mild pain

  • Drainage of pus containing yellowish crystals

  • Fever

  • Hard lumps under the skin or mouth lining

  • Red to reddish-purple discoloration of the overlying skin or mucous membranes

  • Weight loss

Symptoms of pulmonary Actinomyces infections

Actinomyces infections can occur in the chest, typically in the lungs. Symptoms of pulmonary Actinomyces infections include:

Symptoms of abdominal Actinomyces infections

Actinomyces infections can also occur in the abdomen, where they generally affect the digestive tract. Symptoms of abdominal Actinomyces infections include:

  • Abdominal pain

  • Changes in bowel habits, such as diarrhea or constipation

  • Drainage of pus containing yellowish crystals through the abdominal wall

  • Fever

  • Mass in the abdomen

  • Nausea and vomiting

  • Weight loss

Symptoms of pelvic Actinomyces infections

Actinomyces infections can occur in the pelvis, most commonly in women using an intrauterine device (IUD) for contraception. Symptoms of pelvic Actinomyces infections include:

Serious symptoms that might indicate a life-threatening condition

In some cases, serious infections of the lungs, abdomen or pelvis can develop. Also, the infections can spread from one area to adjacent areas, such as the structures in the mouth and neck, brain, liver, kidney, bone, and blood. Actinomyces infections can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Bluish coloration of the lips or fingernails (cyanosis)

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

  • Decreased urine output

  • High fever (higher than 101 degrees Fahrenheit)

  • Lumps that are near your eyes or interfere with eating or drinking

  • Rapid heart rate (tachycardia)

  • Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking

  • Severe pain

  • Severe dizziness or sudden loss of balance

  • Seizure

  • Vision changes

What causes Actinomyces infection?

Actinomyces infections are caused by a type of bacteria known as Actinomyces, most commonly the species Actinomyces israelii. These bacteria reside in the nose, mouth and throat, where they do not cause disease. However, they can cause infection by entering the skin or body through breaks in the skin or mucous membranes. This can occur during surgery, through a tooth abscess, by aspiration, if another infection is present, or if an intrauterine device (IUD) is present.

Actinomyces infections are not contagious, but they tend to be chronic, which means they can last for an extended period of time. These infections are more common in men than in women. The reason for this is not known, but some speculate that it is because men have a greater likelihood of skin trauma though activities such as shaving.

What are the risk factors for Actinomyces infection?

A number of factors increase the risk of developing Actinomyces infections. Not all people with risk factors will get Actinomyces infections. Risk factors for Actinomyces infections include:

  • Aspiration of mouth contents into the lungs

  • Compromised immune system due to such conditions as HIV/AIDS or other immunodeficiencies, taking corticosteroids, organ transplant, or cancer and cancer treatment

  • Dental procedures

  • Periodontitis (gum disease)

  • Poor dental hygiene

  • Presence of an intrauterine device (IUD)

  • Surgery, especially for conditions such as appendicitis, gallbladder disease, or perforated ulcer (a hole in the stomach or intestines caused by an ulcer)

  • Tooth abscess

  • Trauma

Reducing your risk of Actinomyces infections

You may be able to lower your risk of Actinomyces infections by:

  • Keeping cuts and wounds clean and dry

  • Practicing good dental hygiene and getting regular dental checkups

  • Washing your hands before and after touching an injured area

How is Actinomyces infection treated?

Although Actinomyces infections can be chronic, they can be readily treated with antibiotics and surgery if necessary. The antibiotics typically need to be taken for more than a month and sometimes up to a year until the infection clears. In the case of pelvic Actinomyces infections, any intrauterine device (IUD) that is present should be removed.

Because Actinomyces infections are chronic, it is important to follow your treatment plan precisely and to take all the antibiotics as instructed to avoid recurrence. Additionally, some people will need multiple surgical procedures to remove infected tissue.

Common treatments for Actinomyces infections

Treatments for Actinomyces infections include:

  • Antibiotics such as penicillin
  • IUD removal
  • Surgical drainage if needed
  • Surgical removal of infected tissues if needed

What are the potential complications of Actinomyces infection?

If Actinomyces infections are diagnosed early and treated appropriately, most people experience a full recovery. Complications are related to the site of the infection. Because the infection tends to spread outward from inside the body, complications from infection of nearby tissues and organs can occur.

Complications of untreated or inadequately treated Actinomyces infections can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of Actinomyces infections include:

  • Abdominal abscess
  • Brain abscess
  • Meningitis (infection or inflammation of the sac around the brain and spinal cord)
  • Myocarditis (infection of the middle layer of the heart wall)
  • Neck abscess
  • Pelvic abscess
  • Pericarditis (infection of the lining that surrounds the heart)
  • Peritonitis (infection of the lining that surrounds the abdomen)
  • Pneumonia
  • Scarring
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 9
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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  3. Smego RA Jr, Foglia G. Actinomycosis. Clin Infect Dis 1998; 26:1255.