Actinomycosis

Overview

Actinomycosis is a rare, slow-growing bacterial infection. It causes swollen areas called abscesses, which are pockets of pus, often around the face and jaw. It can also affect the chest, belly, or pelvic area. The infection is not contagious, so you cannot catch it from another person.

No, actinomycosis is rare. In developed countries, it is much less common than in the past, thanks to better dental care and wider use of antibiotics.

It can affect people of any age, but it is more common in adult men, particularly between the ages of 20 and 60. People with weakened immune systems, poor dental hygiene, or recent dental procedures may have a higher risk.

Symptoms

Common symptoms

• A hard, painless or slightly painful lump, most often on the jaw or face
• A small area of skin that breaks open and drains pus or fluid
• Fever and chills
• Unexplained weight loss
• Tiredness and generally feeling unwell
• Pain or swelling in the belly, chest, or pelvic area, depending on where the infection is

Symptoms in children

• A swollen jaw or face that does not go away
• Dental pain or loose teeth
• Fever and poor appetite
• A draining sore near the jaw or neck

Symptoms in older adults

• Chest pain or a cough that lasts, if the infection is in the chest
• Belly pain or discomfort, if the infection is in the abdomen
• Confusion or drowsiness, which can happen with any serious infection
• A general decline in health or energy

Causes

Main causes

• Actinomycosis is caused by bacteria from the Actinomyces family. These bacteria normally live in the mouth, throat, gut, and uterus without causing harm, but they can enter deeper tissues through a break in the skin or mucus membrane.
• Once inside the tissues, the bacteria can slowly multiply and form an abscess.

Risk factors

• Poor dental hygiene or untreated tooth decay
• Dental procedures, tooth extractions, or jaw injury
• A weakened immune system from illness or certain medications
• Long-term use of an intrauterine device (IUD) for birth control, which has been linked to pelvic actinomycosis
• Inhaling food or drink into the lungs, which can sometimes allow bacteria to reach the chest

When to see a doctor

See a doctor urgently if:

• See a doctor promptly if you have a new lump, a persistent fever, or pain in your jaw, chest, belly, or pelvic area that does not improve.
• Go for same-day care if you have a wound that keeps draining pus or red, swollen skin around a lump.

Book a routine appointment if:

• Book a routine appointment if you notice any unusual swelling, a sore that does not heal, or unexplained weight loss.

Diagnosis

A doctor will ask about your symptoms, examine you, and may take a small sample of tissue or fluid from the affected area to check for Actinomyces bacteria. This sample is called a biopsy. They may also order imaging scans to see how far the infection has spread and to check for abscesses.

Tests that may be done

• Physical examination and medical history
• Blood tests to check for signs of infection
• A biopsy or needle sample from the lump or draining fluid
• Laboratory culture, where doctors try to grow the bacteria from the sample
• Imaging scans such as CT, MRI, or ultrasound

What to expect at your appointment

The diagnosis can take time because actinomycosis grows slowly and can look like other conditions, including cancer or other infections. You may need several appointments and tests. This is normal, and it does not mean your situation is urgent or dangerous. Your doctor will explain each step and keep you informed.

Treatment

Actinomycosis is treated with antibiotics, usually taken for a long time, often several months. The doctor may also drain any abscesses. With the right treatment, most people are cured, but it is important to finish the full course of antibiotics even if you feel better.

Self-care at home

• Take your antibiotics exactly as prescribed and do not stop early.
• Keep any draining wounds or sores clean and covered.
• Keep up with good dental care, including gentle brushing and flossing, unless your doctor advises otherwise.
• Attend all follow-up appointments so your doctor can monitor your progress.
• Tell your doctor if you have any side effects from your medication.

Medical treatments

Treatment usually involves a long course of antibiotic therapy. This may be given by mouth or, in more serious cases, through an intravenous drip in the hospital. The exact antibiotic and length of treatment depend on the location and severity of the infection. Never take antibiotics without a healthcare provider's advice.

When is surgery considered?

Sometimes surgery is needed to drain an abscess or remove dead or infected tissue. This is more common if the infection is deep, has formed a large pus collection, or has spread to nearby areas. The surgery works alongside antibiotics, not instead of them.

Living with this condition

Living with actinomycosis means following your treatment plan closely and staying patient. Symptoms may improve slowly, and it is normal to feel frustrated. Keep a diary of your symptoms and bring it to your appointments.

Lifestyle tips

• Stay hydrated and get regular rest.
• Keep your mouth and teeth healthy with regular brushing and dentist visits.
• Avoid smoking and limit alcohol, as these can affect your immune system.
• Wash your hands often, especially before touching any wound.

Diet and exercise

Try to eat a balanced diet with plenty of fruits, vegetables, whole grains, and protein to support your immune system. Gentle exercise, such as walking, can help maintain energy and mood, but take it easy while your body is fighting the infection.

Mental health and emotional wellbeing

Living with a long-term infection can feel stressful and isolating. It is normal to feel anxious or worried. Talk to your healthcare team about how you are feeling, and consider reaching out to a counsellor or support group if needed.

Prevention

Actinomycosis cannot always be prevented, but good dental hygiene and prompt treatment of dental infections can lower the risk. If you have an intrauterine device (IUD), talk to your doctor about recommended replacement times to reduce the risk of pelvic actinomycosis.

Vaccines

There is no vaccine to prevent actinomycosis.

Screening programmes

There is no routine screening for actinomycosis in the general public. Early diagnosis is usually noticed when someone sees a doctor about symptoms.

Complications

If left untreated

• The infection can slowly spread to nearby bones, muscles, or organs.
• Abscesses may form in the chest, belly, or brain, which can be serious.
• Fistulas, abnormal tunnels between organs or between an organ and the skin, may develop.
• The infection can come back after treatment if it was not treated long enough.

Long-term outlook

With proper treatment, the outlook for actinomycosis is very good. Most people improve and eventually recover completely. Early diagnosis and finishing your full treatment are the best ways to avoid problems. Your healthcare team will support you throughout treatment.

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