Actinomycetoma

Actinomycetoma is a chronic granulomatous infection of the subcutaneous tissue caused by fungus-like bacteria, that is, Nocardia sp, Actinomyces sp

Actinomycetoma is caused by actinomycetes which include the genera Nocardia, Actinomyces, and Streptomyces. The members of the genus Nocardia are filamentous Gram-positive bacteria that are ubiquitous soil saprophytes. N. Brasiliensis is the main pathogenic organism followed by N. Asteroides, which usually causes fulminant systemic infection. It is a slowly progressive infection

Side of exposure

They enter through:

·         Traumatic inoculation.

·         Inhalation

·         Skin

Causes of Actinomycetoma:

The following medical conditions are some of the possible causes of Actinomycetoma. There are likely to be other possible causes, so ask your doctor about your symptoms. 

• Actinomyces israelii
• Actinomyces gerencseriae
• Propionibacterium propionicus
• Poor oral hygiene
• Radiation therapy
• Periodontal disease
• Tooth decay

Comorbid Symptoms

Some of the comorbid or associated medical symptoms for Actinomycetoma may include these symptoms:

·         Bad breath

·         Bleeding from the mouth

·         Bleeding gums

·         Body symptoms

·         Breath odor

·         Breath odor symptoms

·         Breath symptoms

Treatment of Actinomycetoma

·         Actinomycetoma is amenable to medical treatment with antibiotics and other chemotherapeutic agents. Combined drug therapy is always perfect in contrast to a single drug to avoid drug resistance and for disease eradication. In the past, the treatment of actinomycetoma was by combination of streptomycin sulphate

·         Many other drugs such as Rifampin, Sulfadoxine and Pyrimethamine (Fansidar) and sulphonomides had been tried as a second line of treatment

·         In actinomycetoma, combined medical and surgical treatments are beneficial. This regime facilitates surgery, accelerates healing and reduces the chance of relapse, however a good number of patients respond to medical treatment alone.

·         Medical treatment is effective in all stages of actinomycetoma even in patients with advanced disease and with a great deal of bone damage. Cure is possible, though a prolonged period of treatment is needed.

CLINICAL MANIFESTATIONS

·         Thoracic Disease

·         Abdominal Disease

·         Pelvic Disease

·         Central Nervous System  Disease

·         Disseminated disease

LABORATORY DIAGNOSIS

·         Gram-positive, beaded, branching filaments usually weak acid fast+ve .

·         Standard blood culture :48 hrs to several wks, but, typical = 3 to 5 days

·         Susceptibility testing

            -Deep-seated /disseminated dz. fail initial therapy

            -Relapse after therapy

            -Alternatives to sulfonamides are being considered

DIAGNOSIS

·         chronicity, progress across tissue boundaries, masslike

·         develop sinus tract, resolve and recur

·         refractory/relapsing after a short course therapy

Risk Factors

·         Foreign bodies : IUCDs

·         Abnormal host defense : HIV

·         Post transplantation

·         Radio-Chemotherapy

·         Ulcerative mucosal infection: HSV/CMV