Carious teeth can become a source of actinomycosis

Patients with actinomycosis, as a rule, are treated by a dermatologist with advanced chronic forms, since general practitioners often cannot make a correct and timely diagnosis. Most often, cosmetologists and dentists are the first to encounter actinomycosis, since actinomycetes saprophyte in the oral cavity, in the cavities of carious teeth, and affect the skin of the face and neck. The development of purulent inflammation and organ damage can be prevented due to the timely accurate diagnosis of actinomycosis.

The history of the study of actinomycosis has more than a hundred years. The first cases of this disease were described in cattle, and then an actinomycotic lesion of the lymph nodes was registered in humans. 

Actinomycosis – This is a chronic purulent non-contagious disease caused by radiant fungi of the order Actinomycetales, which affects people of working age, lasts for years and causes significant medical, social and economic damage. The severity of the disease, especially its visceral forms, is due to the formation of chronic inflammation and specific granulomas, then abscess formation and the formation of fistulous tracts with purulent discharge in soft and bone tissues of almost any localization, the addition of bacterial flora in 70-80% of cases, dysfunction of the affected organs, development anemia, intoxication and amyloidosis.

Actinomycosis occurs everywhere in the practice of doctors of various specialties (dentists, surgeons, dermatologists, etc.) and among chronic purulent diseases it is up to 5–10%. 

Visceral localizations among the entire population of patients account for 20%, lesions of the face and neck – about 80%. Patients, as a rule, come under observation in the late stages of the disease due to insufficient familiarity of practitioners with various clinical forms of the disease, the absence of mycological laboratories in many medical institutions, and for other reasons.

The causative agents of actinomycosis are microaerophilic (Proactinomyces israelii, Micromonospora monospora) and aerobic (Actinomyces albus, A. violaceus, A. candidus) microorganisms. An important diagnostic feature – detection in the pathological material of the drusen of the radiant fungus (radiant formations with characteristic "cones" at the end, consisting of thickened threads of the mycelium).

The causative agents of actinomycosis are anaerobic forms of radiant fungi, widespread in nature, as well as permanently living in the human body – actinomycetes. Findings of actinomycetes in soil and water contributed to the fact that the exogenous theory of the occurrence of actinomycosis has long been given the main role. However, when it was repeatedly confirmed that actinomycetes saprophyte in the oral cavity, in the cavities of carious teeth, tonsillar "plugs", upper respiratory tract, bronchi, gastrointestinal tract, anal folds, etc., endogenous theory.

Causes of actinomycosis

Chronic inflammatory processes and traumatic factors play a significant role in the pathogenesis of maxillofacial actinomycosis. Its development is facilitated by violation of the integrity of the mucous membranes of the oral cavity with dentures or rough food, traumatic extraction of teeth, fractures of the bones of the facial skeleton, the formation of periapical granulomas, the presence of salivary stones, anatomical anomalies (urachus, branchiogenic fistula of the neck), etc.

Thoracic actinomycosis is characterized by the presence of a previous chest injury, surgery, chronic pneumonia, etc.

In case of abdominal actinomycosis, there is often a history of appendectomy or other operations, cholelithiasis, gunshot wounds, bruises, enterocolitis, fecal stones, etc. Appendicitis in 5% of cases is due to saprophytic actinomycetes.

In the pathogenesis of genital actinomycosis, the use of intrauterine devices, which are not only a traumatic object, but sometimes also a carrier of infection, plays a role.

Actinomycosis of the urinary system is often caused by the presence of urinary stones, chronic inflammatory diseases, etc.

Pararectal actinomycosis is closely related to the condition of the rectum, the presence of epithelial-coccygeal cysts, chronic purulent hidradenitis of the inguinal regions and perineum, hemorrhoids and fissures in the anus.

Rare forms of the disease include actinomycosis of the middle ear, mastoid process, auricle, tonsils, nose, pterygo-maxillary space, thyroid gland, lacrimal canaliculus and sac, orbit of the eye with its membranes, tongue, salivary glands, brain and spinal cord , pericardium, liver, bladder, etc. 

Despite the variety of localizations, the actinomycotic lesion has common patterns of development, expressed in a successive change in the stages of the disease: infiltrative, abscessing, fistulous, which leads to an even greater variety of clinical manifestations of actinomycosis.

Treatment of actinomycosis

The pathogenesis features and the variety of clinical manifestations of visceral actinomycosis require complex treatment, including anti-inflammatory, immunomodulatory, restorative agents, surgical and physiotherapeutic treatment. 

Treatment of visceral actinomycosis, especially severe forms, is still difficult due to the late admission of patients to specialized departments, prolonged intoxication and the development of irreversible changes in organs and tissues. Due to the formation of antibiotic resistance, it is often difficult to select antibiotics. Therefore, it is necessary to take into account the microflora accompanying actinomycosis in order to select the most effective antibacterial drugs. Often, with actinomycosis, there are difficulties (or impossibility) to perform radical surgical operations, which dictates the need for careful preparation, the use of adequate methods of anesthesia and surgical tactics.

Optimized treatment includes: actinolysate immunotherapy; anti-inflammatory therapy, incl. the use of antibiotics; restorative therapy and surgical treatment.

Actinolysate is a sterile filtrate of the culture fluid of some species of spontaneously lysing actinomycetes, containing the products of their autolysis and metabolism. In experimental studies, it was found that after the administration of actinolysate, phagocytosis is stimulated in the actinomycotic granuloma and a positive dynamics of immune reactions occurs. In recent years, the immunomodulatory effect of actinolysate has been established not only in actinomycosis, but also in many chronic purulent diseases of the skin and internal organs. Actinolysate is prescribed 3 ml intramuscularly 2 times a week, 20-25 injections. Subsequent courses are carried out with an interval of 1 month, strictly according to indications.

Antibacterial therapy for actinomycosis should be carried out taking into account the microflora. The frequency of sowing aerobic microflora from the foci of actinomycosis is, according to our data, 85.7%. The microbial composition is dominated by staphylococci (59.8%) and Escherichia coli (16.9%), with pararectal localization, there are associations of several microorganisms. An increased resistance of the microflora to antibiotics in actinomycosis compared with acute purulent-septic diseases was stated, which is explained by the long-term previous use of various chemotherapy drugs in these patients. Antibiotic resistance contributes to the activation of secondary microflora, incl. non-spore-forming anaerobic microorganisms. If fungal-bacterial associations are detected, antifungal drugs are prescribed: fluconazole, itraconazole, terbinafine, ketoconazole, etc.

Surgical treatment of actinomycosis

Surgical treatment of patients with actinomycosis of the face and neck in the stage of abscess formation consists in opening and draining the foci. In the first days, dressings with iodoform emulsion, dioxidine, iodopyrone ointment are applied to open wounds to activate granulations. Antiseptics are used to sanitize the wound. To cleanse wounds from purulent-necrotic discharge, water-soluble ointments are used: levosin, levomekol, dioxicol, film- and foam-forming aerosols. To speed up the regenerative process, dressings are applied with methyluracil ointment, solcoseryl, vinyline, etc.

Surgeries are an integral part of the complex treatment of most cases of actinomycosis. Their effectiveness largely depends on the optimal preoperative preparation, the correct choice of anesthesia, drug and restorative treatment in the postoperative period.

Thus, actinomycosis, which is characterized by a variety of localizations and clinical manifestations, can be diagnosed in a timely manner and effectively treated only on the basis of knowledge of the patterns of its pathogenetic development, predisposing factors, characteristics of pathogens and treatment methods. 

According to rmj.ru

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