History and exam
Key diagnostic factors
common
presence of risk factors
Include male sex, previous local tissue injury or inflammation, diabetes mellitus, and immunosuppression.
soft-tissue swelling
Swelling is generally painless, involving the submandibular or perimandibular region in the case of cervicofacial actinomycosis.
Other diagnostic factors
common
multiple sinuses
May be seen if the ends of the sinuses are cutaneous.
skin discoloration
Reddish or bluish discoloration of the skin overlying the lesion may be seen. [Figure caption and citation for the preceding image starts]: Example of the clinical picture of a cervicofacial actinomycosisFrom the collection of Dr Juergen Ervens, Head, Department of Oral and Plastic Maxillofacial Surgery, Charité - University Medicine Berlin, CBF, Berlin, Germany [Citation ends].
chewing difficulties
May occur if the muscles of mastication are involved.
constitutional symptoms
May include low-grade fever, weight loss, fatigue, or anorexia.
Non-specific. Other causes must be excluded.
change in bowel habits
Non-specific symptom that may occur in intestinal actinomycosis; other causes must be excluded.
abdominal discomfort
Non-specific symptom that may be associated with abdominal or pelvic actinomycosis; other causes must be excluded.
nausea and vomiting
Non-specific symptoms that may be associated with abdominal actinomycosis; other causes must be excluded.
sensation of abdominal mass
Non-specific symptom that may occur especially in abdominal actinomycosis; other causes must be excluded.
vaginal bleeding or discharge
Non-specific symptom that may occur in pelvic actinomycosis; other causes must be excluded.
dry or productive cough
May occur in thoracic actinomycosis.
blood-streaked sputum
May occur in patients with thoracic actinomycosis and a productive cough.
shortness of breath
Non-specific symptom that may occur in thoracic actinomycosis; other causes must be excluded.
chest pain
Non-specific symptom that may occur in thoracic actinomycosis; other causes must be excluded.
focal neurological defects
Non-specific feature of CNS actinomycosis caused by a space-occupying lesion. May be accompanied by raised intracranial pressure.
Risk factors
strong
injury or inflammation of the oral cavity
diabetes mellitus
Associated with actinomycosis.[7] White blood cell dysfunction may increase invasion by actinomycetes. In addition, diabetic ulcers may facilitate entry of the organisms.
immunosuppression
Immunosuppression and immunodeficient states, may favour invasion by actinomycetes.[7]
local tissue damage by neoplasia, trauma, or irradiation
Favours invasion by actinomycetes.[13]
intra-uterine device
aspiration
Aspiration of oral contents enhances risk of pulmonary actinomycosis.[32]
weak
male sex
Male-to-female ratio of 3:1.[8]
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