Introduction:
Actinomycosis is a fascinating yet challenging condition indeed. As a medical professional, I must say that Actinomycosis is a topic that requires the utmost attention and diligence. (1) The nature of this condition, caused by the Actinomyces bacterium, is quite intriguing. (2) You see, Actinomyces species are part of the Actinomycetal order, which includes other clinically significant taxa such as Actinobaculum, Actinomadura, Corynebacterium, Cutibacterium (formerly Propionibacterium), Frankia, Gardnerella, Mobiluncus, Nocardia, and Varibaculum. (3) These Actinomyces bacteria, being anaerobic, non-spore-forming Gram-positive rods, have a peculiar radial arrangement of their filaments, giving them their name derived from the Greek words ”aktinos” meaning ray and ”mykes” meaning fungus. (4) Actinomycosis, primarily affects various anatomical areas, including the cervicofacial, thoracic, abdominopelvic, and other regions. (5) Now, the pathogenicity of Actinomyces is still not fully understood. However, it is believed that the bacteria enter and multiply in the body through the infiltration of ruptured or necrotic tissue. (6) While actinomycosis can be effectively treated with medical and surgical therapies, delays in diagnosis or aggressive disease spread can lead to severe complications and even fatal outcomes for patients. (7)
In conclusion, Actinomyces infections, including actinomycosis, pose unique challenges in the medical field. (18) Understanding the characteristics of Actinomyces species and their role in causing this condition is vital in ensuring accurate diagnosis and appropriate management. (8) It is true that due to their similar morphologies and the presence of reproductive asexual spores, several genera such as Actinomyces, Frankia, Nocardia, and Streptomyces are often mistakenly referred to as the ”actinomycetes” group in medical care. (9) Actinomyces israelii stands out as the most commonly isolated species from human infections, accounting for the majority of clinical cases of actinomycosis. (7) On the other hand, A. israelii, A. meyeri, and A. odontolyticus are commonly associated with actinomycosis that spreads hematogenously. (2) Actinomyces species are significant components of the normal microflora in both animals and humans. They are predominantly found in the oropharynx, residing in areas such as gingival crevices, periodontal pockets, tonsillar crypts, carious teeth, and dental plaques. (5)
In human actinomycosis lesions, Actinomyces often coexists with other aerobic and anaerobic species, including A. actinomycetemcomitans, Eikenella corrodens, Capnocytophaga, Fusobacteria, Bacteroides, Staphylococci, Streptococci, and Enterobacteriaceae. (5) The polymicrobial nature of these infections highlights the importance of isolating and identifying the infecting bacteria through culture and pathology to accurately diagnose actinomycosis and select appropriate antibiotics. (10) In cases of odontogenic maxillary sinusitis, Actinomyces species can potentially cause maxillary osteomyelitis.
While cervicofacial actinomycosis is the most common form of actinomycosis with bone invasion, Actinomyces species can also be implicated in extrafacial bone and joint infections. These infections can occur through hematogenous spread from a distant source, continuous expansion of pulmonary actinomycosis to the spine, or polymicrobial invasion following bone exposure, particularly in patients with conditions such as paraplegia and ischial tuberosity osteomyelitis. (11)
In conclusion, diagnosing actinomycosis and identifying the specific Actinomyces species involved can be a complex task. (10) However, with advancements in diagnostic technologies and collaboration between healthcare professionals, we can overcome these challenges and provide effective treatment for patients suffering from this intriguing condition. (12)