The patients with actinomycosis of orofacial area comprise up to 80% of all infection cases. The main causative agents of the disease are Actinomyces israelii and A. gerencseriae. They are commonly associated with Aggregatibacter actinomycetemcomitans and propionibacteria.
In relatively large amounts actinomycetes reside in dental plaques of clinically healthy individuals. Also they are present in soil, contaminate herbs and grains. In this vein actinomycosis contraction occurs from endogenous or exogenous microbial infection.
The disease transmission is possible by airborne, contact or rarely by alimentary route. After initial contact with skin or oral mucosa the bacteria activate their lymphogenous or hematogenous spread into deep tissues. They can reach adipose tissue, muscles and fascia resulting in formation of long-term granulomatous and poorly healing abscesses. In case of progression the abscesses enlarge and may open spontaneously with purulent discharge.
Primary actinomycosis is readily complicated by secondary infection predominantly of anaerobic genesis.
Microbiological examination starts from microscopy of purulent discharges taken from inflammatory abscess lesions. Round-shaped branched microcolonies of actinomycetes are indicated. Their inner structure resembles mycelium – fungus-like branched network of hyphae.
Successful treatment of actinomycosis requires high-dose administration of antimicrobial drugs for which the bacteria retain sensitivity: beta-lactams, macrolides, or doxycycline.