actinomycosis (pulmonary)

Last reviewed 01/2018

Pulmonary actinomycosis accounts for 15-20% of cases.

  • may result from
    • aspiration of oropharyngeal secretions
    • oesophageal perforation
    • local spread from cervicofacial or abdominal infection
    • haematogenous spread.
  • a higher incidence of pulmonary actinomycosis is seen in patients with underlying lung disease such as emphysema, chronic bronchitis, and bronchiectasis
  • it may coexist with lung disease such as  tuberculosis or malignancy making the diagnosis and treatment challenging
    • initial clinical picture may be similar to pneumonia with a low-grade fever, cough, shortness of breath, and chest pain
    • however, there is usually a longer history of illness and associated weight loss and haemoptysis.
  • complications may include:
    •  empyema necessitans (a rare complication of empyema in which the pleural infection spreads to affect the soft tissues of the chest wall)
    • pleural effusion
    • mediastinal invasion
      •  can progress into the heart causing pericarditis (commonly)
    • rib destruction
    • less often myocarditis or endocarditis may occur either via extension from the pericardium or by haematogenous spread (1)