bubble_chart Overview

Actinomycosis is a chronic specific inflammation. The face and neck are among the common sites for actinomycosis, and it can also affect the salivary glands, though this is relatively rare.

bubble_chart Etiology

The most common pathogenic bacterium found in the human body is Actinomyces israelii, which is anaerobic, Gram-positive, and non-acid-fast. This bacterium is present in the oral cavity of many people. Due to inflammation, tissue hypoxia and reduced resistance can occur, which favors the growth and spread of Actinomyces, potentially invading the salivary glands.

bubble_chart Pathological Changes

After invading the tissue, actinomycetes can cause tissue necrosis and the formation of abscesses, which contain actinomycotic granules, also known as "sulfur granules." These granules are composed of bacterial bodies and filaments, appearing pale yellow in color and can reach several hundred micrometers in diameter. Under the microscope, irregular basophilic lobulated bodies are observed, with a homogeneous central region and radiating branched filaments at the periphery. The tips of these filaments often have a colloidal sheath membrane, forming hyaline club-shaped structures. Surrounding these structures are numerous polymorphonuclear neutrophils, followed by a layer of epithelioid cells, giant cells, eosinophils, and plasma cells. The outermost layer consists of dense fibrous connective tissue.

bubble_chart Clinical Manifestations

The age of onset is mainly between 20 and 50 years, with males being twice as likely as females.

Early symptoms include the appearance of a painless small lump in the salivary gland area, which gradually enlarges. Examination reveals glandular swelling, firm tissue with indentations, and no secretion from the gland duct when squeezed. The lump is immobile, quickly forms an abscess, and presents with pain or a sensation of heat. The overlying skin becomes dark red or purple, board-like in hardness, with no clear boundary from the surrounding normal tissue. As the inflammation progresses, the surface skin softens, and the abscess gradually ruptures, discharging a thick, yellowish pus. "Sulfur granules" can be observed either macroscopically or through staining of the pus. After expelling pus, the inflammatory infiltrate soon forms new nodules and abscesses around it, which communicate with each other, forming fistulas and transitioning into a chronic phase, with irregular granulation tissue at the fistula openings. If accompanied by suppurative infection later, acute episodes may occur, presenting symptoms of acute cellulitis, with body temperature rising to 38.5～39℃ or higher. This acute inflammation differs from general inflammation; although expelling pus through incision may improve the condition, the board-like hard swelling of actinomycosis does not completely subside. After healing, a purplish-red atrophic scar remains.

bubble_chart Diagnosis

Diagnosis primarily relies on clinical manifestations and bacteriological examination. If an early clinical diagnosis cannot be confirmed, a biopsy may be performed when necessary.

bubble_chart Treatment Measures

The main treatment is antibiotics. If an abscess forms, surgical incision to expel pus can effectively control the inflammation.

I. Drug Therapy: Antibiotics and sulfonamides Yaodui are significantly effective against actinomycosis.

1. Generally, a large dose of penicillin G is used for treatment, with more than 2 million units daily, administered intramuscularly or with procaine for local lesion blockade. When possible, antibiotics should be selected based on drug sensitivity tests. Combining with streptomycin, tetracycline, etc., may enhance efficacy.

2. Sulfonamides: Can be used alone or in combination with antibiotics.

3. Iodine preparations: Oral iodine preparations can achieve certain effects for actinomycosis with a longer course. Commonly used is a 5-10% potassium iodide solution, taken orally three times a day.

4. Immunotherapy: Also has certain effects. Generally, actinomycin is used for intradermal injection, starting with a dose of 0.5 ml, then increasing every 2-3 days, gradually increasing the dose to 0.7-0.9 ml, and then increasing by 0.1 ml each time. The full course is 14 times, or until reaching 2 ml each time. Actinomycin immunotherapy can enhance the body's immune capacity.

II. Surgical Therapy: If actinomycosis has formed an abscess or left a fistula after ulceration, often with necrotic granulation tissue hyperplasia, surgical incision to expel pus or scraping of granulation tissue can be adopted. Due to unclear lesion boundaries within the gland and adhesion to surrounding tissues, the gland is often removed together.

III. Hyperbaric Oxygen Therapy: Since actinomyces are anaerobic bacteria, hyperbaric oxygen therapy has been applied in recent years to treat actinomycosis, playing a good role in inhibiting the development of actinomyces, and is one of the current comprehensive treatment methods.