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Pulmonary actinomycosis

Actinomycosis - pulmonary; Actinomycosis - thoracic

Pulmonary actinomycosis is a rare lung infection caused by bacteria.

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Causes

Pulmonary actinomycosis is caused by certain bacteria normally found in the mouth and gastrointestinal tract. The bacteria often do not cause harm. But poor dental hygiene and tooth abscess can increase your risk for lung infections caused by these bacteria.

People with the following health problems also have a higher chance of developing the infection:

• Alcohol use
• Scars on the lungs (bronchiectasis)
• Chronic obstructive pulmonary disease (COPD)

The disease is rare in the United States. It may occur at any age but is most common in people 30 to 60 years old. Men get this infection more often than women.

Symptoms

The infection often comes on slowly. It may be weeks or months before diagnosis is confirmed.

Symptoms may include any of the following:

• Chest pain when taking a deep breath
• Cough with phlegm (sputum)
• Fever
• Shortness of breath
• Unintentional weight loss
• Lethargy
• Night sweats (uncommon)

Exams and Tests

The health care provider will perform a physical exam and ask about your medical history and symptoms. Tests that may be done include:

• Bronchoscopy with culture
• Complete blood count (CBC) with differential
• Chest x-ray
• Chest CT scan
• Lung biopsy
• Modified AFB smear of sputum
• Sputum culture
• Tissue and sputum Gram stain
• Thoracentesis with culture
• Tissue culture

Treatment

The goal of treatment is to cure the infection. It may take a long time to get better. To be cured, you may need to receive the antibiotic penicillin through a vein (intravenously) for 2 to 6 weeks. Then you need to take penicillin by mouth for a long period. Some people need up to 18 months of antibiotic treatment.

If you cannot take penicillin, your provider will prescribe other antibiotics.

Surgery may be needed to drain fluid from the lungs and control the infection.

Outlook (Prognosis)

Most people get better after treatment with antibiotics.

Possible Complications

Complications may include:

• Brain abscess
• Destruction of parts of the lungs
• COPD
• Meningitis
• Osteomyelitis (bone infection)

When to Contact a Medical Professional

Contact your provider if:

• You have symptoms of pulmonary actinomycosis
• Your symptoms get worse or do not improve with treatment
• You develop new symptoms
• You have a fever of 101°F (38.3°C) or higher

Prevention

Good dental hygiene may help reduce your risk for actinomycosis.

Related Information

Dental care - adult
Tooth abscess
Pleural effusion
Brain abscess
Meningitis
Osteomyelitis
Empyema

References

Brook I. Actinomycosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 313.

Russo TA. Agents of actinomycosis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 254.

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Review Date: 3/10/2022  

Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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