Abdominal actinomycosis: Changed concepts?

Abstract

The epidemiology, incidence, diagnosis, and therapy of abdominal actinomycosis have always been problematic. New concepts have been formed, but some remain inconclusive. The apparent etiologic agent, Actinomyces israeli, is a known endemic organism and common inhabitant of the human mouth and gastrointestinal tract. What initiates its pathogenicity within the abdomen is not clear. It may require other microorganisms for production of its typical lesions. If so, their role is not known. The exact incidence of abdominal actinomycosis cannot be assessed. Many such infections are probably undiagnosed. Some may be suppressed or cured by antibiotic therapy being given for other conditions. The diagnosis can be most elusive. A. israeli is often not found or found only after long search and at the depths of the process. With the dearth of organisms, the cause of the excessive fibroblastic response is also obscure. When abdominal actinomycosis is suspected or diagnosed, the value of aggressive surgical therapy appears established. Along with this, massive doses of penicillin over a prolonged period is accepted treatment. However, the most practical dosage and length of treatment with this effective, yet expensive and potentially hazardous, antibiotic have not been clarified.