Radiotherapy in Actinomycosis

Abstract

ACTINOMYCOSIS is a chronic infectious disease produced by the ray-fungus. Streptothrix actinomyces, and characterized by infiltrative or suppurative lesions in the subcutaneous tissues of the head and neck, in the submucous tissues of the mouth and tongue, in the digestive or respiratory tracts, and sometimes even in the brain and liver. New and Figi published a series of 157 cases, in more than 68 per cent of which the head and neck were involved. The clinical features and the course of the disease may vary greatly; its characteristic aspect is that of a small or large indurated mass, which subsequently breaks down and forms multiple abscesses. The mass may appear as a small nodule beneath the skin or mucosa or as a large, firm, and diffuse tumefaction, and its progress may be rapid or slow and indolent. When fully developed the disease is essentially pyemia. Etiology Ever since Ponfick established the identity of the disease in cattle and in man, infection in the latter has been generally attributed to contagion from the lower animals. This has often been questioned and it is difficult in many cases to prove such a connection; it probably means that direct contagion from animals is uncommon and that in most cases the infection is indirect. New and Figi have obtained evidence of indirect infection in the form of “dental caries, picking decayed teeth with straws, or chewing bits of straw or grass.” A definite history of trauma and foreign body was secured in five cases. In six other cases the onset of the disease followed immediately on the extraction of teeth. The digestive tract is by far the most common pathway of infection. Symptoms The symptoms depend on the site of the original lesion and on the form of the disease. When it first invades the skin of the head or neck, or the oral mucous membrane, the clinical manifestations may consist in stiffness, pain, and swelling in the affected region. The pain is often severe and throbbing, but it may be slight or absent at the outset. Soreness of the throat, stiffness of the neck, earache, dysphagia or dyspnea may occur, according as the base of the tongue or the hypopharynx and epiglottis are involved. Pulmonary infection is usually unilateral and is accompanied by cough, fever, loss of weight and strength, and mucopurulent expectoration. Abscesses and cavities may form, and erosion of vertebrae, ribs, or sternum may be encountered in certain cases. The symptoms sometimes suggest tuberculosis. Infection of the intestine may be primary or secondary, and the region of the cecum and appendix is the most common seat of the disease; it may simulate appendicitis, for which it is often mistaken. Irregular fever, and loss of weight and strength are frequent manifestations but the fever depends on the extent and degree of the suppurative process. Occasionally the course of the disease may resemble that of typhoid fever, at least for a time.