actinomycosis

Infectious disease, commonly known as ‘lumpy jaw’ or ‘big jaw’, characterized by chronic inflammation and often resulting in tumours about the jaws. It was first observed in cattle, caused by the bacteria Actinomyces bovis, and sometimes also occurs in humans, when it is caused by A. israelii.

A. israelii is found in the mouth and tonsils of many normal people, and it is uncertain whether the disease is precipitated by trauma, bacterial infection, or allergy. It appears that the bacteria enter the mouth in association with certain cereals, chiefly barley; and it is noteworthy that those infected have generally been concerned in occupations dealing with cereals. Most cases of actinomycosis have occurred in connection with the oral cavity. The patient complains of toothache and of difficulty in opening the jaw, swelling appears at the angle of the jaw, which passes into suppuration, pus being discharged externally and into the mouth. From this the disease may spread downwards into any organ. Pulmonary actinomycosis is characterized by a cough and fetid expectoration. The bacteria may also infect the intestines, where they grow on the mucous membrane, leading to ulceration. Perforation of the serous coat of the bowel may occur, leading to peritonitis.

The diagnosis of the disease rests solely upon the discovery of Actinomyces, a large, branching, filamentous bacterium. Treatment consists in surgical drainage of pus where feasible and penicillin in large doses over a long period.