Anaerobic culture of the purulent material or a portion of the tissue is critical for proper identification of the responsible organism and ultimately for choosing the appropriate therapy. Material should be sent anaerobically immediately to the laboratory. Yellow to white sulfur granules form as the culture material grows. Evaluation of the sulfur granules with the use of an oil immersion microscope shows the filamentous bacteria.
Pathogenesis: Actinomycosis is caused by one of the gram-positive filamentous bacteria of the Actinomyces genus: A. israelii, A. turicensis, A. lingnae, A. gravenitzii, A. meyeri, A. naeslundii, A. radingae, A. europaeus, A. viscosus, A. neuii, or A. odontolyticus. A. israelii is the organism most frequently observed to cause disease. These are anaerobic, acid-fast bacteria that have a filamentous morphology with varying amounts of branching. The definitive diagnosis is made by culture of the organism.
Treatment: The drug of choice to treat this bacterial infection is penicillin. Therapy needs to be maintained for months to be certain of complete cure. If the infection is treated promptly, almost all patients have a full and complete recovery. Patients who are allergic to penicillin can be treated with any of the tetracycline-based antibiotics.
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