Actinomycosis: a case report of two patients treated for the condition who required stoma formation

Actinomycosis is a rare, insidious disease (García-García et al, 2017). It occurs slowly (Wagenlehner et al, 2003) and subtly, but with harmful effects. To date, no epidemiological studies have been undertaken to determine its prevalence or incidence across the world (García-García et al, 2017). Centres and institutes globally appear to have encountered small numbers of patients with actinomycosis over many decades; clinical cases have been reported in Africa, Oceania, Asia, Europe and America. Some clinicians may never see it in their entire medical career (García-García et al, 2017).

Actinomycosis is a chronic bacterial infection caused by Actinomyces spp., which are Gram-positive, anaerobic bacteria (García-García et al, 2017), ie bacteria that do not require oxygen for growth. The bacteria spread by direct extension across tissue planes creating multiple abscesses, sinus and florid granulation tissue as they encroach on new tissue (Sung et al, 2011). This follows a breach in the normal mucosal barrier (García-García et al, 2017). Destruction of the mucosal barrier can occur through injury or trauma, surgery, inflammatory bowel disease or immunosuppression (Jung et al, 1999). Mucosal destruction allows the pathogen to cross the mucosal membrane or epithelial surface (Sánchez Hernández et al, 2004) and penetrate deep inside the tissue (Jung et al, 1999), where it proliferates and grows.