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Pelvic Actinomycosis

Last updated Dec. 16, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Actinomycosis is a rare and chronic infection, caused predominantly by the bacterium Actinomyces israelii and to a lesser extent by other Actinomyces species. Pelvic Actinomycosis is a very rare bacterial infection of the organs and tissues in the pelvic region.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Genitourinary Tract Actinomycosis
  • Testicular Actinomycosis
  • Uterine Actinomycosis

What is Pelvic Actinomycosis? (Definition/Background Information)

  • Actinomycosis is a rare and chronic infection, caused predominantly by the bacterium Actinomyces israelii and to a lesser extent by other Actinomyces species. Pelvic Actinomycosis is a very rare bacterial infection of the organs and tissues in the pelvic region
  • The bacteria exist naturally in the mucous lining of the nose, throat, mouth, digestive tract, and female reproductive tract, and are not normally harmful. These anaerobic bacteria have the ability to grow in the absence of oxygen, or in reduced concentrations of oxygen
  • However, any injury, trauma, or surgical procedure can cause the bacterial cells to enter deeper tissues, where they are not normally found. Since these bacteria can grow without oxygen, they can thrive in such environments, resulting in infection
  • In the case of Pelvic Actinomycosis, a majority of the affected individuals are females, who have used or are currently using intra-uterine contraceptive devices (IUDs). However, some cases of testicular and bladder infections have also been reported
  • It is believed that the use of IUDs may cause erosion of the endometrium, facilitating the entry of bacteria to the depths of uterine tissue. The exact mechanism of infection of testes or bladder is presently unclear
  • The symptoms of Pelvic Actinomycosis may include genital mass or abscess, lower abdominal or pelvic pain, constipation, and vaginal discharge (in women)
  • Examination of the fluid drainage under microscope to check for “sulfur granules” and culture of affected tissue specimen, along with imaging techniques may be employed to diagnose actinomycosis. The tissue specimen may need to be procured surgically
  • Intense and prolonged treatment with antibiotics is necessary to remove the infection. In some cases, the abscess may need to be surgically drained or removed
  • With prompt diagnosis and sustained treatment, Pelvic Actinomycosis is curable. However, if the infection becomes generalized via spread of bacteria through the bloodstream, it can spread to other organs and tissues. In such cases, the recovery can be prolonged 

Who gets Pelvic Actinomycosis? (Age and Sex Distribution)

  • Pelvic Actinomycosis is a rare and chronic infection that is reported worldwide
  • The infection occurs more frequently in adult women, who use or have used intra-uterine contraceptive devices
  • The condition can also occur in men (in their testes)

What are the Risk Factors for Pelvic Actinomycosis? (Predisposing Factors)

The following are some known risk factors for Pelvic Actinomycosis:

  • Use of intrauterine contraceptive devices by women, for periods longer than recommended by the device manufacturer
  • Malnutrition
  • Compromised immunity owing to HIV/AIDS, organ transplantation, chemotherapy or radiation therapy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Pelvic Actinomycosis? (Etiology)

Pelvic Actinomycosis constitutes approximately 10% of all cases of actinomycosis. It is caused by anaerobic bacteria,belonging to the family Actinomycetaceae. These bacteria are gram-positive and can survive in very low concentrations of oxygen

The following are some bacterial species known to cause Actinomycosis:

  • Actinomyces israelii, which is responsible for majority of infections
  • Actinomyces gerencseriae
  • Actinomyces viscosus
  • Actinomyces meyeri
  • Actinomyces naeslundii

Under normal circumstances, the bacteria are present in the mucous lining of the mouth, throat, digestive system, and the female reproductive tract, without causing harm.

  • However, when the mucous lining gets damaged owing to numerous factors, such as injury (erosion of endometrium caused by use of IUD), trauma, or surgery, the bacteria enter the inner/deeper tissues
  • Being anaerobic, they can survive and multiply in the low oxygen conditions of deep tissue, causing the development of scar tissue and fistula (or abnormal tracts)
  • Abscess formation can take place with the accumulation of pus, which may drain when the tracts reach the surface of skin. This process may take months to years

Pelvic Actinomycosis is not limited to the reproductive tract, since the urinary bladder and abdominal wall can get affected as well. The exact mechanism of formation of these infections is not known. Additionally, in rare cases, Testicular Actinomycosis has been reported in men as well.

Note: Pelvic Actinomycosis is not a contagious infection and it does not spread from one individual to another.

What are the Signs and Symptoms of Pelvic Actinomycosis?

The signs and symptoms of Pelvic Actinomycosis may vary depending on the site and severity of infection, and may include:

  • Abscess formation in the genitals, urinary bladder, or abdominal wall
  • Pelvic pain
  • Vaginal discharge, bleeding
  • Constipation
  • Weight loss

How is Pelvic Actinomycosis Diagnosed?

Pelvic Actinomycosis is diagnosed on the basis of the following test and exams:

  • A thorough physical examination and assessment of symptoms
  • Evaluation of the affected individual’s medical history
  • Microscopic observation of fluid drainage from abscess or tissue samples to check for sulfur granules (which are named after the characteristics of the granules i.e., round and yellow, and not because they contain sulfur). The tissue samples may have to be obtained surgically
  • Culture of fluid or tissue from infected area: These bacteria are slow to grow in culture, and it may take over 3 weeks to obtain a (positive) culture result
  • X-ray or computed tomography (CT) imaging to ascertain location and number of abscesses, as well as differentiate inflammatory masses due to infection from the tumors

Note: Pelvic Actinomycosis may mimic some malignant conditions, and therefore, ruling out other health conditions may often be necessary to arrive at a final diagnosis.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Pelvic Actinomycosis?

Some potential complications from Pelvic Actinomycosis include:

  • Formation of large lesions
  • Scar tissue formation in the uterus
  • Spread of infection to tissues in contact with the infected tissue
  • Formation of fistulas
  • Peritonitis
  • The infection spreading to other organs away from the primary site of infection

How is Pelvic Actinomycosis Treated?

Pelvic Actinomycosis is treated through the following measures:

  • Prolonged use of antibiotics (anywhere from 2 months to over 12 months); typically, β-lactam (such as penicillin, amoxicillin) or tetracycline (doxycycline) family of antibiotics are used
  • Surgical drainage of abscess; draining the abscess by inserting a needle
  • Surgical removal of infected tissue
    • Surgery is sometimes necessary for cases in which large abscesses have developed, the infection has spread to organs and bones, and antibiotics alone are unsatisfactory
    • Surgery creates an aerobic environment, which is detrimental to bacterial growth. It also allows for the excision of lesions, drainage of sinuses, as well as containment and elimination of the disease
  • Hyperoxygen therapy to eliminate bacteria:
    • This therapy helps increase the concentration of oxygen in the infected tissues
    • The presence of oxygen results in higher amounts of oxygen-derived radicals that harm, and are specifically drawn to anaerobic organisms, such as Actinomyces
    • This method has only been approved as an adjunct to other forms of treatment

How can Pelvic Actinomycosis be Prevented?

Pelvic Actinomycosis can be prevented through the following practices:

  • Avoiding intra-uterine devices (when possible); adopting alternative contraceptive practices
  • Not using IUDs beyond the duration recommended by the manufacturer
  • Educating oneself or monitoring self for any signs of discomfort following a surgery, and promptly reporting to the attending healthcare provider, so that infections may be detected early and treated appropriately

Completing the full course of prescribed antibiotics regimen, to eliminate the infection causing bacteria from deep tissue, as well as to prevent relapse of infection and development of drug-resistant bacterial species.

What is the Prognosis of Pelvic Actinomycosis? (Outcomes/Resolutions)

The prognosis of Pelvic Actinomycosis is good with early diagnosis and prompt treatment in individuals with good overall health status.

  • The outcomes may be influenced by underlying medical conditions and/or compromised immunity
  • Additionally, a lack of treatment may allow the infection to spread to other organs and tissues, which may prolong the treatment and recovery process

Additional and Relevant Useful Information for Pelvic Actinomycosis:

Actinomycosis commonly occurs in animals (mostly cattle) and rarely in humans. In cattle, the bacteria target areas around the head, especially the jaw, which gives rise to the name “big/lumpy jaw”.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 6, 2017
Last updated: Dec. 16, 2018