Eleven cases of actinomycosis involving the liver were reported in Japan. In most patients, there were no predisposing factors. Common symptoms and laboratory findings included fever, abdominal pain, leukocytosis, and elevated C-reactive protein.1 Actinomyces is a causative organism in conjunctivitis, blepharitis, canaliculitis, dacryocystitis, keratitis and porous orbital implant.2 Patients with actinomycosis, nocardiosis and actinomycoma are seen consistently, albeit infrequently, in the United States; diagnosis can be difficult because of their resemblance to other bacterial, mycobacterial and fungal infections.3 Cervicofacial actinomycoses are due largely to Actinomyces israelii and A. gerencseriae (plus several other Actinomyces spp.) and to a lesser extent to Propionibacterium propionicum together with 1 to 9 or more aerobic and/or anaerobic synergistic companions which complement the relatively low invasive power of the actinomycetes.4
Detection of Actinomyces israelii by direct fluorescent antibody (DFA), culture or cytology is significantly related to the use of intrauterine devices.5,6 DFA offers better sensitivity.5 Serotyping of A. israelii does not appear to have prognostic value because Actinomyces israelii serotypes 1 and 2 are detected at approximately equal frequencies in patients with pelvic inflammatory disease.5 Fermentative actinomycetes are primarily identified via biochemical reactions including the Minitek identification system (cf. #4). Four commercially available kits for rapid identification of Actinomyces and related species do not adequately identify the strains to the species level.7
