Actinomycosis of the paranasal sinus

Maxillary sinus actinomycosis: a diagnostic and therapeutic challenge

The authors present a case of maxillary sinus actinomycosis in a young adult woman.This is a rare condition whose unspecific clinical presentation makes its diagnosis challenging. In this case, the diagnosis was given by the identification of Actinomyces colonies in samples of infected tissue.Treatment consisted of a combined medical and surgical approach. Endoscopic sinus surgery was performed to remove diseased mucosa and to aerate the involved sinuses, followed by long-term antibiotic therapy. No recurrence of the disease was observed during follow-up.

Actinomycosis Confined to the Nasal Septum

Actinomycosis is common in the head and neck region but rarely occurs in the nasal septum. A 75-year-old male patient with an edentulous maxilla, hypertension, and diabetes developed actinomycosis confined to the nasal septum and showed mucosal necrosis and septal bony sequestration. The patient underwent surgery and medication therapy; this case was reported using endoscopic photographs and radiographs and a literature review was conducted to provide further context and understanding of the condition of the patient.

Actinomycosis of the paranasal sinuses: case report and literature review

Actinomycosis is a chronic granulomatous condition caused by filamentous gram-positive anaerobic bacteria that colonizes the mouth, gastrointestinal tract and urogenital tract. Infection occurs through the mucosal surfaces, often resulting from dental procedures or trauma, primarily affecting the maxillary sinus. We report a case of Actinomyces sinusitis affecting the right maxillary and right ethmoidal sinuses of a 41-year-old woman. The diagnosis was made through a combination of histopathological report and computed tomography scan. The patient underwent endoscopic sinus surgery followed by long-term antibiotics for 6 months and reported improvement of her symptoms.

Actinomycosis of the middle turbinate

Actinomycosis is an uncommon bacterial disease caused by actinomyces. Cervicofacial infection accounts for more than 60% of all cases. However, nasal and paranasal sinus involvement has rarely been described. We report herein a case of a patient presenting with middle turbinate actinomycosis.

Actinomyces Acute Rhinosinusitis Complicated by Subperiosteal Abscess in an Immunocompromised 12-Year-Old: Case Report and Literature Review

Objective

To describe a rare case of pediatric actinomycotic rhinosinusitis with orbital subperiosteal abscess and review the current literature to assess methods of diagnosis, treatment modalities, and outcomes with appropriate treatment.

Methods

A case report and a review of the literature.

Results

A 12-year-old patient with Crohn's disease on infliximab presented with rhinosinusitis with orbital subperiosteal abscess formation. Endoscopic sinus surgery was performed and cultures grew actinomyces. A prolonged course of antibiotics was started, resulting in the complete resolution of the infection. In a literature review, all cases of uncomplicated and complicated actinomyces rhinosinusitis managed with appropriate surgery and prolonged antibiotics resulted in a cure. Our case is the first reported in a pediatric patient and the first taking immunosuppressive medication. Overall, only 3 cases of actinomyces rhinosinusitis in immunosuppressed individuals have been reported, each with uncontrolled diabetes and each also responded well to surgery and appropriate antibiotics.

Conclusion

Actinomycosis of the paranasal sinuses poses a diagnostic challenge, with infections varying widely in presentation and extent of disease. A high index of suspicion, appropriate testing, and early aggressive treatment are critical in managing patients with this infection. Our case and prior published studies show that actinomyces rhinosinusitis can be successfully managed with endoscopic sinus surgery, abscess drainage as necessary, and a prolonged course of antibiotics, even in immunocompromised and pediatric populations.

Paranasal sinus actinomycosis treated with a combination of surgery and long-term low-dose macrolide

Actinomycosis is a bacterial infection caused by actinomyces. Although almost 50% of cases are related to the head and neck region, those in the nose and paranasal sinuses (PNS) are rare. Actinomycosis of the PNS is presumed to be typically caused by dental caries, dental manipulation, and maxillofacial trauma, which facilitate the penetration of oral pathogens into the sinus, and should thus be treated by the combination of surgical removal and potent antibiotics for at least two months. The current use of these antibiotics might be redundant, considering the nature of actinomycosis of the PNS, which does not invade the mucosal surface. We herein report a 67-year-old female treated with endoscopic sinus surgery (ESS) and diagnosed with actinomycosis of the PNS by pathological findings. She had no history of dental impairment or treatment. She was given routine perioperative prophylactic antibiotics (cefazolin) during the surgery, followed by low-dose clarithromycin. The mucosa of the PNS normalized without any discharge by three months after the operation. The patient is a valuable example that should prompt reconsideration of the commonly accepted pathogenesis and treatment of actinomycosis of the PNS.

Actinomycosis of the Nasal Septum: A Rare Entity

Actinomycosis is a rare bacterial infection that can affect almost any site in the body. Its occurrence at the nasal septum is extremely rare. We present the case of an 84-year-old diabetic woman, with a past medical history of breast cancer that came to medical attention because of progressive nasal obstruction and severe sleep apnea. Nasal endoscopy revealed a submucosal mass at the anterior nasal septum obstructing both nasal cavities and extending to the anterior hard palate. With a cancer metastasis in mind, she was submitted to surgical resection of the lesion through a Rouge-Denker approach, with the final histologic diagnosis of actinomycosis. She was then treated with a three-month cycle of amoxicillin and remains without recurrence. This case describes a rare disease that should be considered in the differential diagnosis of sinonasal lesions, especially in diabetic patients and after dental procedures.

Actinomycosis of the nasal cavity

INTRODUCTION

Actinomycosis of the nasal cavity is very rare.

OBJECTIVE

The purpose of this study was to investigate the clinical features, treatment methods, and treatment results of actinomycosis of the nasal cavity in our hospital.

METHODS

We retrospectively enrolled 11 patients with histopathologically identified actinomycosis of the nasal cavity from January 2010 to May 2020.

RESULTS

This study included five males and six females. The most common symptom was purulent nasal discharge (36.4%). Nasal actinomycosis occurred in the maxillary sinus in 5 (45.5%) patients, the ethmoid sinus in two, the hard palate in two, the frontal sinus in one, and the nasal septum in one. After surgery, intravenous administration of antibiotics was performed on average for 7.4 days and oral antibiotics were prescribed for about 120.5 days. The clinical characteristics of the patients with nasal actinomycosis and the duration of antibiotic usage were not significantly different. Trauma was significantly associated with repeated nasal actinomycosis infections (p < 0.05).

CONCLUSION

Actinomycosis of the nasal cavity should be suspected when a patient with chronic sinusitis does not respond to medical therapy and has a history of dental treatment, local surgery or radiation therapy. Nasal can be sufficiently treated with antibiotics and endoscopic surgery.

[Formation of concrements in the lacrimal excretory system]

Studying the pathogenesis of concrements formation in lacrimal ducts is of fundamental and practical importance. This article attempts to analyze available information related to the pathogenesis of this phenomenon, provides information on the etiopathogenesis, physical and chemical properties of concrements obtained from horizontal and vertical parts of the lacrimal duct, and considers in detail bacteriological and mycotic composition of concrements, as well as various theories of their formation. The analysis helped justify the need to separate the concrements formed in the horizontal and vertical parts of the lacrimal ducts on the basis of differences in their pathogenesis. Actinomycotic infection is the cause of concrements formation in the horizontal part of the lacrimal duct in the overwhelming majority of cases. The process of concrements formation in the vertical part of the lacrimal duct in some cases occurs as a result of previous clinical events, but in many other cases the trigger mechanisms remain unknown. To date, the role of the initial narrowing of the lacrimal ducts in the pathogenesis of concrements is not clearly defined. The accumulated knowledge regarding the pathogenesis of concrements is currently not enough to formulate a complete theory of the development of this phenomenon. Further studies of the pathogenesis of concrements will help develop new diagnostic and therapeutic measures aimed at restoring the patency of the lacrimal ducts.

Nasal Septum Actinomycosis Mimicking Mucocele

Actinomycosis commonly occurs in the cervicofacial region, but rarely in the paranasal sinus. The authors report an unusual case of nasal septum actinomycosis that was mistaken for a mucocele. The patient was treated accordingly using antibiotic therapy after endoscopic sinus surgery was performed. It is noteworthy that actinomycosis of the nasal septum could appear as a mucocele without central calcification or bony destruction in imaging studies.

Unilateral Maxillary Sinus Actinomycosis with a Closed Oroantral Fistula

Actinomycosis is a bacterial infection due to Actinomyces israelii, a gram-positive, anaerobic organism that normally affects the cervicofacial region. However, facial injury or trauma (i.e., dental procedures) can allow this bacteria to inhabit other regions. There have been rare reports of actinomycosis of the paranasal sinuses. We present a case of a 50-year-old female who originally presented with a suspected oroantral fistula who subsequently was found to have actinomycosis involving her right maxillary sinus. Additionally, the dental extraction site revealed no connection with the maxillary sinus. We discuss the diagnostic approach and management of this patient as it relates to the limited existing literature.

Actinomyces and related organisms in human infections

Actinomyces israelii has long been recognized as a causative agent of actinomycosis. During the past 3 decades, a large number of novel Actinomyces species have been described. Their detection and identification in clinical microbiology laboratories and recognition as pathogens in clinical settings can be challenging. With the introduction of advanced molecular methods, knowledge about their clinical relevance is gradually increasing, and the spectrum of diseases associated with Actinomyces and Actinomyces-like organisms is widening accordingly; for example, Actinomyces meyeri, Actinomyces neuii, and Actinomyces turicensis as well as Actinotignum (formerly Actinobaculum) schaalii are emerging as important causes of specific infections at various body sites. In the present review, we have gathered this information to provide a comprehensive and microbiologically consistent overview of the significance of Actinomyces and some closely related taxa in human infections.

Intracranial complication of rhinosinusitis from actinomycosis of the paranasal sinuses: a rare case of abducens nerve palsy

Sinonasal actinomycosis should be suspected when a patient with chronic sinusitis does not respond to medical therapy or has a history of facial trauma, dental disease, cancer, immunodeficiency, long-term steroid therapy, diabetes, or malnutrition. Radiological evaluation with computed tomography and magnetic resonance imaging are important in differential diagnosis, evaluating the extent of disease, and understanding clinical symptoms. Endoscopic sinus surgery associated with long-term intravenous antibiotic therapy is the gold standard for treatment of sinonasal actinomycosis. We report an unusual case of abducens nerve palsy resulting from invasive sinonasal actinomycosis in a patient with an abnormally enlarged sphenoid sinus. A review of the current literature highlighting clinical presentation, radiological findings, and treatment of this uncommon complication is also presented.

Actinomyces-associated calcifications in a dentigerous cyst of the mandible

Actinomyces-associated lesions in the jaw, such as radicular cyst and osteomyelitis, have been reported by many authors. The lesions are caused by infection from peripheral sites and can be seen to contain Actinomyces druses on pathologic examination. To our knowledge, no previous reports have described Actinomyces-associated calcification in the jaw, although the lesions in the jaw often include druses. We report here a rare case of Actinomyces-associated calcifications in a dentigerous cyst of the mandible.

Treatment of cervicofacial actinomycosis: a report of 19 cases and review of literature

OBJECTIVES

Actinomycosis is a chronic suppurative granulomatous infection caused by the Actinomyces genus. Orocervicofacial actinomycosis is the most common form of the disease, seen in up to 55% of cases. All forms of actinomycosis are treated with high doses of intravenous penicillin G over two to six weeks, followed by oral penicillin V. Large studies on cervicofacial actinomycosis are lacking. Therefore proper guidelines for treatment and treatment duration are difficult to establish. The aim of this study is to establish effective treatment and treatment duration for orocervicofacial actinomycosis.

STUDY DESIGN

A Pubmed and Embase search was performed with the focus on treatment and treatment duration for cervicofacial actinomycosis. The hospital records of all patients presenting to our department with head and neck infection from January 2000 to December 2010 were reviewed, retrospectively. The following data were collected: age, gender, clinical presentation, aetiology, duration of symptoms, microbiological findings, treatment, and duration of treatment. The treatment and treatment duration is subsequently compared to the literature.

RESULTS

The literature search provided 12 studies meeting the inclusion criteria. All studies were retrospective in nature. Penicillin or amoxicillin/clavulanic acid are the preferred antibiotic regimens found in the literature. Most of our patients were treated with a combination of penicillin G 12 million units/day and metronidazol 500 mg 3/day, most commonly for a duration of 1 - 4 weeks, being shorter than the 3 - 52 weeks reported in the literature.

CONCLUSION

When actinomycosis is suspected, our review has shown that a surgical approach in combination with intravenous penicillin and metronidazol until clinical improvement is seen, followed by oral antibiotics for 2 - 4 weeks is generally efficient.

Invasive sinonasal actinomycosis: case report and literature review

Actinomycosis is a rare anaerobic bacterial infection typically caused by Actinomyces israelii. Although part of normal flora in the oral cavity, and respiratory and digestive tracts, A israelii can give rise to pathologic infections most commonly reported in the oral cavity from odontogenic causes. We present a rare case of invasive actinomycosis presenting with extensive midface destruction involving the maxilla and paranasal sinuses, with mucosal necrosis mimicking an aggressive neoplasm. The diagnosis is usually reached only after histopathologic analysis showing characteristic sulfur granules with filamentous gram-positive, non-acid-fast bacteria. We review the literature on its epidemiology, clinical presentation, diagnosis, treatment, and prognosis.

Simultaneous actinomycosis with aspergillosis in maxillary sinus

We report a case with review of literature of actinomycosis accompanied with aspergillosis arising in unilateral maxillary sinus, in which it was completely cured after endoscopic sinus surgery and short term antibiotic therapy. To the best of our knowledge, this is the first case report in literature reporting actinomycosis in combination with aspergillosis in the paranasal sinus. Also, we suggest short term antibiotic therapy within one month may be sufficient if the surgical opening of paranasal sinus involved by actinomycosis could be well preserved.

Chronic rhinorrhea revealing an actinomycotic rhinolithiasis with ectopic tooth

Intranasal ectopic tooth is a rare nidus for a rhinolith where local infection may be concomitant. No description of the triple association 'actinomycotic rhinolithiasis ectopic tooth' could be found in the medical literature. Classically, the Actinomyces species are sensitive to regimens of penicillin from 6 to 12 months or longer. Immunocompetent patients can benefit from shorter courses of antibiotic therapy, such as ciprofloxacin, with a favourable outcome. The authors describe the case of a 25-year-old man who presented with an actinomycosis chronic discharge revealing actinomycosis associated with rhinolithiasis and ectopic tooth. They attempt to explain the likely mechanism of occurrence of this triple association.

Complete unilateral maxillary sinus opacity in computed tomography

BACKGROUND/PURPOSE

Unilateral maxillary sinus opacity can be caused by many diseases, but an exact diagnosis is difficult to make. The aim of this study was to describe the pathological conditions and clinical features of patients with unilateral maxillary sinus opacity.

METHODS

From 2004 to 2008, 830 consecutive patients underwent sinus surgery or endonasal endoscopic biopsy at an academic tertiary care center. The preoperative computed tomography (CT) images for these patients were reviewed, and 11 6 patients were identified with complete unilateral maxillary sinus opacification. We then analyzed presenting symptoms, physical examinations, specific CT findings, and pathology.

RESULTS

The most frequent diagnoses were as follows: chronic rhinosinusitis (52.6%), fungus ball (29.3%), antrochoanal polyp (2.6%), benign tumor (10.4%), and malignancy (5.1%). Fungus ball was the most common diagnosis (10/18, 55.6%) in the subgroup of patients with isolated maxillary sinus opacity without disease in the other sinuses. Nasal discharge and foul-smelling breath were more common in inflammatory disease than in neoplastic disease. Neoplastic disease was more likely to present as epistaxis; a polyp or mass revealed by nasal endoscopy; mass effect in the cheek, palate, or gingiva; and bony erosion on CT. Erosion of the maxillary posterolateral wall and extra-sinus extension suggested malignancy.

CONCLUSION

Although unilateral maxillary sinus opacity is usually inflammatory in origin, fungal sinusitis and neoplastic disorder are also likely. A careful history-taking, a thorough head and neck examination including nasal endoscopy, and CT evaluation are all imperative for reaching a correct diagnosis.