Acute cervico-facial actinomycosis

Cervicofacial actinomycosis following third molar removal: case-series and review

Actinomycosis is an opportunistic infection caused by bacteria of the Actinomyces spp., commonly A. israelii. These are non-pathogenic commensals in the mouth, gut, and female genital tract. An infection may arise following trauma or surgery, such as tooth extraction. More than half of cases of actinomycosis occur in the perimandibular area and are termed cervicofacial actinomycosis. Initially, the infection develops as a painful, rapidly progressive swelling. The lesion may then indurate and is often painless while the overlying skin discolors red to purple-blue. Prolonged treatment with antibiotics and surgery are often required for resolution, unless treatment is promptly started. However, diagnosis may be delayed or missed because of difficult bacterial culturing and frequent confusion with malignancy and other infections. This case study describes six patients who developed cervicofacial actinomycosis following third molar extraction. The purpose of this study is to inform clinicians on this stubborn and deceitful disease entity and to highlight the importance of clinical recognition for quick resolution with minimal morbidity.

Invasive actinomycosis: surrogate marker of a poor prognosis in immunocompromised patients

OBJECTIVES

Actinomycosis is a rare disease favored by disruption of the mucosal barrier. In order to investigate the impact of immunosuppression on outcome we analyzed the most severe cases observed in patients hospitalized in three tertiary care centers.

METHODS

We reviewed all cases of proven invasive actinomycosis occurring over a 12-year period (1997 to 2009) in three teaching hospitals in the Paris area.

RESULTS

Thirty-three patients (16 male) were identified as having an invasive actinomycosis requiring hospitalization. The diagnosis was made by microbiological identification in 26 patients, pathological examination in eight patients, and by both methods in one. Twenty patients (61%) were immunocompromised. Actinomycosis localization was abdominal or pelvic in 17 patients, thoracic in 11, cervicofacial in three, and neurological in two. Twenty patients (61%) underwent surgery. All strains were susceptible to amoxicillin. All patients were treated with a beta-lactam antibiotic, for a median length of 82 days. Twenty-eight patients (85%) were considered as cured. Overall mortality at hospital discharge was 21% (7/33). Mortality was higher in immunocompromised patients (7/20; 21%) compared to non-immunocompromised patients (0/13) (p=0.027). However, six of seven deaths were directly related to the underlying disease.

CONCLUSIONS

Actinomycosis is a cause of severe infection in immunocompromised patients and a surrogate marker of a poor prognosis in this specific population.

Acute primary actinomycosis involving the hard palate of a diabetic patient

Actinomycosis is a relatively rare infection caused by saprophytic bacteria of the oral cavity and gastrointestinal tract that can become pathogenic. The chronic hyperglycemia of diabetes mellitus induces events that promote structural changes in various tissues and are associated with problems in wound healing. This infection remains largely unknown to most clinicians because of its different presentations, and palatal involvement is extremely rare. This report describes the case of a 46-year-old woman who was diagnosed with actinomycosis involving the hard palate. The main clinical, histopathologic, and therapeutic characteristics and differential diagnosis of actinomycosis are reviewed. To date, 3 cases of actinomycosis involving the hard palate have been reported.

Actinomycosis in the mandible: CT and MR findings

SUMMARY

Mandibular actinomycosis is an uncommon disease. We retrospectively reviewed 6 patients with pathologically proven mandibular actinomycosis who underwent both CT and MR imaging to evaluate the characteristic imaging findings. CT results showed an irregularly marginated lesion with increased bone marrow attenuation, osteolysis, and involvement of the skin in all patients. Periosteal reaction and intralesional gas were seen in 4 patients. MR imaging results revealed low signal on T1-weighted and high signal on T2-weighted images of the mandible, and moderate heterogeneous enhancement was seen in all patients who received intravenous contrast. Cervical lymphadenopathy was not observed. Involvement of the masseter, lateral pterygoid, and medial pterygoid muscles was seen in 4 patients, whereas parotid gland and submandibular gland as well as parapharyngeal space involvement were seen in 3 patients. Familiarity with the imaging findings of mandibular actinomycosis may help to diagnosis this entity.

Actinomycotic osteomyelitis of the mandible: an unusual case

BACKGROUND

Actinomycotic osteomyelitis is an infection in soft tissues and/or bones, being associated with trauma or a previous nonspecific infection. This article presents an unusual case of mandibular osteomyelitis caused by Actinomyces.

CASE REPORT

A 19-year-old male patient was referred for endodontic treatment of the lower right first molar about 16 months ago and removal of lower right third molar approximately 3 years before. The panoramic radiography showed change in bone density in the region of ill-defined mandibular angle boundaries, and the computed tomography (CT) showed mixed density image in the mandibular angle, with discreet expansion of cortical vestibular and lingual. Biopsy was performed, and content was aspirated in small quantity and purulent tissue fragments were sent to anatomical-pathological examination. The collected purulent secretion was colored for cytopathologic study, which showed infection by Actinomyces.

DISCUSSION

In this case, the causative agent was Actinomyces, which makes it even more unusual. The origin of the microorganism has not been clearly established; however, the diagnosis allowed long-term treatment with antibiotics, which has resulted in the resolution of the case.

Short‐Term Treatment of Actinomycosis: Two Cases and a Review

Recommendations for prolonged penicillin treatment of actinomycosis date from the early antibiotic era, when patients often presented with neglected, advanced disease and received interrupted therapy at suboptimal dosages. This report describes cases of esophageal and of cervicofacial actinomycosis treated successfully with short-term antibiotic therapy and reviews the literature. Many patients are cured with <6 months of antibiotic therapy. If short-term antibiotic treatment is attempted, the clinical and radiological response should be closely monitored. Cervicofacial actinomycosis is especially responsive to brief courses of antibiotic treatment.

Actinomycosis of the frontal and parotid regions

Cervicofacial actinomycosis still occurs infrequently and should be included in the differential diagnosis of neoplasms, and chronic suppurative and granulomatous lesions of the head and neck region. The authors present two cases of actinomycosis. Patient 1 was a 32-year-old man who was first seen with a firm, suppurative mass at his left frontal region. Patient 2 was a 36-year-old woman with an indurated mass at her left parotid area. Both patients were diagnosed histopathologically with cervicofacial actinomycosis, but each patient had a different clinical course and different response to antimicrobial and surgical treatments.

Opportunistic actinomycosis in osteoradionecrosis of the jaws in patients affected by head and neck cancer: incidence and clinical significance

Actinomycosis is occasionally an opportunistic infection occurrence in patients with osteoradionecrosis (ORN). A retrospective study (1992-97) of 50 patients with ORN of the jaws was done to evaluate the incidence and its clinical significance in the management of ORN. Actinomycosis was diagnosed in 12% of ORN cases. In 36 of the 50 patients including five cases of actinomycosis, the ORN was considered to be resolved after treatment. The median treatment duration of ORN was significantly longer (P<0.007) in patients with actinomycosis (29.7 months) than those without the disease (13.4 months). In conclusion, bone biopsy should be considered in cases of ORN with unsatisfactory response to its specific therapies, aiming to identify possible opportunistic actinomycosis infection.

Actinomycosis of the posterior triangle: a case report and review of the literature

Actinomycosis presents acutely as an abscess, or as a chronic lesion mimicking malignancy, tuberculosis, or aspergillosis. Most disease involves the mouth and its immediate site of lymphatic drainage, the anterior triangle of the neck. We present a case of actinomycosis at the apex of the posterior triangle, suspected of being a malignancy, and discuss the importance of being aware of this as a cause of neck lumps. The diagnosis is usually made late because of the difficulties in culturing the organism, or in identifying characteristic 'sulphur granules' in pus or biopsy specimens. For these reasons, the disease is underdiagnosed. When acute or chronic neck lesions prove difficult to diagnose, microscopy and prolonged anaerobic culture of pus and biopsy specimens should be performed in addition in Ziehl-Neelsen staining, tuberculosis and fungal cultures. The tests should be repeated if negative. Specific treatment requires prolonged courses of antibiotics, despite adequate surgical excision, to prevent relapse.

Actinomycosis of the vallecula: report of a case and review of the literature

A rare case of actinomycosis presenting primarily as a mass in the vallecula is described. The patient was a healthy, 65-year-old Saudi, lady who was not immunocompromised and had no other primary pathology in the oral cavity. The clinical presentation and management of the case are discussed and the relevant literature reviewed.

Cervicofacial actinomycosis presenting as acute upper respiratory tract obstruction

An unusual case of cervicofacial actinomycosis presenting as acute upper airway obstruction and demanding urgent tracheostomy is reported. Diagnosis was established by microscopic examination of the pus and culture of Actinomyces israelii. Repeated surgical drainage of the purulent foci and prolonged treatment with penicillin obtained resolution of the disease. Clinicians dealing with acute head and neck swellings should always consider actinomycosis as a possible diagnosis.

Nonhealing extraction site due to Actinomyces naeslundii in patient with AIDS

There are many oral complications of human immunodeficiency virus infection. One of the infectious sequelae is contamination and delayed healing of the tooth extraction site. We report a case of a nonhealing extraction site in a patient with the acquired immunodeficiency syndrome. Histologic and microbiologic evaluation determined the causative species of bacterium to be Actinomyces naeslundii. Diagnosis and treatment are discussed.