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Abera MT, Dumessa KA, Robele TJ, Tefera TG, Woldeyohannes AM. Dot-in-circle sign in cervical actinomycotic mycetoma: An extremely rare case report. Radiol Case Rep 2024; 19:2160-2167. [PMID: 38515773 PMCID: PMC10950569 DOI: 10.1016/j.radcr.2024.02.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Actinomycosis is an unusual, chronic granulomatous infection caused by Actinomycetes spp. The organism also causes mycetoma, a neglected tropical disease in endemic regions. We present a very uncommon case of extensive actinomycosis of the soft tissues in the neck with perivertebral extension that showed the dot-in-circle sign on magnetic resonance imaging. A 29-year-old male patient presented with progressively enlarging hard posterior neck swelling of 4 years duration. Subsequently, magnetic resonance imaging showed the dot-in-circle sign in an avidly enhancing infiltrative lesion with extensive involvement of the neck and perivertebral soft tissue. The pathologic examination was in line with actinomycosis. The patient responded to high doses of combination parenteral and oral antibiotics.
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Affiliation(s)
- Michael T. Abera
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Kebron A. Dumessa
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Taye J. Robele
- MCM Comprehensive Specialized Hospital, Department of Pathology, Addis Ababa, Ethiopia
| | - Tesfaye G. Tefera
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Abebe M. Woldeyohannes
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
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2
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Jeyasree RM, Muthuraj TS, Usha GK, Raja J. Actinomycosis of periodontium, mimicking gingival enlargement - A case report and its management. J Indian Soc Periodontol 2023; 27:651-654. [PMID: 38434499 PMCID: PMC10906796 DOI: 10.4103/jisp.jisp_63_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 03/05/2024] Open
Abstract
Gingival abscess is a localized, acute inflammatory lesion which is caused by various factors that include microbial plaque infection, foreign body impaction, and trauma. Management includes a simple incision and draining of the purulent exudate along with systemic antibiotics in most of the cases. This article reports a case of a 16-year-old female patient, with a chief complaint of painful and swollen gums in her lower right front tooth region of the jaw along with fever for the past 5 days. Emergency treatment of abscess drainage was done on day 1. On 5th day of review, the case presented with persistent signs of gingival inflammation in relation to 43 to 41. Considering the provisional diagnosis as dentigerous cyst with persistent gingival abscess, definitive treatment was performed by transalveolar extraction of the impacted canine and debridement of the osseous lesion. The histologic analysis of the lesion exhibited foci of eosinophilic coagulum-like areas with epicentric and radiating filamentous appearance at the periphery, which is suggestive of an inflamed dentigerous cyst with actinomycosis infection of periodontium.
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Affiliation(s)
- Renganath Murugan Jeyasree
- Department of Periodontics and Implantology, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India
| | - Thamil Selvan Muthuraj
- Department of Periodontics and Implantology, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India
| | | | - Jacob Raja
- Department of Periodontics and Implantology, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India
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Periapical Actinomycosis: A Rare Subdivision of Cervicofacial Actinomycosis, Review of the Literature, and a Case Report. Case Rep Dent 2022; 2022:7323268. [PMID: 35706907 PMCID: PMC9192198 DOI: 10.1155/2022/7323268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background Periapical actinomycosis, which is reckoned as a subgroup of cervicofacial actinomycosis, is an uncommon, more indolent, less invasive, and limited type of actinomycosis infection. However, it can be considerably underreported due to the low number of periapical surgical specimens that are submitted for histopathological analysis after excision of the lesion with the preliminary diagnosis of typical periapical infections. It is believed that during root canal treatment, the organisms are displaced from the oral cavity into the periapical regions as a result of failure to establish aseptic techniques which can further result in actinomycosis infections and, in rare instances, lead to more severe events and can even be life-threatening. Case Presentation. We intend to report a case of periapical actinomycosis in a 34-year-old female who presented with the chief complaint of pain and slight mobility of the mandibular right second premolar and first molar with no significant issues in the patient's medical history. Initial orthopantomography revealed a uniloculated, radiolucent lesion engulfing the apices of the aforementioned teeth. An incisional biopsy was then obtained which revealed fragments of fibroconnective tissue including few crushed bone particles severely infiltrated by acute inflammatory cells and some foamy macrophages. The suppurative exudate focally surrounds colonies of filamentous bacteria as round basophilic masses with radial configuration resembling “sulfur granules.” Surgical approach consisted of curettage accompanied with peripheral ostectomy and cautious burnishing of the two involved tooth roots. Conclusion This case report emphasizes the importance of aseptic techniques during endodontic and more invasive treatments, as they can cause penetration of Actinomyces into the periapical region which in some cases can lead to more serious complications and even life-threatening situations.
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Choi SG, Lee EY, Lee OJ, Kim S, Kang JY, Lim JS. Prediction models for early diagnosis of actinomycotic osteomyelitis of the jaw using machine learning techniques: a preliminary study. BMC Oral Health 2022; 22:164. [PMID: 35524204 PMCID: PMC9074201 DOI: 10.1186/s12903-022-02201-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to develop and validate five machine learning models designed to predict actinomycotic osteomyelitis of the jaw. Furthermore, this study determined the relative importance of the predictive variables for actinomycotic osteomyelitis of the jaw, which are crucial for clinical decision-making. METHODS A total of 222 patients with osteomyelitis of the jaw were analyzed, and Actinomyces were identified in 70 cases (31.5%). Logistic regression, random forest, support vector machine, artificial neural network, and extreme gradient boosting machine learning methods were used to train the models. The models were subsequently validated using testing datasets. These models were compared with each other and also with single predictors, such as age, using area under the receiver operating characteristic (ROC) curve (AUC). RESULTS The AUC of the machine learning models ranged from 0.81 to 0.88. The performance of the machine learning models, such as random forest, support vector machine and extreme gradient boosting was significantly superior to that of single predictors. Presumed causes, antiresorptive agents, age, malignancy, hypertension, and rheumatoid arthritis were the six features that were identified as relevant predictors. CONCLUSIONS This prediction model would improve the overall patient care by enhancing prognosis counseling and informing treatment decisions for high-risk groups of actinomycotic osteomyelitis of the jaw.
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Affiliation(s)
- Sun-Gyu Choi
- Department of Oral and Maxillofacial Surgery, Hankook General Hospital, Danjae-ro 106, Sangdang-gu, Cheongju, South Korea
| | - Eun-Young Lee
- Department of Oral and Maxillofacial Surgery, College of Medicine and Medical Research Institute, Chungbuk National University, Chungdae-ro 1, Seowon-Gu, Cheongju, Chungbuk, 28644, South Korea
- Department of Oral and Maxillofacial Surgery, Chungbuk National University Hospital, 776, 1Sunhwan-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea
| | - Ok-Jun Lee
- Department of Pathology, Chungbuk National University Hospital, 776, 1Sunhwan-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea
| | - Somi Kim
- Dental Clinic Center, Chungnam National University Hospital, Sejong, South Korea
| | - Ji-Yeon Kang
- Department of Oral and Maxillofacial Surgery, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Jae Seok Lim
- Department of Oral and Maxillofacial Surgery, Chungbuk National University Hospital, 776, 1Sunhwan-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea.
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An Interesting Case Series of Actinomycosis Masquerading as Ovarian Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00619-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Targeted histological evaluation shows high incidence of actinomyces infection in medication-related osteonecrosis of the jaws. Sci Rep 2022; 12:3406. [PMID: 35233034 PMCID: PMC8888741 DOI: 10.1038/s41598-022-07375-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/28/2022] [Indexed: 11/08/2022] Open
Abstract
Medication-Related Osteonecrosis of the Jaws (MRONJ) is a difficult-to-treat complication of the therapy of osteoporosis and some malignancies cured with bisphosphonates and antiresorptive drugs. The pathomechanism is unclear, but there is increasing observation that Actinomyces infection may play a role in its development and progression. The aim of our study was to demonstrate that histological examination using a validated triple staining procedure for Actinomyces bacteria strains can detect a high rate of Actinomyces infection in patient's samples with MRONJ. 112 previously hematoxylin-eosin (HE) stained samples submitted with the clinical diagnosis of MRONJ were re-evaluated histologically using an appropriate triple special staining validated for the identification of Actinomyces infection. During the first evaluation, when pathologists did not specifically look for Actinomyces, only 8.93% of the samples were reported as positive. In contrast, re-evaluation with triple staining provided a yield of 93.7% positive samples, therefore, we suggest the triple special staining to be standard in MRONJ histology evaluation. These results show that if the clinician suspects Actinomyces infection and brings this to the attention of the pathologist, it could significantly increase the number of correct diagnoses. It serves as an aid for clinicians in therapeutic success of MRONJ by selecting a long-term adequate antibiotic medication which is suitable for the elimination of actinomyces infection.
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Yeo JJY, Hopkins ME, Isa A. A de-escalated treatment strategy in the management of paediatric cervicofacial actinomycosis. BMJ Case Rep 2021; 14:e245950. [PMID: 34753731 PMCID: PMC8578952 DOI: 10.1136/bcr-2021-245950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/03/2022] Open
Abstract
Actinomycosis is a rare invasive bacterial disease that is characterised by granulomatous inflammation often mistaken as malignancy. Traditionally, this has been managed with prolonged courses of antibiotics with durations up to 6-12 months. Surgical intervention as an adjuvant treatment has been shown to reduce the length of antibiotic treatment significantly to 4 weeks. We report a case of cervicofacial actinomycosis in a 12-year-old girl who was adequately treated with an 11-day course of antibiotics without surgical intervention and shows no signs of recurrence at 6 months post-treatment.
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Affiliation(s)
- Justin Jui Yuan Yeo
- ENT/Otolaryngology, NHS Lothian, Edinburgh, Scotland, UK
- ENT/Otolaryngology, NHS Highland, Inverness, Scotland, UK
| | | | - Aidah Isa
- ENT Department Raigmore Hospital, NHS Highland, Inverness, Highland, UK
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8
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Cherni I, Hentati H, Hadhri R, Bouguezzi A, Chokri A, Selmi J. [The role of piezosurgery in the treatment of a rare case of superinfected cemento-osseous dysplasia caused by actinomyces: a case report]. Pan Afr Med J 2021; 38:106. [PMID: 33912276 PMCID: PMC8051225 DOI: 10.11604/pamj.2021.38.106.27167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/08/2020] [Indexed: 12/05/2022] Open
Abstract
La dysplasie cémento-osseuse est une lésion fibro-osseuse non néoplasique qui touche l´os alvéolaire. Elle peut se présenter sous l´une des trois formes: périapicale, focale ou floride. Elle est souvent asymptomatique de découverte fortuite lors d´un examen radiologique de routine. Cependant, elle peut devenir symptomatique suite à une surinfection, une fois exposée à la flore bactérienne buccale. Nous rapportons un cas de dysplasie cémento-osseuse floride associée à une actinomycose osseuse chez une femme tunisienne de 53ans. Cette surinfection est rarement évoquée dans la littérature; une recherche sur PubMed utilisant la formule booléenne « cemento-osseous dysplasia AND actinomyces » a révélé un seul article (Smith et al. 2011). Le traitement de l´infection actinomycosique nécessite souvent une antibiothérapie de longue durée parfois associée à une chirurgie de débridement comme dans ce cas où la piézochirurgie a été utilisée dans l´élimination de la dysplasie et de l´os nécrotique.
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Affiliation(s)
- Imen Cherni
- Service de Médecine et Chirurgie Buccales, Clinique Universitaire de Médecine et Chirurgie Dentaire, Monastir, Tunisie.,Laboratoire de Recherche Santé Orale et Réhabilitation Bucco-Faciale LR12ES11, Faculté de Médecine Dentaire de Monastir, Université de Monastir, Monastir, Tunisie
| | - Hajer Hentati
- Service de Médecine et Chirurgie Buccales, Clinique Universitaire de Médecine et Chirurgie Dentaire, Monastir, Tunisie.,Laboratoire de Recherche Santé Orale et Réhabilitation Bucco-Faciale LR12ES11, Faculté de Médecine Dentaire de Monastir, Université de Monastir, Monastir, Tunisie
| | - Rim Hadhri
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Fattouma Bourguiba, Monastir, Tunisie
| | - Adel Bouguezzi
- Service de Médecine et Chirurgie Buccales, Clinique Universitaire de Médecine et Chirurgie Dentaire, Monastir, Tunisie.,Laboratoire de Recherche Santé Orale et Réhabilitation Bucco-Faciale LR12ES11, Faculté de Médecine Dentaire de Monastir, Université de Monastir, Monastir, Tunisie
| | - Abdellatif Chokri
- Service de Médecine et Chirurgie Buccales, Clinique Universitaire de Médecine et Chirurgie Dentaire, Monastir, Tunisie.,Laboratoire de Recherche Santé Orale et Réhabilitation Bucco-Faciale LR12ES11, Faculté de Médecine Dentaire de Monastir, Université de Monastir, Monastir, Tunisie
| | - Jamil Selmi
- Service de Médecine et Chirurgie Buccales, Clinique Universitaire de Médecine et Chirurgie Dentaire, Monastir, Tunisie.,Laboratoire de Recherche Santé Orale et Réhabilitation Bucco-Faciale LR12ES11, Faculté de Médecine Dentaire de Monastir, Université de Monastir, Monastir, Tunisie
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9
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Vandeplas C, Politis C, Van Eldere J, Hauben E. Cervicofacial actinomycosis following third molar removal: case-series and review. Oral Maxillofac Surg 2020; 25:119-125. [PMID: 32820354 DOI: 10.1007/s10006-020-00896-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Cedric Vandeplas
- Faculty of Medicine, KU Leuven, Sint-Jansbergsesteenweg 3, box 0201(D), 3001, Leuven, Belgium.
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Johan Van Eldere
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Esther Hauben
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, Translational Cell and Tissue Research, Faculty of Medicine, KU Leuven, Leuven, Belgium
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10
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Surgical debridement as a treatment strategy for cervicofacial actinomycosis-Literature review and case report. Int J Surg Case Rep 2020; 73:22-26. [PMID: 32629216 PMCID: PMC7339033 DOI: 10.1016/j.ijscr.2020.06.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/09/2020] [Accepted: 06/14/2020] [Indexed: 11/21/2022] Open
Abstract
Antibiotic therapy and surgical debridement as a form of treatment of actinomycosis. Actinomycosis does not respond well antibiotic therapy before curettage. Debridement proved to be important for the reduction of antibiotic therapy time.
Introduction Actinomycosis is a rare chronic disease caused by bacterial infection of the Actinomyces genus. Standard treatment usually involves drainage and high doses of antibiotic therapy, which takes between 6–12 weeks for complete resolution. Presentation of case A 57-year-old male was admitted with soft tissue infection-like inflammation of the parasymphysis region, further diagnosed as cervicofacial actinomycosis. Treatment comprised of surgical debridement associated with antibiotic therapy, which took only 4 weeks for complete healing. Discussion Although surgical debridement isn’t part of the standard treatment, it has shown to be an interesting tool for promoting quick healing and infection control. Conclusion The authors reported a successfully treatment of cervicofacial actinomycosis using surgical debridement as an adjuvant therapy, promoting faster healing, reducing antibiotic therapy time, costs and risks of bacterial resistance, which must be considered as an alternative approach in similar cases.
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11
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Cho JJ, Shupak RP. Cervicofacial actinomycosis of the mandible in a paediatric patient. BMJ Case Rep 2020; 13:13/5/e233681. [PMID: 32467116 DOI: 10.1136/bcr-2019-233681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cervicofacial actinomycosis remains a rare pathogenic finding in the paediatric population. Diagnosis is challenging, as findings are often non-specific and Actinomyces species are generally difficult to culture. Treatment is a prolonged course of antibiotics, either intravenous and oral, often combined with a surgical procedure to remove the lesion. This patient had non-specific intermittent left mandibular pain for 8 months that was eventually attributed to an Actinomyces odontolyticus infection in the mandible. Diagnosis required incisional biopsy, and treatment involved 12 months of oral antibiotics.
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Affiliation(s)
- Jason J Cho
- Oral and Maxillofacial Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raymond Patrick Shupak
- Oral and Maxillofacial Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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12
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Sibanda L, Wates E, Higginson J. Bony cystic lesion with associated submandibular lymphadenopathy on a background of breast carcinoma: an unexpected case of cervicofacial actinomycosis. BMJ Case Rep 2020; 13:13/4/e232850. [PMID: 32265208 DOI: 10.1136/bcr-2019-232850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Actinomycosis is an uncommon, chronic suppurative granulomatous infection and needs to be considered as a differential diagnosis. A 56-year-old woman with a background of type 2 diabetes mellitus and breast carcinoma was referred to the Oral and Maxillofacial Surgery 2-week wait clinic, regarding a tender sublingual mass and firm erythematous swelling in the right submandibular and submental region. This was slowly progressive and had not responded to oral co-amoxiclav. An orthopantomogram showed a well-defined radiolucency and smaller radiolucent lesions throughout the edentulous right body of the mandible. A contrast-enhanced CT confirmed a right submandibular abscess communicating with cavitating lesions. The differentials included osteomyelitis, bony metastases, multiple myeloma or other cystic lesions. The patient underwent incision and drainage of the abscess, alongside biopsies, and intravenous co-amoxiclav was given. Microbiology cultures confirmed the presence of Actinomyces israelii and a diagnosis of cervicofacial actinomycosis with mandibular osteomyelitis. The patient was successfully treated with prolonged antibiotics.
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Affiliation(s)
- Lwazi Sibanda
- Department of Oral and Maxillofacial Surgery, Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK
| | - Emma Wates
- University of Bristol Medical School, Bristol, UK
| | - James Higginson
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
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13
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Karanfilian KM, Valentin MN, Kapila R, Bhate C, Fatahzadeh M, Micali G, Schwartz RA. Cervicofacial actinomycosis. Int J Dermatol 2020; 59:1185-1190. [PMID: 32162331 DOI: 10.1111/ijd.14833] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/04/2020] [Accepted: 02/10/2020] [Indexed: 11/28/2022]
Abstract
Cervicofacial actinomycosis is an uncommon, chronic, suppurative, and granulomatous bacterial infection. It is often of dental origin and tends to mimic other dental infections, granulomatous disorders, and cancers. The initial diagnostic workup, predicated upon imaging and tissue biopsies, is frequently nonspecific. A definitive diagnosis is usually rendered only after surgical excision and histologic examination of the cervicofacial mass. We propose a classification of three stages: localized infection without sinus involvement, localized infection with sinus involvement, and disseminated infection, to facilitate recognition, diagnosis, and early aggressive treatment. Untreated infection may be life-threatening. Therapy may require long-term antibiotics; however, many cases may also necessitate complete surgical excision.
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Affiliation(s)
| | | | - Rajendra Kapila
- Infectious Disease, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Chinmoy Bhate
- Dermatology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Giuseppe Micali
- Dermatology, University of Catania School of Medicine, Catania, Italy
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14
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McCann A, Alvi SA, Newman J, Kakarala K, Staecker H, Chiu A, Villwock JA. Atypical Form of Cervicofacial Actinomycosis Involving the Skull Base and Temporal Bone. Ann Otol Rhinol Laryngol 2018; 128:152-156. [PMID: 30371104 DOI: 10.1177/0003489418808541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Cervicofacial actinomycosis is an uncommon indolent infection caused by Actinomyces spp that typically affects individuals with innate or adaptive immunodeficiencies. Soft tissues of the face and neck are most commonly involved. Actinomyces osteomyelitis is uncommon; involvement of the skull base and temporal bone is exceedingly rare. The authors present a unique case of refractory cervicofacial actinomycosis with development of skull base and temporal bone osteomyelitis in an otherwise healthy individual. METHODS: Case report with literature review. RESULTS: A 69-year-old man presented with a soft tissue infection, culture positive for Actinomyces, over the right maxilla. Previous unsuccessful treatment included local debridement and 6 weeks of intravenous ceftriaxone. He was subsequently treated with conservative debridement and a prolonged course of intravenous followed by oral antibiotic. However, he eventually required multiple procedures, including maxillectomy, pterygopalatine fossa debridement, and a radical mastoidectomy to clear his disease. Postoperatively he was gradually transitioned off intravenous antibiotics. CONCLUSIONS: Cervicofacial actinomycosis involves soft tissue surrounding the facial skeleton and oral cavity and is typically associated with a history of mucosal trauma, surgery, or immunodeficiency. The patient was appropriately treated but experienced disease progression and escalation of therapy. Although actinomycosis is typically not an aggressive bacterial infection, this case illustrates the need for prompt recognition of persistent disease and earlier surgical intervention in cases of recalcitrant cervicofacial actinomycosis. Chronic actinomycosis has the potential for significant morbidity.
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Affiliation(s)
- Adam McCann
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, KS, USA.,2 University of Kansas School of Medicine, Kansas City, KS, USA
| | - Sameer A Alvi
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, KS, USA
| | - Jessica Newman
- 3 Division of Infectious Diseases, University of Kansas Health System, Kansas City, KS, USA
| | - Kiran Kakarala
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, KS, USA
| | - Hinrich Staecker
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, KS, USA
| | - Alexander Chiu
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, KS, USA
| | - Jennifer A Villwock
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kansas Health System, Kansas City, KS, USA
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15
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Yamamoto S, Takegawa H, Taniike N, Takenobu T. Actinomycotic Osteomyelitis of the Mandible Diagnosed Using Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry: A Case Report. J Oral Maxillofac Surg 2018; 76:2122-2130. [PMID: 29782813 DOI: 10.1016/j.joms.2018.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 02/01/2023]
Abstract
Actinomycosis is a rare, chronic, slowly progressive granulomatous disease caused by filamentous gram-positive anaerobic bacteria from the Actinomycetaceae family (genus Actinomyces). It has become a rare condition because of the widespread use of antibiotics. When clinical symptoms are not typical, diagnosis of this condition becomes difficult. This report describes a case involving an 82-year-old woman who was diagnosed with actinomycotic osteomyelitis of the mandible using matrix assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). The patient was referred to the authors' department with chief complaints of swelling, multiple fistulae in the left preauricular region, and trismus. The authors performed fine-needle aspiration microbiology (FNAM) and identified Actinomyces oris using MALDI-TOF MS. A diagnosis of actinomycotic osteomyelitis of the mandible was made and the patient was treated with minocycline and extraction of the culprit tooth. The findings from this case have 2 important implications. First, for patients with clinically suspected actinomycosis, bacteriologic examinations should include not only surface swab tests but also FNAM; moreover, communication with the laboratory medical technologist is important to improve detection of the causative organisms. Second, MALDI-TOF MS could be an effective tool for improving the diagnosis and treatment outcomes of actinomycosis.
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Affiliation(s)
- Shinsuke Yamamoto
- Head Physician, Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Hiroshi Takegawa
- Chief Examiner, Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Naoki Taniike
- Head Physician, Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshihiko Takenobu
- Department Head, Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Sezer B, Akdeniz BG, Günbay S, Hilmioğlu-Polat S, Başdemir G. Actinomycosis osteomyelitis of the jaws: Report of four cases and a review of the literature. J Dent Sci 2017; 12:301-307. [PMID: 30895066 PMCID: PMC6400081 DOI: 10.1016/j.jds.2013.02.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 02/01/2012] [Indexed: 10/26/2022] Open
Abstract
Actinomycosis osteomyelitis of the jaw bones, particularly in the maxilla, is an extremely rare disease. This report presents two cases of maxillary and two cases of mandibular actinomycosis osteomyelitis, with the diagnosis particularly based on histological procedures. The highly diversified pathogenicity of the phenomenon and the absence of solid diagnostic criteria are discussed. Laboratory challenges are emphasized, and a comprehensive overview of the entity including treatment alternatives is given along with a review of the relevant literature.
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Affiliation(s)
- Bahar Sezer
- Department of Oral Surgery, School of Dentistry, Ege University, Izmir, Turkey
| | - B. Güniz Akdeniz
- Department of Oral Diagnosis and Radiology, School of Dentistry, Ege University, Izmir, Turkey
| | - Sevtap Günbay
- Department of Oral Surgery, School of Dentistry, Ege University, Izmir, Turkey
| | | | - Gülçin Başdemir
- Department of Pathology, School of Medicine, Ege University, Izmir, Turkey
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Akhtar M, Zade MP, Shahane PL, Bangde AP, Soitkar SM. Scalp actinomycosis presenting as soft tissue tumour: A case report with literature review. Int J Surg Case Rep 2015; 16:99-101. [PMID: 26439419 PMCID: PMC4643463 DOI: 10.1016/j.ijscr.2015.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 11/27/2022] Open
Abstract
Cutaneous actinomycosis presenting as tumoriform mass is rare. Histopathological confirmation is mandatory with visualization of sulfur granules which is seen only in 25% cases and can be missed in small biopsy specimen. Management of a classical case of cutaneous actinomycosis is high dose IV antibiotics for 4–6 weeks followed by oral penicillin or amoxycillin for 6–12 months. Surgical resection is a useful adjuvant therapy specially in large, disfiguring masses not responding to treatment and excisional biopsy is helpful in establishing histopathological confirmation.
Introduction Actinomycosis is a rare subacute or chronic bacterial infection caused by Gram positive, anaerobic or microaerophilic bacilli. It is characterized by suppuration, abscess formation, tissue fibrosis, draining sinuses & rarely as a soft tissue mass mimicking a tumor. Case report A 16 year old boy sustained a trauma over right forehead & wound after which patient presented with swelling over right forehead which was excised and was histopathologically reported as angiomatous lesion. Patient presented with recurrent swelling with ulceration over the same site. CT scan showed soft tissue mass with periosteal reaction of right frontal bone. Wide local excision with removal of periosteum was carried out. Raw area was covered with rotational scalp flap. Histopathology of the excised specimen showed features of actinomycosis. Discussion Cutaneous actinomycosis presenting as pseudocarcinomatous or sarcomatous mass is rare. Trauma is a common preceding event which was observed in present case. Histopathological confirmation is mandatory with visualization of sulfur granules. It is managed by high dose IV antibiotics. Surgical resection is a useful adjuvant therapy specially in large, disfiguring masses not responding to medical treatment and where excisional biopsy is helpful in establishing the diagnosis surgical excision alone is not curative, post operative long term antibiotics are adjuvant therapy to avoid recurrence. Conclusion Actinomycosis of scalp skin is a rare entity and tumor like presentation is still uncommon. Lesions not resolving with routine antibiotics therapy should be suspected clinically as actinomycosis and treated with high dose antibiotics as histopathology from small biopsy is unreliable.
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Affiliation(s)
- Murtaza Akhtar
- Dept. of Surgery, NKP Salve Institute Of Medical Sciences, Digdoh Hills, Hingna Road, Nagpur 440019, India.
| | - Manish P Zade
- Dept. of Plastic Surgery, NKP Salve Institute Of Medical Sciences, Digdoh Hills, Hingna Road, Nagpur 440019, India
| | - Pawan L Shahane
- Dept. of Plastic Surgery, NKP Salve Institute Of Medical Sciences, Digdoh Hills, Hingna Road, Nagpur 440019, India
| | - Akshay P Bangde
- Dept. of Surgery, NKP Salve Institute Of Medical Sciences, Digdoh Hills, Hingna Road, Nagpur 440019, India
| | - Sagar M Soitkar
- Dept. of Surgery, NKP Salve Institute Of Medical Sciences, Digdoh Hills, Hingna Road, Nagpur 440019, India
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Oukessou Y, Ait Elkerdoudi M, Abada RL, Mahtar M. Complicated actinomycosis of the temporal bone: A historical case report. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:227-9. [PMID: 25825360 DOI: 10.1016/j.anorl.2015.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Actinomycosis is a chronic infection caused by anaerobic Gram-positive bacteria belonging to the Actinomyces family. The zones of predilection of this infection are mainly the head, neck and abdominal regions. CASE REPORT We report the case of a 30-year-old man admitted for aggressive right oto-mastoiditis complicated by facial nerve palsy and sensorineural hearing loss. CT scan demonstrated extensive destruction of the temporal bone. The patient underwent radical mastoidectomy followed by long-term antibiotic therapy. DISCUSSION Its non-specific symptoms and atypical course, combined with difficult isolation of the causative agent, make actinomycosis a difficult infection to diagnose. Actinomycosis very rarely involves the temporal region, as fewer than 30 cases have been reported in the literature. Treatment of this form of actinomycosis is based on surgery and prolonged antibiotic therapy. Surgical treatment is designed to reduce the bacterial load by mechanical debridement and create aerobic conditions. CONCLUSION Compared to other cases reported in the literature, the case of temporal actinomycosis reported here was distinguished by its highly aggressive nature. Temporal actinomycosis should be suspected in the context of chronic otitis media with an atypical course. Treatment is based on a combination of surgery and antibiotics.
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Affiliation(s)
- Y Oukessou
- Department of otorhinolaryngology, 20 August 1953 Hospital, 4, rue Lahcen El Arjoune-ex Dalton, quartier des hôpitaux, BP 20360, Casablanca, Morocco.
| | - M Ait Elkerdoudi
- Department of otorhinolaryngology, 20 August 1953 Hospital, 4, rue Lahcen El Arjoune-ex Dalton, quartier des hôpitaux, BP 20360, Casablanca, Morocco
| | - R L Abada
- Department of otorhinolaryngology, 20 August 1953 Hospital, 4, rue Lahcen El Arjoune-ex Dalton, quartier des hôpitaux, BP 20360, Casablanca, Morocco
| | - M Mahtar
- Department of otorhinolaryngology, 20 August 1953 Hospital, 4, rue Lahcen El Arjoune-ex Dalton, quartier des hôpitaux, BP 20360, Casablanca, Morocco
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Laios A, Terekh I, Majd HS, Pathiraja P, Manek S, Haldar K. Differentiating pelvic actinomycosis from advanced ovarian cancer: a report of two cases, management reflections and literature review. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2014; 1:5. [PMID: 27231558 PMCID: PMC4877746 DOI: 10.1186/2053-6844-1-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/02/2014] [Indexed: 11/18/2022]
Abstract
Pelvic actinomycosis comprises a rare, subacute to chronic bacterial infection characterised by suppurative and granulomatous inflammation. Diagnosis is difficult as it may simulate pelvic malignancies. Laboratory and radiological findings are non-specific. We reported on 2 cases of pelvic actinomycosis mimicking ovarian malignancy with different management approaches that lead to opposite outcomes. We reviewed the literature on pelvic actinomycosis imitating ovarian cancer with a focus on its surgical management. Despite agreement on the duration of antibiotic therapy following surgical management, consensus regarding surgical approach was rather equivocal. We concluded that pelvic actinomycosis should be strongly suspected in women with presumed ovarian cancer of atypical presentation and a history of intrauterine devices (IUD).
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Affiliation(s)
- Alex Laios
- Gynaecologic Oncology Unit, Churchill Hospital, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Iryna Terekh
- Gynaecologic Oncology Unit, Churchill Hospital, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Hooman Soleymani Majd
- Gynaecologic Oncology Unit, Churchill Hospital, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Pubudu Pathiraja
- Gynaecologic Oncology Unit, Churchill Hospital, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Sanjiv Manek
- Department of Cellular Pathology, Oxford University Hospitals, Oxford, UK
| | - Krishnayan Haldar
- Gynaecologic Oncology Unit, Churchill Hospital, Oxford University Hospitals, NHS Trust, Oxford, UK
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Lo Muzio L, Favia G, Lacaita M, De Lillo A, Scully C, Napoli A, Lo Russo L, Maiorano E. The contribution of histopathological examination to the diagnosis of cervico-facial actinomycosis: a retrospective analysis of 68 cases. Eur J Clin Microbiol Infect Dis 2014; 33:1915-8. [DOI: 10.1007/s10096-014-2165-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
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Sasaki Y, Kaneda T, Uyeda JW, Okada H, Sekiya K, Suemitsu M, Sakai O. Actinomycosis in the mandible: CT and MR findings. AJNR Am J Neuroradiol 2013; 35:390-4. [PMID: 23928143 DOI: 10.3174/ajnr.a3673] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
- Y Sasaki
- From the Departments of Radiology (Y.S., T.K., K.S.)
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Moghimi M, Salentijn E, Debets-Ossenkop Y, Karagozoglu KH, Forouzanfar T. Treatment of cervicofacial actinomycosis: a report of 19 cases and review of literature. Med Oral Patol Oral Cir Bucal 2013; 18:e627-32. [PMID: 23722146 PMCID: PMC3731091 DOI: 10.4317/medoral.19124] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 03/14/2013] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Meshkan Moghimi
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherland.
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Anavi-Lev K, Anavi Y, Chaushu G, Alon DM, Gal G, Kaplan I. Bisphosphonate related osteonecrosis of the jaws: clinico-pathological investigation and histomorphometric analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:660-6. [DOI: 10.1016/j.oooo.2013.03.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 02/06/2013] [Accepted: 03/03/2013] [Indexed: 11/30/2022]
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Figueiredo LMG, Trindade SC, Sarmento VA, de Oliveira TFL, Muniz WR, Valente RODH. Actinomycotic osteomyelitis of the mandible: an unusual case. Oral Maxillofac Surg 2012; 17:299-302. [PMID: 23239430 DOI: 10.1007/s10006-012-0381-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 11/29/2012] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Leonardo Morais Godoy Figueiredo
- Biochemistry Department, Institute of Health Sciences, Federal University of Bahia, Rua Francisco Martins Duarte, 572, Centro, Juazeiro-Bahia, 48 904-070, Brazil,
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Actinomycosis Is an Important Diagnosis Consideration in the Presentation of a Perimandibular Mass. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2012. [DOI: 10.1097/ipc.0b013e318255d571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Actinomycotic Brain Abscess and Subdural Empyema of Odontogenic Origin: Case Report and Review of the Literature. J Oral Maxillofac Surg 2012; 70:e210-3. [DOI: 10.1016/j.joms.2011.09.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 09/21/2011] [Accepted: 09/26/2011] [Indexed: 11/24/2022]
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Actinomycosis: report of a case with a persistent extraoral sinus tract. ACTA ACUST UNITED AC 2011; 112:e121-3. [DOI: 10.1016/j.tripleo.2011.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/08/2011] [Accepted: 06/14/2011] [Indexed: 10/17/2022]
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Identification and Treatment of Bisphosphonate-Associated Actinomycotic Osteonecrosis of the Jaws. IMPLANT DENT 2011; 20:331-6. [DOI: 10.1097/id.0b013e3182310f03] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Cervicofacial actinomycosis is an uncommon infection and in most cases odontogenic in origin. Pharyngeal and/or laryngeal lesions, usually occurring secondary to mucosal trauma, are very rare and may mimic a malignant tumor. In such cases, which represent less than 1% of all cases, the differential diagnosis with upper aerodigestive tract malignancy remains challenging. We report a case of actinomycosis in a 56-year-old male patient who presented with an extensive, centrally necrotic mass in the oropharynx, hypopharynx and larynx region suspected to be a tumor. The lesion was diagnosed 6 months following accidental ingestion of an ear of corn and ultimately proved to be cervicofacial actinomycosis. The clinical and pathological features and current aspects of the diagnosis and treatment of cervicofacial actinomycosis are discussed.
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Abstract
Nasopharyngeal actinomycosis is a rarely encountered bacterial infection which usually occurs after nasal trauma or surgery. In some clinical cases, nasopharyngeal actinomycosis has appeared in patients without prior trauma, making diagnosis difficult. Here we present three such cases successfully treated with appropriate dosages of penicillin. One 16-year-old boy with no previous medical antecedents showed an important thickening of the posterior wall of the nasopharynx. A similar nasopharyngeal thickening was found in a 42-year-old woman exhibiting poor dental hygiene. In another 42-year-old woman, nasopharyngeal inflammation was accompanied by multiple right lymphoadenopathies. Like the first two patients, the woman had no prior trauma but did exhibit poor dental hygiene and teeth rottenness. In all three patients, actinomycosis diagnosis was confirmed by anaerobic microbial culturing of the biopsy specimen. Although diagnosis is delayed in patients with no prior trauma, treatment with antibiotics has greatly improved the prognosis for all forms of actinomycosis, and neither death nor deformity is common.
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Fishbone-Associated Actinomycosis of the Anterior Cervical Space: A Diagnostic Dilemma. Case Rep Med 2010; 2010:282167. [PMID: 21113303 PMCID: PMC2990022 DOI: 10.1155/2010/282167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 10/28/2010] [Accepted: 10/31/2010] [Indexed: 11/23/2022] Open
Abstract
We report the imaging and pathologic findings of fishbone-associated actinomycosis of the anterior cervical space in a 57-year-old man, misdiagnosed preoperatively as a malignancy originating from thyroglossal duct cyst. CT revealed an enhancing mass containing a small abscess pocket and two sharp linear calcifications within it, which infiltrated into the strap muscle. Pathologic examination demonstrated two fishbones within the actinomycotic abscess. Fishbone-associated actinomycosis should be considered when a cervical mass contains sharp linear calcifications.
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Kaplan I, Anavi K, Anavi Y, Calderon S, Schwartz-Arad D, Teicher S, Hirshberg A. The clinical spectrum of Actinomyces-associated lesions of the oral mucosa and jawbones: correlations with histomorphometric analysis. ACTA ACUST UNITED AC 2009; 108:738-46. [PMID: 19748292 DOI: 10.1016/j.tripleo.2009.06.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 05/02/2009] [Accepted: 06/26/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To characterize the clinical manifestations of Actinomyces-associated lesions of the oral mucosa and jawbones, and to correlate the clinical course and treatment requirements with the findings of histomorphometric analysis. STUDY DESIGN The study was a 10-year retrospective analysis of archived cases with microscopic identification of Actinomyces infection. Actinomyces colonies were identified, using hematoxylin-eosin, Gram, and periodic acid-Schiff stains, exhibiting filamentous morphology with color variation between center and periphery. Only colonies with adjacent tissue reaction (inflammation, fibrosis) were analyzed. Actinomyces density (AD) was calculated by dividing total number of colonies by tissue surface, Actinomyces relative surface (ARS) was calculated by dividing total bacterial surface by tissue surface. RESULTS The study included 106 cases (48 male, 58 female; aged 13-84 years, mean 50.5 years). Cases presented a wide clinical spectrum, involving jawbone and/or oral soft tissues. Cases included osteomyelitis associated with bisphosphonates, osteoradionecrosis, osteomyelitis unrelated to radiation or bisphosphonates, periapical lesions, odontogenic cysts, periimplantitis, and lesion mimicking periodontal disease. The AD correlated with median length of antibiotic treatment (R = 0.284; P = .028). CONCLUSIONS Because we were able to identify 106 such cases, the results indicate that Actinomyces-associated lesions may not be as rare as would be expected from the relatively low number of cases in the literature. Actinomyces-associated lesions presented in a wide spectrum of clinical settings and a variety of contributing factors. Quantitative analysis of the number of bacterial colonies (representing bacterial load) could help in evaluating the aggressive potential of the lesion and help in treatment planning.
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Affiliation(s)
- Ilana Kaplan
- Institute of Pathology, Rabin Medical Center, Petah-Tiqva, Israel, and Sackler School of Medicine, Tel-Aviv University, Israel.
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Woo HJ, Bae CH, Song SY, Choi YS, Kim YD. Actinomycosis of the paranasal sinus. Otolaryngol Head Neck Surg 2008; 139:460-2. [PMID: 18722231 DOI: 10.1016/j.otohns.2008.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 06/03/2008] [Accepted: 06/03/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report clinical characteristics and treatment outcomes of actinomycosis of the paranasal sinus. STUDY DESIGN Retrospective review. SUBJECTS AND METHODS The medical records of six patients with actinomycosis of the paranasal sinus between 1998 and 2006 were analyzed. RESULTS There were no immunocompromised patients and all lesions were unilateral. Only one patient had a history of an oroantral fistula due to facial trauma. On CT scan, all patients had unilateral opacification of the maxillary sinus with focal calcified densities. All cases underwent endoscopic sinus surgery followed by relatively short-term antibiotic administration, and there was no recurrence. CONCLUSIONS Chronic unilateral maxillary sinusitis, a calcified density in the involved sinus on radiological studies, and unresponsiveness to antibiotics are characteristics of actinomycotic sinusitis. Surgical removal of the involved tissues and the restoration of sinus ventilation seem to be important factors for treating the disease.
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Affiliation(s)
- Hyun-Jae Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam University, Nam-Gu, Daegu, Republic of Korea
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Abstract
A 39-year-old Samoan man presented to the emergency department with fever, progressive weakness, and left flank pain of 1-month duration. For several months, he had also experienced progressive weight loss. There was no history of recent trauma, and he was not taking any medication. His medical history was notable for a large left groin abscess and left lower lobe pneumonia of unknown cause 1 year prior to the current admission. Furthermore, he had undergone exploratory laparotomy and gastric surgery for peptic ulcer disease approximately 10 years ago. Physical examination findings were positive for a tender firm mass in the left flank with no associated skin changes. Laboratory findings revealed an elevated white blood cell count of 18 x 10(9)/L. The urine cultures were negative. A computed tomographic (CT) image obtained 1 year prior to the current admission was unremarkable. CT of the abdomen and pelvis (section thickness, 5 mm) was performed after ingestion of 900 mL of 2% diatrizoate meglumine and diatrizoate sodium (Gastrografin; Bracco Diagnostics, Princeton, NJ). A 150-mL dose of iohexol (300 mg of iodine per milliliter) (Omnipaque; Nycomed, New York, NY) was administered intravenously at a rate of 4 mL/sec with a 70-second scan delay. Unenhanced CT images (not shown) did not reveal any areas of high attenuation.
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Affiliation(s)
- Panuch Yenarkarn
- Department of Radiology, San Francisco General Hospital, University of California San Francisco Medical School, Box 0628, San Francisco, CA 94143-0628, USA
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Iida T, Takushima A, Asato H, Harii K. Extensive actinomycosis of the face requiring radical resection and facial nerve reconstruction. J Plast Reconstr Aesthet Surg 2006; 59:1372-6. [PMID: 17113522 DOI: 10.1016/j.bjps.2006.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2005] [Accepted: 01/18/2006] [Indexed: 11/29/2022]
Abstract
We present a case of extensive actinomycosis of the face, which appeared after dental surgery. Since antibiotic therapy was ineffective, the lesion was radically resected, and the skin, soft tissue and facial nerve were reconstructed using a free rectus abdominis musculocutaneous flap and simultaneously harvested intercostal nerves. Successful reanimation of the face was achieved 14 months postoperatively.
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Affiliation(s)
- Takuya Iida
- Department of Plastic and Reconstructive Surgery, Kyorin University, School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 182-8611 Japan.
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Takasaki K, Kitaoka K, Kaieda S, Hayashi T, Abe K, Takahashi H. A case of actinomycosis causing unilateral tonsillar hypertrophy. Acta Otolaryngol 2006; 126:1001-4. [PMID: 16864502 DOI: 10.1080/00016480600590604] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a case of unusual presentation of actinomycosis in the tonsil causing massive unilateral enlargement in a 78-year-old female. To our knowledge, only three cases of actinomycosis causing unilateral tonsillar enlargement have been published previously. Since this anaerobic organism is difficult to culture, the diagnosis is made by observing its associated sulfur granules in the biopsy specimen. In the present case, treatment consisting of tonsillectomy and antibiotic therapy (penicillin) for several days produced a good prognosis.
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Affiliation(s)
- Kenji Takasaki
- Division of Otorhinolaryngology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
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Kalioras V, Thanos L, Mylona S, Pomoni M, Batakis N. Scalp actinomycosis mimicking soft tissue mass. Dentomaxillofac Radiol 2006; 35:117-8. [PMID: 16549439 DOI: 10.1259/dmfr/61817095] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Actinomycosis is a rare, subacute or chronic bacterial infection, characterized by localized swelling with suppuration, abscess formation, tissue fibrosis, and draining sinuses. It is caused by gram-positive, pleomorphic non-spore-forming, non-acid-fast anaerobic or microaerophilic bacilli of the genus Actinomyces. In humans, actinomyces are often normally found in the oral cavity, the gastrointestinal tract and the female genital tract. Infections of the oral and cervicofacial regions are the most commonly reported cases. We present a case of subcutaneous actinomycosis, localized at the upper segment of the posterior neck space, with scalp involvement.
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Affiliation(s)
- V Kalioras
- Radiology Department, Korgialeneio-Benakeio, Red-Cross Hospital of Athens, Athens, Greece
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Cheng K, Kinninmonth A, Tansey P. An Unusual Presentation of Metastatic Actinomycosis: A case report. Scott Med J 2006. [DOI: 10.1258/rsmsmj.51.2.54g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of a 49-year-old man presenting with a history of painful swollen leg, due to a solitary metastatic deposit in the tibia. After investigation, it was found to be secondary to infection with Actinomycosis israelii, which is normally a commensal of the oral and buccal cavity. Actinomycosis israelii is the predominant organism causing infectious disease in humans3 and although soft tissue infections are well documented, osseous involvement is very rare.
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Affiliation(s)
- Kenneth Cheng
- Department of Orthopaedic & Musculoskeletal Trauma, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF
| | | | - Patrick Tansey
- Department of Orthopaedic & Musculoskeletal Trauma, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF
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Damante JH, Sant'Ana E, Soares CT, Moreira CR. Chronic sinusitis unresponsive to medical therapy: a case of maxillary sinus actinomycosis focusing on computed tomography findings. Dentomaxillofac Radiol 2006; 35:213-6. [PMID: 16618858 DOI: 10.1259/dmfr/52799578] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Actinomycosis of the paranasal sinuses is a rare occurrence and its clinical presentation does not suggest a specific diagnosis. Therefore, actinomycosis should be included in the differential diagnosis of neoplasms and granulomatous lesions of the head and neck region. However, the differentiation from a malignant neoplasm is not easy because the radiological findings are frequently similar and positive cultures are difficult to obtain. This report highlights the clinical progress of paranasal actinomycosis associated with some computed tomography findings that can be extremely helpful in the correct diagnosis. The characteristics of the disease are described and the relevant literature is discussed.
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Affiliation(s)
- J H Damante
- Al. Dr. Octávio Pinheiro Brisolla, 9-75--Faculdade de Odontologia de Bauru--Departamento de Estomatologia, Vila Universitária--Bauru--SP, Cep: 17012-901, Brazil.
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Loppin M, Adamski H, Larrègue M, Cadre B, Godey B, Chevrant-Breton J. Ulcérations cervicofaciales liées à un foyer infectieux dentaire chez l'enfant. Arch Pediatr 2006; 13:149-51. [PMID: 16337113 DOI: 10.1016/j.arcped.2005.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Accepted: 10/21/2005] [Indexed: 11/20/2022]
Abstract
UNLABELLED In children, chronic cervicofacial ulceration related to dental infection is rare. Thus the diagnosis is often late and the treatment is consequently delayed. We report 2 new cases. CASES REPORT A 13-year-old boy presented with a 1-year history of chronic and suppurative ulceration on the right cheek. Culture was positive for actinomycetes. In spite of a prolonged and miscellaneous antibiotherapy, the lesion recured. The ulceration healed after the eradication of infection on a right superior molar. A 12-year-old girl presented with a right sub-mandibular ulceration, which appeared 3 months before. This lesion did not respond to penicillinotherapy given during 3 months. An infection on a right inferior molar was diagnosed on a tomodensitometry. 3 months after the tooth extraction, the ulceration healed without recurrence. CONCLUSION These cases emphasize the interest to look for a dental infection at the origin of chronic cervicofacial lesion.
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Affiliation(s)
- M Loppin
- Service de dermatologie CHU Pontchaillou, rue H-Le-Guilloux, 35033 Rennes, France
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Oysu C, Uslu C, Guclu O, Oysu A. Actinomycotic abscess of the thyroid gland in an infant. Int J Pediatr Otorhinolaryngol 2005; 69:701-3. [PMID: 15850692 DOI: 10.1016/j.ijporl.2004.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2004] [Revised: 12/06/2004] [Accepted: 12/06/2004] [Indexed: 10/25/2022]
Abstract
Actinomycotic abscess of the thyroid gland is rare especially in childhood. In this article, we report the second pediatric case in literature, at age of 18 months. Although spread of actinomycotic infection to the thyroid gland from upper aerodigestive tract by preformed pathways such as piriform sinus fistula seems rational, it was demonstrated neither in current nor in previous cases. Therefore, further work-up such as barium swallow, which is onerous to perform in a child may be reserved for recurrent cases.
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Affiliation(s)
- Cagatay Oysu
- Haydarpasa Numune Hospital for Research and Education, Department of Otolaryngology, Istanbul, Turkey.
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Ozcan C, Talas D, Görür K, Aydin O, Yildiz A. Actinomycosis of the middle turbinate: an unusual cause of nasal obstruction. Eur Arch Otorhinolaryngol 2004; 262:412-5. [PMID: 15549341 DOI: 10.1007/s00405-004-0832-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Accepted: 06/17/2004] [Indexed: 10/26/2022]
Abstract
Actinomycosis is a rare chronic infectious disease caused by Actinomyces israelii, which is an anaerobic filamentous, gram-positive saprophyte organism of the oral cavity. Historically, these bacteria were known as fungi because of their light microscopic appearance. Actinomycosis consists of three different forms: cervico-facial (the most common form), abdominal and pulmonothoracic. It commonly involves the head and neck region including the mandible, paranasal sinuses, lacrimal gland, parotid gland and orbit. Poor oral hygiene and dental diseases have been known to be the source of actinomycosis. Actinomycosis is diagnosed with positive culture or detecting actinomyces colonies and sulfur granules in histopathologic specimens. The treatment of choice is surgical excision of the lesion and long-term penicillin therapy. Actinomycosis of the internal nose is extremely rare. There was only one nasal septum actinomycosis reported in the English literature, but there was no lateral nasal wall actiomycosis regarding the turbinate. Therefore, actinomycosis should not be overlooked for the differential diagnosis of intra-nasal lesions for the initiation of appropriate and early treatment.
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Affiliation(s)
- Cengiz Ozcan
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey.
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Abstract
OBJECTIVES To present an unusual case of actinomycosis abscess of the thyroid gland as well as review the history, etiology, pathogenicity and treatment of actinomycosis infections of the head and neck. STUDY DESIGN Case study. METHODS A report of a 39 year-old female status post tooth extraction that developed an actinomycosis abscess of the thyroid. RESULTS After a thyroid actinomycosis abscess was suggested by physical exam, ultrasound, CT scan and needle aspiration, an otolaryngology consult was obtained. The patient successfully was managed with thyroidectomy and intravenous ceftriaxone. CONCLUSIONS Although Actinomycosis soft tissue infections of the head and neck are relatively uncommon, the head and neck surgeon must include it in the differential diagnosis when clinical presentation raises suspicion. Early biopsy is necessary for appropriate identification of the organism with the appearance of sulfur granules lending a clue to the diagnosis. Debridement and/or excision are often necessary for antibiotics to be used successfully. Antimicrobial therapy should be used for six to twelve months to completely eradicate the disease and prevent recurrence.
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Affiliation(s)
- John J Cevera
- Division of Otolaryngology-Head and Neck Surgery, Albany Medical Center, 35 Hackett Boulevard, Albany, NY 12208, USA
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Barabás J, Suba Z, Szabó G, Németh Z, Bogdán S, Huszár T. False diagnosis caused by Warthin tumor of the parotid gland combined with actinomycosis. J Craniofac Surg 2003; 14:46-50. [PMID: 12544220 DOI: 10.1097/00001665-200301000-00008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A case is reported in which a unilateral parotid gland cystadenolymphoma was combined with actinomycosis. A 48-year-old woman presented with a mass in the left parotid region and paresis of the lower left palpebra. The computed tomography, echography, and parotid radiographic findings did not exclude a neoplasm of the left parotid gland. The ramus of the mandible was involved in the process. Intraoperative freezing histology, total parotidectomy, and partial mandibulectomy were performed, with sacrifice of the facial nerve followed by nerve reconstruction. The final histological evaluation was Warthin tumor with actinomycosis. Four years after treatment, the patient is free of disease. No similar cases seem to have been reported thus far.
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Affiliation(s)
- József Barabás
- Department of Oral and Maxillofacial Surgery, Semmelweis University, Budapest, Hungary.
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Aguirrebengoa K, Romaña M, López L, Martín J, Montejo M, González De Zárate P. [Oral and cervicofacial actinomycosis. Presentation of five cases]. Enferm Infecc Microbiol Clin 2002; 20:53-6. [PMID: 11886672 DOI: 10.1016/s0213-005x(02)72741-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Actinomycosis is a suppurative and granulomatous chronic infectious disease caused by Actinomyces sp. and most commonly affecting the cervicofacial area. AIM To study the clinical characteristics of patients with actinomycosis, with regard to clinical history, presentation, method of diagnosis, treatment and follow up. PATIENTS AND METHODS A retrospective review was performed on all cases of microbiologically or histologically proven oral or cervicofacial actinomycosis. RESULTS Five patients were studied, 2 men and 3 women, 25-69 years old. Four patients had a history of surgical procedures and/or dental manipulations. Three patients showed the classic presentation of a lump and fistulization, and two patients presented intra-oral lesions. Four patients were diagnosed by cultures positive to A. israelii on microbiologic study and the remaining patient by cytologic detection of a sulfur granule. The first patient received the classic initial regimen of iv penicillin and 3 were treated with third-generation cephalosporins, continuing with oral amoxicillin during 12 months. Patient no.2 required a second surgical procedure. Patient no. 5, who had an exclusively oral process, received a short course of amoxicillin. There were no relapses during follow-up. CONCLUSION Actinomycosis is an uncommon disease. Establishment of the definite diagnosis requires a high index of suspicion and good clinical-microbiological collaboration. The classic course of iv penicillin and oral amoxicillin during 6-12 months is effective. For the acute phase treatment, iv penicillin can be replaced by third-generation cephalosporins.
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Affiliation(s)
- Koldo Aguirrebengoa
- Unidad de Enfermedades Infecciosas. Hospital de Cruces. Baracaldo. Vizcaya. Spain.
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Houman MH, Ben Ghorbel I, Ben Achour NR, Ezzaouia K, Fendri C, Zlitni M, Miled M. [Vertebral actinomycosis with spinal cord compression. A case report]. Rev Med Interne 2001; 22:567-70. [PMID: 11433566 DOI: 10.1016/s0248-8663(01)00388-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Vertebral involvement of actinomycosis is extremely rare and associated spinal cord compression is unusual. EXEGESIS We report a case of a 31-year-old man with vertebral actinomycosis presenting with spinal cord compression. Magnetic resonance imaging demonstrated a paravertebral abscess and lytic areas on the vertebral body of C5 requiring emergency surgery and antibiotic treatment. The patient was still asymptomatic after 12 months of follow-up. CONCLUSION Clinical aspects of this unusual localization are reviewed. Treatment may be particularly difficult.
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Affiliation(s)
- M H Houman
- Service de médecine interne, hôpital La Rabta, 1007 Tunis, Tunisie.
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Abstract
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.
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Affiliation(s)
- I Ermis
- Department of Plastic and Reconstructive Surgery, Istanbul University, School of Medicine, Turkey
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Nagler RM, Ben-Arieh Y, Laufer D. Case report of regional alveolar bone actinomycosis: a juvenile periodontitis-like lesion. J Periodontol 2000; 71:825-9. [PMID: 10872966 DOI: 10.1902/jop.2000.71.5.825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cervicofacial actinomycosis infection most often involves the mandibular bone and rarely the alveolar crest. METHODS We describe a 14-year-old patient who had actinomycosis involving the alveolar bone at the left lower dental quadrant region. Resembling juvenile periodontitis, it was difficult to diagnose properly and resulted in devastating dental and periodontal consequences: loss of one tooth with most of its adjacent regional alveolar bone, severely compromising the support of two other teeth. RESULTS With the diagnosis came successful treatment, including surgical removal of the soft and hard tissues with concomitant prolonged penicillin administration. CONCLUSIONS We feel that this case should raise the interest and concern of both the periodontist and the general practitioner so that early diagnosis can be obtained, significantly improving the clinical outcome.
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Affiliation(s)
- R M Nagler
- Department of Oral and Maxillofacial Surgery, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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49
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Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC. Bacterial Diseases. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Rivera-Hidalgo F, Stanford TW. Oral mucosal lesions caused by infective microorganisms. I. Viruses and bacteria. Periodontol 2000 1999; 21:106-24. [PMID: 10551178 DOI: 10.1111/j.1600-0757.1999.tb00171.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F Rivera-Hidalgo
- Department of Periodontics, Baylor College of Dentistry, Texas A&M University System, Dallas, USA
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