A de-escalated treatment strategy in the management of paediatric cervicofacial actinomycosis

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.

Apical actinomycosis: case report

Actinomycosis has increasingly been recognized as a cause of persistent or recurrent periapical disease associated with endodontic therapy. After conventional root canal therapy of the lower left first and second molars, a 24-year-old woman presented with a persistent periapical lesion associated with one of the sinus tracts. The lesion was surgically removed, and actinomycosis was diagnosed on the basis of biopsy results. The clinical and histologic features of this rare condition are discussed.

[Cervicofacial actinomycosis: two case reports]

Infectious diseases transmitted by actinomycosis species cause severe destructive lesions. This rare and specific infection is mainly found in the orofacial regions. Causes of any hard tissue swelling in the jaw have, thus, to be assessed carefully. When actinomycosis is identified, a surgical intervention with curettement, draining and long-term antibiosis is required. The aim of the current article is to describe two clinical cases and to show the necessity of both, microbiological and histological laboratory diagnostics, to hedge the clinic diagnosis.

Coexistence of actinomycosis and sialolithiasis in the submandibular gland

Actinomycosis of the submandibular gland is unusual. A 55-year-old male presented with a right, painless submandibular mass of four-year duration. Physical examination revealed a 4 x 3-cm mass in the submandibular region. Ultrasonography-guided fine needle aspiration from the lesion showed microorganisms compatible with actinomyces colonies in the glandular tissue. The diagnosis was made as actinomycosis of the right submandibular gland accompanied by sialolithiasis. The patient was treated with penicillin G (10 million U/day) for three months, followed by 3 g/day oral penicillin for six months. After this medication, physical examination showed no decrease in the size of the mass and the clinical features remained unchanged. Submandibular gland excision under general anesthesia was performed.

[Clinical symptoms and treatment of cervicofacial actinomycosis. Literature survey and case report]

Actinomycosis is a chronic, specific inflammation which is characterized by suppuration, abscess formation, tissue fibrosis and granuloma formation. Actinomycosis has three main forms (cervicofacial, which is the most frequent, approximately 60%, pulmonary and abdominal), but other regions of the body can be involved, too (e.g. neck, ovaries, bones), that is why its differential diagnosis becomes more and more relevant. Regarding its treatment, the majority of authors recommends the combination of surgical and antibiotic treatment. The authors of this article present a typical case of cervicofacial actinomycosis, in which the authors used the combination of surgical and antibiotic treatment. As a result of the treatment the healing process was completed successfully and without complications.

Actinomycosis of the larynx

Actinomycosis is a rare chronic granulomatous disease that involves the upper airway and gastrointestinal tract. Approximately 40-55% of actinomycosis comprises the cervicofacial form. It presents a challenging clinical diagnostic dilemma because of variable presentations in the head and neck. Herein, we report a rare case of actinomycosis presenting as a vocal cord nodule in a healthy 21-year-old man who was not immunocompromised and had no other known medical disease.

Actinomycosis of the tongue: a diagnostic dilemma

Actinomycotic infections of the cervicofacial region are not uncommon. However, actinomycosis of the tongue is rare. A mass that may mimic both benign and malignant neoplasms can be seen at clinical presentation and may mislead the diagnosis. We report a patient who presented with a tumour-like tongue mass causing speech disturbance, diagnosed as actinomycosis.

Cervicofacial actinomycosis: still a difficult differential diagnosis

Cervicofacial actinomycosis, a rare chronic infectious disease, is, however, an important clinical entity, due to the difficulties involved, still today, in its diagnosis. Following personal experience in a case referred to our Department, and in agreement with reports in the literature, attention is drawn to the presenting clinical manifestations, stressing that these are often confusing since they mimic those of other diseases, Moreover, many pre-operative investigations (radiological scans, incisional biopsy, fine-needle aspiration) are generally nonspecific. Finally, surgical excision of the mass is now the last essential step to make a definitive diagnosis and define the appropriate antibiotic therapy.

Death from actinomycosis

Death from actinomycosis, although unusual today, was devastating at one time. Although commonplace today, using antibiotics to save patients from death was unusual when penicillin was first introduced over 50 years ago.

[Cervico-facial actinomycosis--case reports]

In the article the authors made the review of actinomycosis bibliography. They also presented characteristic features infections enter ways, course of the disease, diagnostic tests and treatment methods. Two cases of face and neck actinomycosis were presented. All of them treated in Katowice-Ochojec Hospital ENT ward in last five years. Abnormal clinic symptoms made difficulty to put the diagnosis. Satisfactory results were achieved after set up final diagnosis and proper treatment.

Atypical presentations of pediatric actinomycosis: report of a case

It is well recognized that cervicofacial actinomycosis is rare in children, especially at maxilla. Actinomycosis involving the maxilla usually is seen as a localized intraoral infection in contrast to classical cervicofacial actinomycosis. In this article, we describe an 8-year-old patient who had actinomycosis involving the bone at the left maxillary lateral incisor region. The diagnosis was based on histologic report because of location and development of the lesion with unusual history. The treatment of choice was removal of the soft and hard tissues with concomitant prolonged penicillin administration. In cases of persistent oral infection the diagnosis of actinomycosis should be actively attempted through microbiologic and histologic examination.

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.

Cervical actinomycosis causing spinal cord compression and multisegmental root failure: case report and review of the literature

OBJECTIVE AND IMPORTANCE

Epidural invasion and the resulting cord compression are clinical entities not usually associated with actinomycosis, and we found only 11 reported cases of cord compression caused by Actinomyces infection in the literature. Only one reported case was described as actinomycosis with epidural granuloma (14, 16), whereas in the other cases, epidural macroabscess (phlegm) formation caused the symptoms. Histopathological demonstration of the inflammatory granulation tissue and gram-positive sulfur-containing filamentous bacteria are important for the diagnosis of actinomycosis, because the clinical and microbiological studies cannot always demonstrate the causative microorganism and primary infection source.

CLINICAL PRESENTATION

In this article, a case of Actinomyces infection causing cervical cord compression is presented. Precise diagnosis was accomplished using specific histopathological studies of the surgical specimens; such a precise diagnosis cannot always be achieved using preoperative investigations and microbiological studies. The treatment modalities and the patient's outcome are also discussed.

CONCLUSION

As shown by hematoxylin and eosin stain, in contrast to the Nocardia species, Actinomyces filaments histopathologically are basophilic in nature and terminate in eosinophilic clubs as a predictive feature. The clinical and radiological findings closely resemble metastatic tumors and other infectious processes. A differential diagnosis is also emphasized in this article, along with a review of the literature.

[Simultaneous occurrence of cervicofacial an pleuropulmonary actinomycosis]

Successful treatment of rapidly spread cervicofacial and pleuropulmonary actinomycosis case is reported. Significant law destruction and pathological fractures were observed as well.

Cervicofacial actinomycosis: a diagnostic challenge

Actinomycosis was first described as a clinical entity over 100 years ago. However, the fundamental characteristics of this entity have not been fully discussed, and major questions remain unanswered, such as the highly diversified pathogenicity of the phenomenon according to numerous published case reports and clarification of solid diagnostic criteria. Even the frequency of cervicofacial actinomycosis occurrence is unclear; some authors consider it to be rare and others to be common. We present 11 cases examined and treated in our department within the last 14 years along with a review of the literature. Diagnostic problems are emphasized, and a comprehensive overview of the entity is suggested.

[Actinomycosis of the tonsils with a pseudotumoral presentation: a clinical case]

A case of actinomycosis of the tonsils with a neoplasm-like clinical presentation is presented. Tonsillectomy confirmed the diagnosis and the patient's evolution was favorable after postoperative antibiotic therapy. The scant literature on cervicofacial actinomycosis is reviewed. These processes often are confused with neoplasms, as in our case, or with mandibular osteomyelitis. Treatment is surgery and prolonged antibiotic administration. Actinomycosis should be considered in the differential diagnosis of cervicofacial masses, particularly when the biopsy is negative for carcinoma.

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.

[Mediastinal actinomycosis with formation of an esophagotracheal fistula. A case report]

Before antibiotics were available, actinomycosis was the most commonly diagnosed "fungal disease" of the lung because of its morphological similarity to true fungi. At that time actinomycosis presented a fairly typical clinical picture of empyema thoracis and sinus tracts in the chest wall. Nowadays it has become a rare infectious disease that is usually caused by the bacterium Actinomyces israelii and is amenable to treatment by most antibiotics available today. The following report describes the case of a 59-year-old man with an uncommon mediastinal actinomycosis that caused an oesophagotracheal fistula. This complication may develop due to the necrotizing inflammatory process that is typical for actinomycosis. With regard to the literature, the clinical manifestations of the disease and diagnostic and therapeutic considerations are discussed.

[Cervicofacial actinomycosis in a patient treated by surgery of the lymph node due to laryngeal cancer: case report]

An actinomycotic cervical abscess was excised in a 55-year-old man who had undergone partial laryngectomy and ipsilateral cervical lymph node dissection 6 years earlier. This rare case is described in detail. We conclude that postoperative structural changes producing the loss of physical and immunologic barriers may be determinant factors in the development of this late actinomycotic infection.

Pediatric cervicofacial actinomycosis

It is well recognized that cervicofacial actinomycosis is rare in children. We have summarized the cases in the English language literature and reported a recent case from our hospital. In only 10% of clinical situations is actinomycosis the primary diagnosis. Failure to consider actinomycosis in the differential diagnosis of a cervical mass may compromise the ability to make the diagnosis, given the fastidious nature of the most common pathogen, Actinomyces israelii. Indeed, the recovery rate of only 30% in some of the earlier studies of actinomycosis may have been in part due to this oversight. The correct diagnosis, however, is imperative because the treatment of actinomycosis is different from that of routine cervical adenitis in that actinomycosis requires high doses of penicillin over a prolonged time, since it is subject to relapse. Our case serves as a reminder to consider actinomycosis as the possible cause of a cervical mass, not only in adults, but in children as well.

Pediatric actinomycosis of the head and neck

Actinomycosis is a rare soft tissue infection caused by a gram-positive, anaerobic bacteria. It is seen only approximately once a year in major medical centers, and is rarer still in the pediatric population. About 50% of all cases of actinomycosis involve the head and neck. The organism is very difficult to isolate in culture and the differential diagnosis is extensive, prompting one reviewer to name actinomycosis the "masquerader" of the head and neck. We review three cases of actinomycosis over the past ten years (1981-1990) at Texas Children's Hospital, Houston, Texas.

[Cervicofacial actinomycosis. A case study]

A case of cervicofacial actinomycosis, sited in the central hyoid region, is reported. The Authors have emphasized the difficulties of the diagnosis. It's very important hat the clinical diagnosis of actinomycotic infection be confirmed by a positive culture test. Actinomycosis can be suspected if multiple recurrent pustular swellings are present, associated with any trauma or teeth extractions.

Actinomycotic pseudo-tumour of the mid-cervical region (a case report)

Cervicofacial actinomycosis is today a rare disease in our country. Isolated actinomycotic neck masses are extremely rare. A case of young man with an isolated midcervical tumour like actinomycotic granuloma without sinuses or discharging granules is reported here.

[A case of cervico-facial actinomycosis]

A 23-year old pregnant women was admitted to the hospital because of a lesion on her face simulating an ulcerated tumoral mass, The lesion had appeared after a dental extraction. Although in several anaerobic cultures actinomyces did not grow, the sulfur granules were observed under microscope and the biopsy specimen suggested actinomycosis. Penicillin therapy for 2 months provided no healing. Excision was performed.

Cervico-facial actinomycosis. A retrospective study

A retrospective investigation of 25 cases of verified cervico-facial actinomycosis recorded in the period 1971--76 is presented. The results have been compared with the findings from a previous examination carried out by one of the authors during 1955--64. A marked increase of cervico-facial actinomycosis was noted. The clinical picture seems to be changing to a more alarming appearance, in agreement with the classical description of this entity. According to this agreement with the classical description of this entity. According to this a prolongation of the period of treatment was found. Other aspects of the disease are discussed based on the present results. The recommended treatment is still a combination of antibiotic medication and surgical removal of infectious foci.

Cervicofacial actinomycosis

Actinomycotic infections are unusual, but the actual incidence is likely to be significantly higher than records indicate. The disease may complicate trauma of many types to the respiratory and digestive tracts, including operative procedures. This possibility should encourage more frequent use of anaerobic cultures in inflammatory diseases, particularly posttraumatic, and should prompt consideration of actinomycosis in the differential diagnosis of infections, especially in the cervicofacial area. We report four cases that demonstrate the variable course of this infection. Treatment is highly successful with appropriate use of antibiotics and surgery. A plea is made to use the least expensive, effective antibiotic in view of the prolonged course of therapy that is necessary to eradicate this infection.

Actinomycosis: masquerader in the head and neck

The diagnosis of cervicofacial actinomycosis is usually not simple, but may be essential for adequate treatment. Cases seen in a Head and Neck Service illustrate some of the many guises under which actinomycosis may be concealed, and a review of recent literature confirms its propensity to be a masquerader. A combination of techniques is necessary to diagnose, and both surgical and medical approaches are needed to treat this often distressingly persistent affliction.