Periapical actinomycosis: a review.

Actinomycosis has increasingly been recognized as a cause of persistent or recurrent periapical disease associated with endodontically treated teeth. This case report shows the classic clinical picture of periapical actinomycosis: persistent periapical disease with recurrent sinus tracts. Although there was no pain or swelling after clinically acceptable initial endodontic treatment, a periapical lesion developed. After retreatment, the periapical lesion persisted, and a sinus tract developed. The sinus tract healed with antibiotic therapy but recurred within a few months. This cycle of sinus tract to antibiotic therapy to recurrence of the sinus tract repeated several times over a period of 5 years. Upon biopsy, periapical actinomycosis was diagnosed, where classic "sulfur granules" were demonstrated in the histologic examination of the periapical lesion. Antibiotic therapy for a period of 6 weeks was prescribed subsequent to the histologic diagnosis because of the possibility of spread of the actinomycotic infection into the maxillary sinus. Considerable healing was evident within 5 months of surgical and antibiotic treatment.     

Apical actinomycosis as a continuum of intraradicular and extraradicular infection: case report and critical review on its involvement with treatment failure

This article reports a case of extraradicular actinomycosis that clearly formed a continuum with the intraradicular infection. Histobacteriologic and histopathologic analyses of the root tip and attached apical periodontitis lesion obtained by surgery from a tooth with persistent disease were performed to look for the possible reasons for persistent disease. Although no stainable bacteria were observed in the apparently well-treated main canal, apical ramifications were clogged with dense bacterial biofilms that were contiguous to extraradicular actinomycotic aggregates. A critical review of the literature revealed that there is no clear evidence that apical actinomycosis is indeed an independent entity leading to persistent apical periodontitis lesions.     

Periapical actinomycosis: a clinicopathologic study

OBJECTIVE: We sought to evaluate the incidence and clinical outcome of an accidental finding of actinomycotic colonies in periapical lesions submitted for histologic examination. STUDY DESIGN: The study included all periapical biopsy specimens submitted for histologic examination between 1997 and 2000. Sections of paraffin-embedded tissues, 5 microm, were cut and stained by using hematoxylin and eosin, periodic acid-Schiff, and the Gram stain. The presence of typical branching colonies of filamentous bacteria staining positive for periodic acid-Schiff and Gram stain was indicative of Actinomyces. RESULTS: Typical actinomycotic colonies were identified in 17 of 963 (1.8%) periapical biopsy specimens. The mean patient age was 42, and males were predominant (65%). The maxilla was the most frequently involved site (65%), with equal distribution in the anterior and posterior areas. Radiographically, most cases presented as well-demarcated radiolucent lesions. Malignancy was suspected in 3 cases. Of the periapical lesions, 15 were epithelialized, and in 4 cases, a true epithelial-lined lumen was found, which was diagnosed as a radicular cyst. A residual cyst was diagnosed in 1 case, and in 1 case, an epithelial lining was not identified. Treatment included surgical curettage and a short course of antibiotic therapy. Healing was uneventful in all cases. CONCLUSIONS: Periapical actinomycosis is not common. Its outcome is favorable after surgical curettage supplemented by short-term antibiotic treatment. The relationship of periapical actinomycosis with the more serious cervicofacial actinomycosis should be evaluated.     

Actinomycosis of the tongue: report of case.

A brief review of the pathogenesis of actinomycotic infections, including cause, frequency, distribution, and symptoms has been presented. A relatively rare occurrence of actinomycosis in the tongue was reported to serve as an illustration of the diagnostic and therapeutic considerations pertinent to this disease.     

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.     

Case 39, part II: Cervicofacial actinomycosis

A case is presented that was unusual in its clinical manifestation. The firm, nontender, submental mass showed no evidence of erythema or fluctuation. It did not respond to intravenous antibiotic therapy until after it had been drained surgically. The apparent source of infection was a chronic periodontal lesion involving tooth No. 18. The patient gave no history of discomfort involving tooth No. 18 or his left mandible.In many respects, the case is a classic one of actinomycosis. The lesion was slow growing, hard, and nontender. Like the majority of the cases in the literature it involved the cervicofacial region. The infection began to resolve rapidly following surgical drainage and debridement. The lesion was identified surgically as an abscess with a central necrotic area surrounded by granulation tissue and firm fibrous tissue, all of which are hallmarks of actinmycosis.After two months of oral penicillin G therapy, the patient was free of any evidence of disease.     

Facial actinomycosis mimicking a desmoid tumour: case report

Actinomycosis is a chronic, suppurative, granulomatous, fibrosing infection that usually occurs in the cervicofacial region. Actinomyces israelii is the most common organism, with sporadic cases being caused by A. odontolyticus. Even though actinomyces are part of the normal oral flora, infections are rare; rarer still is actinomycotic infection of the facial skin. We describe a case of actinomycosis of the skin of the chin, which histologically mimicked a desmoid tumour.     

Actinomyces parotid infection after mandibular third molar extraction

Actinomycosis is currently an uncommonly diagnosed human disease. The disease is a chronic suppurative infection caused by micro-organism from the Actinomyces group, most often Israelii. A patient with cervicofacial actinomycosis generally reports a history of recent dental treatment which, usually, involves extraction of a mandibular molar. The common initial signs and symptoms of infection (such as sudden onset of cervicofacial pain, swelling, erythema, edema and suppuration) can be absent. In this case report a 29-year-old man presented a mass in his left parotid area, 1 week after mandibular molar extraction. Echography and CT scans revealed a parotid abscess area. The needle-biopsy of swelling revealed infection due to Actinomyces. Therapy was started with intravenous cefazolin (fl 1g X 2 in 100 s.s. i.v.) and methylprednisolone (25 mg tablet, 1/die) for 9 days; 14 days after treatment suspension the lesion reappeared with a fistula and a new therapy was given (ceftriaxone 1 g/die and gentamicin 80 mg/i.m. for 3 weeks). To prevent a relapse, the patient received cefalexin 1 gx2/die per os for 4 weeks. After a follow-up of 1 year, the patient was still asymptomatic.     

Actinomycosis: report of a case with a persistent extraoral sinus tract

Cervicofacial actinomycosis is a chronic suppurative and granulomatous infection that may reside for years and recur with sudden onset. It is the second most common type of actinomycosis and could be caused by trauma or infection. We report a draining actinomycotic sinus tract with extraordinary thickness that occurred owing to a long-standing chronic periapical infection of an extracted upper left second premolar 3 years before.     

Diagnostic value of computed tomography,magnetic resonance imaging,and scintigraphy in diagnosing actinomycosis of the mandible

Mandibular actinomycosis is an uncommon disease caused by Actinomyces israelii. Actinomycosis infection typically manifests as a chronic disease resulting in multiple abscesses, firm soft tissue mass, and presence of sulfur granules in exudates or tissues. A few reports have provided imaging findings of actinomycosis in the head and neck, but computed tomography (CT), magnetic resonance imaging (MRI), and scintigraphy of mandibular actinomycosis have not been fully described. Here, we report a case of mandibular actinomycosis with CT, MRI, and scintigraphy. The purpose of this article is to characterize the CT, MRI, and scintigraphy findings in cases of actinomycosis. Contrast-enhanced CT of the masticator space showed heterogeneous enhancement and a nonenhancing portion, suggestive of necrotic foci. Bone tissue algorithm CT showed an osteolytic lesion in the ramus of the left mandible only. On post-contrast T1-weighted images, the masticator space showed heterogeneous enhancement and nonenhancing portion, suggestive of necrotic foci. Bone scintigraphy revealed monostatic involvement of the mandible with a homogeneous intense uptake pattern. Gallium scintigraphy revealed significantly increased uptake in the left side of the face. These findings can be helpful for differentiating actinomycosis from other tumors of the mandible.     

An unusual manifestation of actinomycosis infection of the maxilla

Postoperative actinomycosis infection caused by Actinomyces israelii is uncommon. Cervicofacial actinomycosis may appear as an opportunistc infection in the oral cavity. Initial diagnosis of this condition is difficult after oral surgery and the condition often is mistaken for more common odontogenic infections. Actinomycosis responds to antibiotic therapy but the condition recurs after therapy is discontinued. This article presents an unusual case of postsurgical actinomycosis that manifested in the cheek and appeared to be unrelated to the surgical extraction of an impacted maxillary third molar that had occurred one year earlier. The organism was sampled under anaerobic conditions, isolated, and diagnosed by Gram's stain and culture tests. The condition was cured after extraoral surgical drainage, debridement, and several months of oral antibiotic administration.     

Course of infection and case outcome in individuals diagnosed with microbial colonies morphologically consistent with Actinomyces species

Actinomycosis is considered to be a rare disease in the oral region. A retrospective study of files of the University of Nebraska Medical Center College of Dentistry, Department of Pathology, revealed 30 cases in which Actinomyces species were detected from the years 1982 to 2001 (28,490 specimens). Biopsy submission forms and patient records were reviewed in each of these cases with particular attention to clinical impression, subsequent treatment, and case outcome. Classic treatment for actinomycosis involves the excision of the affected area as well as long-term antibiotics. Our study indicates that antibiotics may not be necessary in treatment of the localized dental presentation of actinomycosis.     

Actinomycosis of the masseter muscle: report of a case and review of the literature

A rare case of cervicofacial actinomycosis arising primarily in the masseter muscle is described. The patient was a healthy 74-year-old woman who was not immunocompromised and had no other primary pathological finding in the oral cavity. The importance of the differential diagnosis for this unusual infection is demonstrated with tumoral pathological findings. Possible predisposing factors as well as diagnostic and therapeutic methods are discussed.     

Oral manifestations of secondary syphilis in the elderly – a timely reminder for dentists

Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum. Cases of syphilis have increased in frequency and are challenging when affecting the elderly. The main causes of increased prevalence of syphilis are sexual promiscuity, lack of knowledge about the disease and decreasing use of barrier protection. Clinically, the oral manifestation of syphilis may resemble other entities, which hampers the correct diagnosis. We report a case of a 79‐year‐old male with weight loss and feeding difficulties. In the oral cavity there were ulcerative lesions in the hard palate and bilaterally in the buccal mucosa. The incisional biopsy revealed only a non‐specific ulceration of the oral mucosa. After 20 days, the patient was re‐evaluated and presented maculopapular lesions in the palmar and plantar areas. Positive serological venereal disease reference laboratory (VDRL) tests confirmed the diagnosis of secondary syphilis. The patient was treated with Benzathine penicillin G. After two weeks of treatment the oral lesion disappeared and the patient returned to normal feeding and gained weight. This case report reinforces the need to alert physicians and dentists to include sexually transmitted infections such as syphilis in the differential diagnosis of oral ulcerative lesions in elderly sexually active patients.     

Treatment of Cervicofacial Actinomycosis: A report of 19 cases and review of literature

Objectives: Actinomycosis is a chronic suppurative granulomatous infection caused by the Actinomyces genus. Orocervicofacial actinomycosis is the most common form of the disease, seen in up to 55% of cases. All forms of actinomycosis are treated with high doses of intravenous penicillin G over two to six weeks, followed by oral penicillin V. Large studies on cervicofacial actinomycosis are lacking. Therefore proper guidelines for treatment and treatment duration are difficult to establish. The aim of this study is to establish effective treatment and treatment duration for orocervicofacial actinomycosis. Study design: A Pubmed and Embase search was performed with the focus on treatment and treatment duration for cervicofacial actinomycosis. The hospital records of all patients presenting to our department with head and neck infection from January 2000 to December 2010 were reviewed, retrospectively. The following data were collected: age, gender, clinical presentation, aetiology, duration of symptoms, microbiological findings, treatment, and duration of treatment. The treatment and treatment duration is subsequently compared to the literature. Results: The literature search provided 12 studies meeting the inclusion criteria. All studies were retrospective in nature. Penicillin or amoxicillin/clavulanic acid are the preferred antibiotic regimens found in the literature. Most of our patients were treated with a combination of penicillin G 12 million units/day and metronidazol 500 mg 3/day, most commonly for a duration of 1 – 4 weeks, being shorter than the 3 – 52 weeks reported in the literature. Conclusion: When actinomycosis is suspected, our review has shown that a surgical approach in combination with intravenous penicillin and metronidazol until clinical improvement is seen, followed by oral antibiotics for 2 – 4 weeks is generally efficient. Key words:Actinomycosis, actinomyces, actinomycosis treatment, cervicofacial infection, actinomycosis diagnosis, head and neck infection.     

Double pathological fracture of mandibula caused by actinomycotic osteomyelitis: a case report

Actinomycosis is an uncommon chronic granulomatous infection that cause formation of abscesses and cutaneous fistula. In mandibular actinomycosis the alveolar bone and mandibular body are usually not involved and the pathogenetic mechanisms of the actinomycotic infiltration is unknown. The patients usually report pain at the alveolar arch with development of a purplish-red swelling firmly attached to the mandibula; the fibrous tissue produces the continued development of new cutaneous fistulas with oncoming pus-secretion. An uncommon case of actinomycotic osteomyelitis with a double pathological fracture of mandibula is reported. Ortopanoramic X-ray and computed tomography scan of the mandibula are effective and relevant diagnostic procedures to quantify the entity and site of the osteolitic areas and to define the precise position of fractures. In association with the intravenous infusion of benzilpenicillina, daily local irrigations of rifamicina have been performed. Moreover, the patient underwent surgical drainage of abscesses with accurate curettage of osteomyelitic lesions and several biopsies of the trabecolar bone and fistulas were taken. It has been also necessary to perform a mandibular blockage using a resinal plaque anchored on premolars. To reach a precise diagnosis, an histopathological examination togheter with batterioscopic-coltural examination is needed. Antibiotic therapy alone is not a sufficient therapeutic approach and surgical treatment must be quickly performed with clean up of the osteomyelitic lesions and contention of fractures by alveolar blockage for at least 40 days.     

Intraoral actinomycotic lesion: a case report

Actinomycosis often referred to, as the chameleon of the head and neck pathology is a rare disease, uncommon in children. This article refers to a case of intraoral actinomycotic lesion of the palate in a child following a rare aetiology, the relevant literature, clinical course and its successful resolution.     

Actinomycotic ulcer of the oral mucosa: an unusual presentation of oral actinomycosis

Although the oral mucosa is often the site of entry of actinomyces into the deeper tissues, actinomycosis in the oral mucosa is extremely rare. Actinomycotic lesions are usually described as either single or multiple abscesses or indurated masses with hard fibrous walls and soft central loculations. Actinomyces israelii is the principal cause of human actinomycosis. We present a rare case of actinomycosis caused by Actinomyces odontolyticus; it presented primarily as a long-standing ulcer of the oral mucosa mimicking a squamous cell carcinoma.     

Intraoral carcinosarcoma on the floor of the mouth mimicking a benign lesion

Carcinosarcoma is a rare malignant disease with aggressive behaviour rarely producing oral manifestations. This article reports a case of an intraoral carcinosarcoma affecting a 71-year-old black male; the diagnosis was made by histopathological and immunohistochemical analyses. Computed tomography scanning showed metastatic masses in the lungs. The patient was underwent a chemotherapy protocol regimen, but died as a consequence of the disease within 10 months of diagnosis. Distinctive characteristics of this presentation were the location of the lesion (floor of the mouth) and its clinical features resembling a benign lesion. A brief review of intraoral carcinosarcoma cases in the literature is also presented.     

A clinical and microbiological study of actinomycetes in oral and cervicofacial lesions

A retrospective study of the incidence of cervicofacial actinomycosis in patients attending the Liverpool Dental Hospital from 1980-1983 was undertaken. A total of 86 patients were found which were divisable into three distinct presentations: acute painful swellings with a duration of less than 1 month; chronic long-standing infections, duration greater than 3 months; unsuspected microbiologically-proven actinomycotic lesions. A prospective study from 1983-1986 also was divisable into three similar types of presentations. The most common presentation in both parts of the study was acute painful swellings associated with soft tissue abscesses secondary to dental lesions. Clinicians dealing with acute dentally-associated swellings should consider the possibility of actinomycosis as a possible diagnosis.