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.     

Cervicofacial actinomycosis following surgical trauma in rats.

Cervicofacial actinomycosis in man is often associated with physical trauma. The presence of intrabony abscesses in rat mandibles following surgical trauma supports the clinical observation that antecedent trauma is an important factor in the pathogenesis of cervicofacial actinomycosis.     

Pediatric cervicofacial actinomycosis: a case report

Cervicofacial actinomycosis in children is a rare disorder. This article reports a case in a 7-year-old-girl. The importance of cervicofacial actinomycosis in the differential diagnosis of cervical masses in young patients is emphasized.     

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.     

Cervicofacial actinomycosis in pregnancy

Two cases of cervicofacial actinomycosis in pregnancy are described and the refractory nature of the condition in pregnancy is discussed.     

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.     

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.     

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.     

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.     

Rare lesions of the oral cavity: case report of an actinomycotic lesion limited to the gingiva

Actinomycosis is an infectious disease that frequently has chronic granulomatous and suppurative lesions caused by saprophytic Actinomyces species. Although cervicofacial actinomycosis is known to be the most common type, intraorally and periodontally types occur rarely in a localized fashion. The present case reports on an adult periodontitis patient with a diffuse and atypic actinomycotic lesion which was limited to the gingiva and had an abscess formation, a large desquamation and subsequent exposure of the alveolar bone in the involved region. Diagnosis was based on histopathological examination, the history of the case and clinical nature of the lesion. The patient responded to daily administration of 100 g doxcycycline (first day-bid) for 3 weeks and 0.2% chlorhexidine gluconate irrigation (following tooth brushing) performed with oral hygiene reinforcement and periodontal debridement procedures. Complete improvement of the lesion was observed after 5 weeks. Due to the opportunistic characteristics of the actinomycotic infection, early and adequate differential diagnosis of actinomycosis prior to therapeutic attempts, as well as management steps, are of great importance in the oral cavity to prevent the spread of the disease.     

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.     

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.     

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.     

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.     

Pediatric cervicofacial actinomycosis: a case report

Cervicofacial actinomycosis affects many soft tissue and bony structures in the head and neck, and has both granulomatous and suppurative features. Pathogenesis of actinomycosis is still unclear, but trauma provides a portal of entry for the infection. It usually presents as a diffuse swelling with multiple sinus tracts containing macroscopic colonies of the organism known as "sulphur granules." Cervicofacial actinomycosis in children is rare. This article reports a case of actinomycosis in a 10-year-old-boy overlying the left ramus of the mandible.     

A patient of severe cervicofacial subcutaneous emphysema associated with Munchausen's syndrome

Subcutaneous cervicofacial emphysema is an entity with the presence of air within the fascial planes of the head and neck, which results from various causes. A case of severe subcutaneous cervicofacial emphysema associated with Munchausen's syndrome is presented. Detailed diagnostic investigations to find out the organic cause of the condition were failed. Episodes of facial swelling were prevented by psychiatric support. Munchausen's syndrome should be kept in mind among the etiological factors of subcutaneous cervicofacial emphysema cases, in whom no organic causes can be found out.     

改良面颈部旋转瓣修复颧区皮肤软组织缺损

目的:探讨面颈部改良旋转皮瓣修复颧区皮肤软组织缺损的方法。方法:选取6例颧区皮肤软组织缺损患者,创伤患者采用患侧颧区清创术,肿瘤患者采用颧面部肿物切除术。所有患者术中缺损均采用同侧改良面颈部旋转瓣转移修复颧区缺损术,术后患者均每月复查填写临床评价表,随访1~2年。结果:所有患者皮瓣全部成活。皮瓣外观满意,面部术区无赘皮堆积,皮肤浅感觉良好,没有医源性面神经分支损伤表现。结论:改良面颈部旋转瓣血供可靠,颜色质地与面部皮肤相匹配,是修复面部颧区皮肤软组织缺损的较好皮瓣。     

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.     

Necrotizing fasciitis in association with Ludwig’s angina – A case report

A 28 year old male diabetic patient developed Ludwig’s angina which subsequently evolved into cervicofacial necrotizing fasciitis. The differential characteristic of Ludwig’s angina and cervicofacial necrotizing fasciitis, as it relates to this rare presentation is discussed. The clinical and radiological features, pathophysiology, diagnosis and the management that resulted in a successful outcome are presented.     

The bacterial associations in maxillofacial actinomycosis

A variety of clinical forms of actinomycosis, difficulties of its early diagnosis and particularly of the differential diagnosis between this condition and tuberculosis, nocardiosis, aspergillosis necessitate the development of present-day methods for the early laboratory diagnosis of actinomycosis. Basing on the data on present-day methods for isolation of anaerobic and microaerobic diphtheroids, the authors characterize the bacterial associations occurring in maxillofacial actinomycosis and other odontogenic processes, discuss problems in isolation and identification of Actinomyces cultures.