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.     

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.     

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.     

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.     

Antibiotic treatment of cervicofacial actinomycosis for patients allergic to penicillin: A clinical and in vitro study

The minimum inhibitory concentrations for erythromycin, clindamycin, lincomycin, tetracycline and minocycline have been determined for 92 clinical and three culture collection isolates of Actinomyces. From a consideration of MIC values and expected serum levels from oral therapy, minocycline was the drug of choice for the treatment of actinomycosis in patients allergic to penicillin. The serum levels of six patients allergic to penicillin, treated with oral minocycline I g/day were monitored and found to exceed the MIC for the Actinomyces species responsible for the condition. In all six Actinomycosis cases resolution was achieved in 8–16 weeks of oral minocycline therapy with no recrudescence for 1 year.     

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.     

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.     

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.     

Systematic review of the role of corticosteroids in cervicofacial infections

The role of corticosteroids in the management of cervicofacial infections continues to cause controversy. Systemic anti-inflammatory and immunomodulatory effects that reduce swelling and improve symptoms in the head and neck may make these agents an effective addition to the antibiotics used and to surgical management, although this same effect may dull the physiological response to infection, and allow infections to progress. We have systematically reviewed the evidence for the use of corticosteroids in common cervicofacial infections following the PRISMA guidelines. MeSH terms included “head”, “neck”, “infection”, and “glucocorticoid”. In total, 31 papers were identified. Eight reported the use of corticosteroids for peritonsillar abscess (PTA), 10 for pharyngitis, four for deep neck space infection (DNSI), four for periorbital cellulitis, and five for supraglottitis. Whilst there is an established evidence base for their use in the treatment of PTA and pharyngitis, other indications need further study, and we highlight the potential pitfalls. The evidence suggests that the use of adjunctive, short-term, high-dose corticosteroids in cervicofacial infections may be safe and effective.     

Mandibular osteomyelitis caused by Actinomyces Israelii. Report of a case

An unusual case of cervicofacial actinomycosis with cortical osteomyelitis of the ascending ramus is presented. The portal of entry of the infection was most probably by an extra oral route. The authors have emphasized the importance of repeated smear examinations, cultures, and sensitivity tests to rule out actinomycosis in such cervicofacial infections. The difficulties encountered in the isolation of A. Israelii are discussed.     

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.     

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.     

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.     

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.     

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.     

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.     

Cutaneous Sinuses of Cervicofacial Region: A Clinical Study of 200 Cases

Purpose

To evaluate the sinuses in the cervicofacial region and to identify the focus of infection. It is also to help the clinician in differentiating the sinuses’ of odontogenic and nonodontogenic focus of infection.

Materials and Methods

The study has been conducted in 200 patients, aged between 11 and 77 years for a period of 6 and a half years at Narayana Dental College and Hospital, Nellore. History of present illness, clinical, radiological and laboratory examinations were carried out on all the patients.

Results

Majority of the cervical sinuses are of odontogenic origin (80%) and non-odontogenic being (20%) of the cases.

Conclusion

The literature reveals that many cases have been misdiagnosed and inappropriately treated by many specialties of Medicine and Surgery wherein the odontogenic foci of infection is the main etiological factor for cervicofacial sinuses. A proper diagnosis is important and forms a key to the successful management of these sinuses in the head and neck region.     

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.     

Actinomycosis as a rare complication of orthognathic surgery

Modern orthognathic surgery is said to be clean contaminated due to the intraoral means of access. Complications after orthognathic surgery, a common operation, occur about 10% of the time. Actinomycosis, a rare specific infection, plays a negligible role. Diagnostically, it should be differentiated from other infections that occur a long time after the operation. Three cases of actinomycosis that occurred after orthognathic surgery were observed, and therapeutic measurements are described case by case.