Cervicofacial actinomycosis: important considerations on a mimicking disease / Actinomicosis cervicofacial: consideraciones importantes sobre una enfermedad imitadora

SUMMARY Actinomycosis is a rare chronic suppurative infection that affects upper airways and the gastrointestinal tract. The aim of this work was to review important information regarding the etiopathogenesis, clinical features and treatment of cervicofacial actinomycosis. According to the anatomic site affected, it is classified into three clinical forms: cervicofacial (50%), thoracic (30%) and abdominal (20%). We present here a literature review focusing on important aspects of cervicofacial actinomycosis. Despite the name comprising the term mycosis, the disease is caused by Gram-positive bacteria of the genus Actinomyces, mainly Actinomyces israelii, which are commensals of the oral microbiota. Nevertheless, when the integrity of the oral mucosa is compromised, they can become pathogenic. Actinomycosis evolves slowly and it often mimics other clinical conditions such as malignancies. Treatment consists in antibiotic therapy and can last up to 12 months in severe cases. Health care professionals' knowledge about the disease is crucial in a way to promote its prevention, early diagnosis and proper treatment.

RESUMEN La actinomicosis es una enfermedad infecciosa muy infrecuente de tipo crónico y supurativo que afecta al área cervicofacial e el tracto gastrointestinal. El presente trabajo tuvo como objetivo, revisar informaciones importantes en cuanto etiopatogenia, presentación clínica y tratamiento de la actinomicosis cervicofacial. Se puede clasificar de tres maneras a depender del sitio anatómico: cervicofacial (50%), torácica (30%) y abdominal (20%). Presentamos una revisión de la literatura con foco en aspectos importantes de la actinomicosis cervicofacial. Aunque se le denomine micosis, la enfermedad es causada por bacterias grampositivas del género Actinomyces, siendo que A. israelli es el agente etiológico más frecuente, cuales son microorganismos comensales de la boca. Sin embargo, si la integridad de la mucosa es violada, ellos se tornan patogénicos. La actinomicosis es lentamente progresiva y frecuentemente imita otras condiciones clínicas como malignidades. El tratamiento consiste en terapia antibiótica y puede durar 12 meses en casos más graves. El conocimiento de los profesionales de salud acerca de esa enfermedad es fundamental para promover su prevención, diagnóstico precoz y tratamiento correcto.

Actinomicosis mandibular

RESUMEN Mujer de 46 años, tiroidectomizada por bocio hiperfuncionante, con bicitopenia (anemia y leucopenia) en estudio, acude por tumoración y dolor del maxilar inferior y secreción purulenta, de 4 meses de evolución, con fiebre intermitente. Presentó disminución de ingesta de alimentos con pérdida de 20 kg de peso aproximadamente. Ya recibió varios esquemas de tratamiento entre los que se incluye antimicrobianos, sin mejoría. Muestras de secreción con cultivo: negativos. Tomografía del macizo facial con lesiones osteolíticas y fractura del maxilar inferior. La biopsia muestra inflamación crónica inespecífica y presencia de Actinomyces sp. Biopsia osteomedular: probable efecto tóxico medular. Recibió tratamiento prolongado con antimicrobiano, mejorando. Actualmente en planes de reconstrucción de maxilar inferior.

ABSTRACT A 46-year-old woman, thyroidectomized by hyperfunctional goiter, with bicytopenia (anemia and leukopenia) under study, consults because of a tumor, pain of the lower jaw and purulent secretion of 4 months of evolution, with intermittent fever. She presented decrease in food intake with loss of approximately 20 kg of weight. She has already received several treatment schemes, including antimicrobials, without improvement. Culture secretion samples: negative. Tomography of the facial massif showed osteolytic lesions and fracture of the lower jaw. The biopsy shows nonspecific chronic inflammation and the presence of Actinomyces sp. Osteomedullary biopsy: probable spinal toxic effect. She received prolonged treatment with antimicrobial, improving. Currently she is in reconstruction plans of the lower jaw.

Actinomicosis orofaríngea como diagnóstico diferencial de carcinoma de cavum: Reporte de un caso / Cervicofacial actinomycosis as differential diagnosis of cavum carcinoma: case report

La actinomicosis es una enfermedad infrecuente en pediatría que implica, habitualmente, un desafío diagnóstico. Es producida por bacterias del género Actinomyces. La forma cervicofacial suele originarse tras la disrupción de la mucosa oral secundaria a alteraciones odontógenas. Se presenta el caso de una adolescente que, tras la colocación de un piercing en la lengua, comenzó con odinofagia y cambios del tono de voz. Luego de ocho meses de persistencia de los síntomas y habiendo realizado múltiples tratamientos antibióticos con leve mejoría, se efectuó una biopsia y se diagnosticó carcinoma de cavum, por lo que se derivó a este Hospital para su tratamiento. Al analizar nuevamente la biopsia, se descartó la patología oncológica y se diagnosticó actinomicosis orofaríngea. Cumplió 6 meses totales de tratamiento antibiótico, con buena evolución. Si bien la colocación de piercings orales no ha sido descrita hasta el momento como factor de riesgo, la disrupción mucosa generada podría favorecer el inicio del cuadro.

Paediatric actinomycosis is an infrequent infectious disease caused by Actinomyces spp. Cervicofacial infections are usually related to disruption in oral mucosal membranes. We discuss the case of a 15-year-old girl who refers an 8-month history of odynophagia and changes in her tone of voice after getting a tongue piercing. She received multiple antibiotic treatments with slight improvement. Nasopharyngeal carcinoma was diagnosed by endoscopic biopsy. The patient was referred to our Hospital for treatment but, when the biopsy was analyzed again, oncological pathology was excluded and oropharyngeal actinomycosis was diagnosed. She received a total of 6 months of antibiotic treatment with favorable evolution.

Six Cases of Cervical Actinomycosis / 대한이비인후과학회지

Actinomycosis is an unusual subacute chronic disease caused by gram-positive anaerobic organisms such as Actinomycetes israelii, A. bovis, A. odontolyticus, and A. viscosus. Actinomycetes are prominent among the normal flora of the oral cavity. Because these organisms are not virulent, a break in the integrity of mucosa is necessary to cause human illness. Three common forms of illness are cervicofacial, thoracic and abdominopelvic actinomycosis. Cervicofacial form is the most common (55%) and often occurs after oral surgery, tooth extraction and cervicofacial trauma. Cervicofacial actinomycosis is characterized by initial soft tissue swelling, along with development of fistulas that discharge purulent yellow sulfur-like material (sulfur granules). Sulfur granule is the pathognomonic pathologic finding of actinomycosis but it has not been reported in all cases. Here, we report 6 cases of cervical actinomycosis that were trea-ted with surgical intervention and administration of proper antibiotics, with the review of literatures.

A Case of Cervical Actinomycosis Misdiagnosed to Malignant Tumor / 대한이비인후과학회지

Actinomyces are gram positive anaerobes which exist as normal flora in the oral and digestive tract. Actinomycosis is a very rare subacute or chronic infectious disease that causes sinus fistula, tract or abscess due to the invasion of surrounding soft tissue when normal mucosa is damaged by inflammation. Clinically, it is categorized into cervicofacial, thorax, abdomen, pelvis, and systemic infection, in which cervicofacial infection accounts for 50% of all actinomycosis. With various nonspecific clinical manifestations and uncertain results of fine needle aspiration cytology and culture examination, treatment may be difficult since it may be misdiagnosed as malignancy or tuberculosis. Along with literature, we present a case of a 57-year old male patient with cervical actinomycosis in the submandibular mass, which was mistaken for malignancy.

Case Report: Cervicofacial Actinomycosis-Misdiagnosed to Parotid Abscess / 대한이비인후과학회지

Actinomycosis is a disease caused by an anaerobic bacteria called Actinomyces species (predominantly Actinomyces israelii), which is a common and normally nonpathogenic organism found in the nose and throat. The four major clinical presentations of actinomycosis include the cervicofacial, thoracic, abdominal, and pelvic region. Actinomycosis is difficult to diagnose because of variable presentation and fastidious nature of the organism in culture. A high index of suspicion and biopsy are often necessary to make the diagnosis, because the disease can mimic neoplasm or a chronic granulomatous infection. We present, with the appropriate review, a case of actinomycosis in the mandibular angle area which was mistaken for a parotid abscess.

A Case of Actinomycosis of the Neck / 대한이비인후과학회지

Actinomycosis of cerivcofacial region is an uncommon disease and presents as an abscess or chronic lesion mimicking malignancy, tuberculosis, or fungal lesion. Actinomycosis is difficult to diagnose because of fastidious nature of the organism in culture and general lack of familiarity with the disease. So, a high index of suspicion is required to make an accurate and timely diagnosis. We present a case of male patient with actinomycosis of submandibular triangle complaining of neck mass.

FACIAL ACTINOMYCOSIS FOLLOWING THE EXTRACTION OF LOWER THIRD MOLAR