[Neurosyphilis or not - a case of a differential diagnostic challenge]. / Neurosyphilis vagy nem ­ egy differenciáldiagnosztikai kihívás esete.

We report the case of a 42-year-old woman with paraparesis associated with transverse myelitis. For differential diagnostics detailed microbiological, cerebrospinal fluid (CSF) and neuroimaging examinations were performed. Syphilis was confirmed, but diagnosis of neurosyphilis was only probable based on the CSF microbiological test results. The beneficial treatment response to application of the therapeutic protocol for syphilis supported the supposed diagnosis of syphilis-associated myelitis in our case. In this case report we reviewed the differential diagnostic tools of myelopathies/myelitis.
Nowadays regarding to growing prevalence of syphilis worldwide physicians should face on its presence and medical consequences.

Image-based and machine learning-guided multiplexed serology test for SARS-CoV-2.

We present a miniaturized immunofluorescence assay (mini-IFA) for measuring antibody response in patient blood samples. The method utilizes machine learning-guided image analysis and enables simultaneous measurement of immunoglobulin M (IgM), IgA, and IgG responses against different viral antigens in an automated and high-throughput manner. The assay relies on antigens expressed through transfection, enabling use at a low biosafety level and fast adaptation to emerging pathogens. Using severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the model pathogen, we demonstrate that this method allows differentiation between vaccine-induced and infection-induced antibody responses. Additionally, we established a dedicated web page for quantitative visualization of sample-specific results and their distribution, comparing them with controls and other samples. Our results provide a proof of concept for the approach, demonstrating fast and accurate measurement of antibody responses in a research setup with prospects for clinical diagnostics.

Diagnosis of Epstein-Barr and cytomegalovirus infections using decision trees: an effective way to avoid antibiotic overuse in paediatric tonsillopharyngitis.

BACKGROUND: The incidence of tonsillopharyngitis is especially prevalent in children. Despite the fact that viruses cause the majority of infections, antibiotics are frequently used as a treatment, contrary to international guidelines. This is not only an inappropriate method of treatment for viral infections, but it also significantly contributes to the emergence of antibiotic-resistant strains. In this study, EBV and CMV-related tonsillopharyngitis were distinguished from other pathogens by using machine learning techniques to construct a classification tree based on clinical characteristics. MATERIALS AND METHODS: In 2016 and 2017, we assessed information regarding 242 children with tonsillopharyngitis. Patients were categorized according to whether acute cytomegalovirus or Epstein-Barr virus infections were confirmed (n = 91) or not (n = 151). Based on symptoms and blood test parameters, we constructed decision trees to discriminate the two groups. The classification efficiency of the model was characterized by its sensitivity, specificity, positive predictive value, and negative predictive value. Fisher's exact and Welch's tests were used to perform univariable statistical analyses. RESULTS: The best decision tree distinguished EBV/CMV infection from non-EBV/CMV group with 83.33% positive predictive value, 88.90% sensitivity and 90.30% specificity. GPT (U/l) was found to be the most discriminatory variable (p < 0.0001). Using the model, unnecessary antibiotic treatment could be reduced by 66.66% (p = 0.0002). DISCUSSION: Our classification model can be used as a diagnostic decision support tool to distinguish EBC/CMV infection from non EBV/CMV tonsillopharyngitis, thereby significantly reducing the overuse of antibiotics. It is hoped that the model may become a tool worth considering in routine clinical practice and may be developed to differentiate between viral and bacterial infections.

Human Thelaziosis Caused by Thelazia callipaeda Eyeworm, Hungary.

Ocular infections with Thelazia callipaeda eyeworms in Europe have become more common. We report a case in Hungary caused by T. callipaeda eyeworms in a 45-year-old woman who had no travel history abroad.

Epidemiology and clinical features of SARS-CoV-2 infection in hospitalized children across four waves in Hungary: A retrospective, comparative study from March 2020 to December 2021.

Background and Aims: From 2019 till the present, infections induced by the novel coronavirus and its mutations have posed a new challenge for healthcare. However, comparative studies on pediatric infections throughout waves are few. During four different pandemic waves, we intended to investigate the clinical and epidemiological characteristic of the pediatric population hospitalized for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infection. Methods: Between March 2020 and December 2021, we performed our retrospective research on children infected with the SARS-CoV-2 virus at the University of Szeged. We analyzed the data of all patients who required hospitalization due to positive results of SARS-CoV-2 tests (Nucleic Acid Amplification Test or rapid antigen test). Data analysis included demographic data, medical history, clinical findings, length of hospitalization, and complications, using medical records. Results: In this study, data from 358 coronavirus-infected children were analyzed. The most affected age group was children over 1 month and under 1 year (30.2%). The highest number of cases was recorded in the fourth wave (53.6%). Fever (65.6%), cough (51.4%), nasal discharge (35.3%), nausea and vomiting (31.3%), and decreased oral intake (28.9%) were the most common symptoms. The most common complications were dehydration (50.5%), pneumonia (14.9%), and bronchitis/bronchiolitis (14.5%). Based on RR values, there are considerable differences in the prevalence of the symptoms and complications between the different age groups and waves. Cox proportional hazard model analyzes showed that fever and tachypnoea had a relevant effect on days to recovery. Conclusions: We found trends similar to those previously published, overall statistics. The proportion of children requiring hospitalization varied from wave to wave, with the fourth wave affecting the Hungarian child population the most. Our findings suggest that hospitalization time is unrelated to age, but that certain symptoms (fever and tachypnoea) are associated with longer hospitalization. The onset of certain symptoms may differ by age group.

Characteristics of hepatitis E viral infections in Hungary.

BACKGROUND: Hepatitis E virus (HEV) is one of the most important causes of hepatitis worldwide. Despite this, limited data published more than ten years ago are only available about HEV epidemiology in Hungary. OBJECTIVES: We aimed to determine the epidemiological features of HEV infections among patients submitted to various departments of our university hospital in Hungary with signs and symptoms referring to acute hepatitis. STUDY DESIGN: One thousand four hundred thirty-one sera samples from 1,383 patients were analyzed by enzyme-linked immunosorbent assays (ELISA). In some patients, HEV RNA was detected by broad-range nested polymerase chain reaction (PCR) if acute hepatitis was confirmed. PCR products were sequenced and compared with other available sequences in GenBank. RESULTS: Five hundred eighteen sera from 429 patients proved positive (31.0%) for HEV-specific immunoglobulin G (IgG) with a mean age of 60.0 years. Most sera with anti-HEV IgG antibodies were collected from adults and elderly patients. Anti-HEV IgM positive results were found in the case of 95 sera samples from 70 patients (5.1%). Acute HEV infections were confirmed mostly over 40 (n = 67, 95.7%). The number of males (n = 47, 67.1%) was higher than females (n = 23, 32.9%). We detected HEV-specific PCR products in seven patients (10.9%). Genotyping was successful for 5 out of 7 PCR-positive samples. All sequences belonged to genotype 3 (subgenotypes: e, f). CONCLUSIONS: In our survey, we confirmed the constant presence of acute HEV infections in Hungary and an increased seroprevalence of anti-HEV IgG antibodies compared to a previous study.

Survival Comes at a Cost: A Coevolution of Phage and Its Host Leads to Phage Resistance and Antibiotic Sensitivity of Pseudomonas aeruginosa Multidrug Resistant Strains.

The increasing ineffectiveness of traditional antibiotics and the rise of multidrug resistant (MDR) bacteria have necessitated the revival of bacteriophage (phage) therapy. However, bacteria might also evolve resistance against phages. Phages and their bacterial hosts coexist in nature, resulting in a continuous coevolutionary competition for survival. We have isolated several clinical strains of Pseudomonas aeruginosa and phages that infect them. Among these, the PIAS (Phage Induced Antibiotic Sensitivity) phage belonging to the Myoviridae family can induce multistep genomic deletion in drug-resistant clinical strains of P. aeruginosa, producing a compromised drug efflux system in the bacterial host. We identified two types of mutant lines in the process: green mutants with SNPs (single nucleotide polymorphisms) and smaller deletions and brown mutants with large (∼250 kbp) genomic deletion. We demonstrated that PIAS used the MexXY-OprM system to initiate the infection. P. aeruginosa clogged PIAS phage infection by either modifying or deleting these receptors. The green mutant gaining phage resistance by SNPs could be overcome by evolved PIASs (E-PIASs) with a mutation in its tail-fiber protein. Characterization of the mutant phages will provide a deeper understanding of phage-host interaction. The coevolutionary process continued with large deletions in the same regions of the bacterial genomes to block the (E-)PIAS infection. These mutants gained phage resistance via either complete loss or substantial modifications of the phage receptor, MexXY-OprM, negating its essential role in antibiotic resistance. In vitro and in vivo studies indicated that combined use of PIAS and antibiotics could effectively inhibit P. aeruginosa growth. The phage can either eradicate bacteria or induce antibiotic sensitivity in MDR-resistant clinical strains. We have explored the potential use of combination therapy as an alternative approach against MDR P. aeruginosa infection.

Effect of An 84-bp Deletion of the Receptor-Binding Domain on the ACE2 Binding Affinity of the SARS-CoV-2 Spike Protein: An In Silico Analysis.

SARS-CoV-2 is a recently emerged, novel human coronavirus responsible for the currently ongoing COVID-19 pandemic. Recombination is a well-known evolutionary strategy of coronaviruses, which may frequently result in significant genetic alterations, such as deletions throughout the genome. In this study we identified a co-infection with two genetically different SARS-CoV-2 viruses within a single patient sample via amplicon-based next generation sequencing in Hungary. The recessive strain contained an 84 base pair deletion in the receptor binding domain of the spike protein gene and was found to be gradually displaced by a dominant non-deleterious variant over-time. We have identified the region of the receptor-binding domain (RBD) that is affected by the mutation, created homology models of the RBDΔ84 mutant, and based on the available experimental data and calculations, we propose that the mutation has a deteriorating effect on the binding of RBD to the angiotensin-converting enzyme 2 (ACE2) receptor, which results in the negative selection of this variant. Extending the sequencing capacity toward the discovery of emerging recombinant or deleterious strains may facilitate the early recognition of novel strains with altered phenotypic attributes and understanding of key elements of spike protein evolution. Such studies may greatly contribute to future therapeutic research and general understanding of genomic processes of the virus.

Verification of tuberculosis infection among Vác mummies (18th century CE, Hungary) based on lipid biomarker profiling with a new HPLC-HESI-MS approach.

Tuberculosis (TB) was a large burden of infections that peaked during the 19th century in Europe. Mummies from the 18th century CE, discovered in the crypt of a church at Vác, Hungary, had high TB prevalence, as revealed by amplification of key fragments of TB DNA and genome-wide TB analysis. Complementary methods are needed to confirm these diagnoses and one approach uses the identification of specific lipid biomarkers, such as TB mycocerosic acids (MCs). Previously, MC derivatives were profiled by specialised gas chromatography-mass spectrometry (GC-MS), so an alternative more direct approach has been developed. Underivatized MCs are extracted and analysed by high-performance liquid chromatography linked to a mass spectrometer, in heated electrospray ionisation mode (HPLC-HESI-MS). The method was validated using representatives of the Mycobacterium tuberculosis complex and other mycobacteria and tested on six Vác mummy cases, previously considered positive for TB infection. Analysing both rib and soft tissue samples, four out of six cases gave profiles of main C32 and major C29 and C39 mycocerosates correlating well with those of M. tuberculosis. Multidisciplinary methods are needed in the diagnosis of ancient tuberculosis; this new protocol accesses important confirmatory evidence, as demonstrated by the confirmation of TB in the Vác mummies.

Multiple SARS-CoV-2 Introductions Shaped the Early Outbreak in Central Eastern Europe: Comparing Hungarian Data to a Worldwide Sequence Data-Matrix.

Severe Acute Respiratory Syndrome Coronavirus 2 is the third highly pathogenic human coronavirus in history. Since the emergence in Hubei province, China, during late 2019, the situation evolved to pandemic level. Following China, Europe was the second epicenter of the pandemic. To better comprehend the detailed founder mechanisms of the epidemic evolution in Central-Eastern Europe, particularly in Hungary, we determined the full-length SARS-CoV-2 genomes from 32 clinical samples collected from laboratory confirmed COVID-19 patients over the first month of disease in Hungary. We applied a haplotype network analysis on all available complete genomic sequences of SARS-CoV-2 from GISAID database as of 21 April 2020. We performed additional phylogenetic and phylogeographic analyses to achieve the recognition of multiple and parallel introductory events into our region. Here, we present a publicly available network imaging of the worldwide haplotype relations of SARS-CoV-2 sequences and conclude the founder mechanisms of the outbreak in Central-Eastern Europe.

Detection of VIM, NDM and OXA-48 producing carbapenem resistant Enterobacterales among clinical isolates in Southern Hungary.

Infections caused by carbapenem-resistant Enterobacterales (CRE) present an important therapeutic problem, as there are limited number of effective therapeutic alternatives available. In this study, phenotypic and genotypic methods were used to characterize carbapenemase-production and other resistance-determinants (AmpC and ESBL-production, efflux pump-overexpression) in 50 isolates (Klebsiella spp. n = 35, Escherichia coli n = 12 and Enterobacter cloacae complex n = 3) collected at the Albert Szent-Györgyi Clinical Center (University of Szeged) between 2014 and 2017. Minimum inhibitory concentrations of meropenem, sulfamethoxazole/trimethoprim, tigecycline, amikacin, moxifloxacin, colistin and fosfomycin were also determined. 24% of isolates were AmpC-producers, while 30% carried blaCTX-M ESBL-genes. Carbapenemase-genes were detected in 18 (36%) of the tested isolates: in 2 isolates blaNDM, in 6 isolates blaOXA-48-like and in 12 isolates, blaVIM was detected by PCR. The species-distribution for isolates positive for carbapenemase-genes was the following: Klebsiella pneumoniae n = 11, Klebsiella oxytoca n = 1, E. coli n = 5, E. cloacae complex n = 1. Efflux pump-overexpression based on the PAßN-screening agar was shown in n = 3 of the tested strains. In nine isolates (18%), carbapenemase and ESBL-genes were detected simultaneously. Highest levels of resistance were noted for fosfomycin (74%) and moxifloxacin (70%), while all isolates were susceptible to colistin. Among applied phenotypic tests in this study the modified carbapenem inactivation method (mCIM) proved to be the most accurate one compared to that of PCR results.

Leclercia adecarboxylata as an emerging pathogen in human infections: a 13-year retrospective analysis in Southern Hungary.

INTRODUCTION: The clinical role of Leclercia adecarboxylata as an opportunistic pathogen in the context of human infections have been highlighted by multiple published case reports, describing these bacteria as novel or emerging pathogens. METHODOLOGY: The study included L. adecarboxylata isolates and laboratory data collected, corresponding to a 13-year time period (between 1 January 2005 and 31 December 2017). Presumptively identified L. adecarboxylata isolates were re-identified using VITEK 2 Compact ID/AST and MALDI-TOF MS analysis. RESULTS: n = 34 isolates were verified by VITEK 2 system and MALDI-TOF. The fosfomycin-agar and CPS Elite agar were effective in the phenotypic differentiation of the isolates. N = 18 (52.9%) of L. adecarboxylata was considered as clinically significant pathogens (based on the clinical signs and symptoms), while n = 16 (47.1%) were considered as contaminants. These pathogens were isolated from wound/abscess samples (n = 9), urine samples (n = 6) and blood cultures (n = 3). 31 out of 34 isolates (91.2%) were pan-sensitive (i.e. wild type) to the tested antibiotics. The median age of affected patients was 57 years (range: 12-80 years), 11 out of 18 patients (61.1%) presented with underlying immunosuppression at the time of isolation. CONCLUSIONS: Based on the finding of this study, the actual (published) frequency of L. adecarboxylata infections needs to be re-evaluated as the risk of misidentification (and reporting the isolate as a pan-sensitive Escherichia coli) is high. Additional reporting of cases, both from a microbiological and clinical standpoint, could help clinicians develop a better understanding of the potential of this organism as a pathogen.

The incidence of bloodstream infections caused by anaerobic bacteria in a university hospital between 2005­2009 and 2013­2017. A retrospective, comparative study. / [Az anaerob baktériumok által okozott véráramfertozések gyakorisága 2005-2009 és 2013-2017 között egy egyetemi központban. Retrospektív összehasonlító vizsgálat].

Introduction: Anaerobes play an important etiological role in invasive infections, and may be clinically significant pathogens in bloodstream infections and septicemia, but little data are available on their true prevalence in Hungary. Aim: The aim of this study was to determine the prevalence of anaerobic bacteria in the blood culture samples received at the Institute of Clinical Microbiology, University of Szeged, retrospectively. Method: Blood culture samples received at the Institute were analyzed over a 5-year period (01. 01. 2013-31. 12. 2017); the comparison was based on a similar study (2005-2009) conducted in the same region. Results: Between 2013 and 2017, our Institute received an average of 23,274 ± 2,756 blood culture bottles, of which an average of 10.5% were positive and 0.4% were positive for anaerobes (3.5-3.8/1000 bottles). Clinically significant anaerobic pathogens were predominantly Bacteroides fragilis group (39.9%) and Clostridium species (32.8%). Conclusion: Despite their relatively low numbers, anaerobic bacteria are considered important etiologic factors in bloodstream infections. Our results highlight the importance of modern identification methods in adequate anaerobic diagnostics. Orv Hetil. 2020; 161(19): 797-803.

Fatal case of bacteremia caused by Streptococcus suis in a splenectomized man and a review of the European literature.

Streptococcus suis is an emerging zoonotic human pathogen, which is a causative agent of invasive infections in people who are in close contact with infected pigs or contaminated pork products. It is associated with severe systemic infections, most commonly meningitis and sepsis, which may lead to high rates of morbidity and mortality. Serotype 2 is the most prevalent type in S. suis infections in humans. We have reported a case of a very rapidly proceeding fatal human S. suis infection in a splenectomized, but otherwise immunocompetent patient in Hungary. We would like to highlight the attention for this pathogen for the risk group patients, not only pig breeders, veterinarians, abattoir workers, meat processing and transport workers, butchers and cooks, that those persons who are immunocompromised including those with spleen removed, persons with diabetes mellitus, cancer and alcoholism, are also at greater risk of infection.

Anaerobic blood culture positivity at a University Hospital in Hungary: A 5-year comparative retrospective study.

Anaerobic bacteremia (AB) is usually detected in about 0.5-13% of positive blood cultures. The aim of this study was to determine prevalence of anaerobic bacteremia over a 5-year period (2013-2017), to identify current trends at our University Hospital and to compare the results to those in a similar study (2005-2009) in the same region. During the study period, an average of 23,274 ±â€¯2,756 blood cultures were received per year. Out of the positive blood cultures, 3.3-3.6% (n = 423) yielded anaerobic bacteria, representing 3.5-3.8 anaerobic isolates/1000 blood culture bottles (including both aerobic and anaerobic bottles) per year for hospitalized patients. Mean age of affected patients was 70-73 years (range: 18-102 years) with a male-to-female ratio: 0.60. Most isolated anaerobes were Cutibacterium spp. (54.0 ±â€¯8.5%; n = 247), while among anaerobes other than Cutibacterium spp., Bacteroides and Parabacteroides and Clostridium spp. were the most prevalent. Blood culture time-to-positivity (TTP) for clinically relevant bacteria was 31.4 ±â€¯23.4 h, while for Cutibacterium spp., TTP values were 112.9 ±â€¯37.2 h (p < 0.0001). In conclusion, the prevalence of anaerobic bacteremia should be determined on institutional basis.

Extraintestinal Clostridioides difficile Infections: Epidemiology in a University Hospital in Hungary and Review of the Literature.

Extraintestinal manifestations of Clostridioides difficile infections (CDIs) are very uncommon, and according to the literature, poor outcomes and a high mortality have been observed among affected individuals. The objective of this study was to investigate the incidence rate of extraintestinal infections caused by C. difficile (ECD) in a tertiary-care university hospital in Hungary. During a 10-year study period, the microbiology laboratory isolated 4129 individual strains of C. difficile; among these, the majority were either from diarrheal fecal samples or from colonic material and only n = 24 (0.58%) were from extraintestinal sources. The 24 extraintestinal C. difficile isolates were recovered from 22 patients (female-to-male ratio: 1, average age: 55.4 years). The isolates in n = 8 patients were obtained from abdominal infections, e.g., appendicitis, rectal abscess or Crohn's disease. These extraintestinal cases occurred without concomitant diarrhea. In all, but two cases C. difficile was obtained as a part of a polymicrobial flora. Our isolates were frequently toxigenic and mostly belonged to PCR ribotype 027. Resistance to metronidazole, vancomycin, clindamycin and rifampin were 0%, 0%, 20.5% and 9.7%, respectively. The increasing amount of reports of C. difficile extraintestinal infections should be noted, as these infections are characterized by a poor outcome and high mortality rate.

[Exudative tonsillitis in children. How can we reduce the unnecessary antibiotic consumption?] / Lepedékes tonsilla gyermekkorban. Hogyan csökkentheto az indokolatlan antibiotikumfelhasználás?

Introduction: Exudative tonsillitis is a common clinical picture during childhood. The majority of these cases are caused by viruses (Epstein-Barr virus [EBV], cytomegalovirus [CMV], influenza virus, parainfluenza virus, and adenovirus), and only some infections are caused by bacteria, mainly group A streptococci (GAS). On the basis of international guidelines, routine use of early antibiotic treatment is not recommended in these cases, because it seems not to prevent GAS-associated complications. Aim: Our aim was to determine those laboratory results which are useful to distinguish between bacterial and viral infections in children with exudative tonsillitis to reduce antibiotic overuse. Method: In our study, we evaluated 135 clinical data from 133 children with exudative tonsillitis. Patients were grouped according to the following criteria: the first group contained patients with acute CMV or EBV infections, while in the second group, CMV or EBV infections were not confirmed using serology. Results: On the basis of our results, EBV or CMV infections (66/135, 48.8%) were serologically confirmed in the majority of cases with exudative tonsillitis between 2016 and 2017, while the causative role of GAS was minimal in this patient group (3/65, 4.61%). In spite of this finding, the majority of patients (92%) were treated with antibiotics. Conclusion: Our retrospective findings confirmed that it is not possible to determine the causative agent of this clinical picture on the basis of symptoms, and physical findings, moreover laboratory results, such as high white blood cell count could not confirm bacterial infection. At the same time, elevated transaminase levels may refer to viral origin of infection, especially EBV or CMV with high predictive value; the use of extended laboratory tests may reduce the unnecessary antibiotic consumption. Orv Hetil. 2020; 161(2): 50-55.

Resistance Levels and Epidemiology of Non-Fermenting Gram-Negative Bacteria in Urinary Tract Infections of Inpatients and Outpatients (RENFUTI): A 10-Year Epidemiological Snapshot.

Background: Urinary tract infections (UTIs) are one of the most common infections in the human medicine, both among outpatients and inpatients. There is an increasing appreciation for the pathogenic role of non-fermenting Gram-negative bacteria (NFGNBs) in UTIs, particularly in the presence of underlying illnesses. Methods: The study was carried out using data regarding a 10-year period (2008-2017). The antimicrobial susceptibility testing was performed using the disk diffusion method, E-tests, and broth microdilution. Results: NFGNB represented 3.46% ± 0.93% for the outpatients, while 6.43% ± 0.81% of all positive urine samples for the inpatients (p < 0.001). In both groups, Pseudomonas spp. (78.7% compared to 85.1%) and Acinetobacter spp. (19.6% compared to 10.9%), were the most prevalent. The Acinetobacter resistance levels were significantly higher in inpatients isolates (p values ranging between 0.046 and <0.001), while the differences in the resistance levels of Pseudomonas was not as pronounced. The ß-lactam-resistance levels were between 15-25% and 12-28% for the Acinetobacter and Pseudomonas spp., respectively. 4.71% of Acinetobacter and 1.67% of Pseudomonas were extensively drug resistant (XDR); no colistin-resistant isolates were recovered. Conclusions: Increasing resistance levels of the Acinetobacter spp. from 2013 onward, but not in the case of the Pseudomonas spp. Although rare, the drug resistant NFGNB in UTIs present a concerning therapeutic challenge to clinicians with few therapeutic options left.

Microbiological and Clinical Aspects of Cervicofacial Actinomyces Infections: An Overview.

Similarly to other non-spore-forming Gram-positive anaerobes, members of the Actinomyces genus are important saprophytic constituents of the normal microbiota of humans. Actinomyces infections are considered to be rare, with cervicofacial infections (also known as 'lumpy jaw syndrome') being the most prevalent type in the clinical practice. Actinomycoses are characterized by a slowly progressing (indolent) infection, with non-specific symptoms, and additionally, the clinical presentation of the signs/symptoms can mimic other pathologies, such as solid tumors, active Mycobacterium tuberculosis infections, nocardiosis, fungal infections, infarctions, and so on. The clinical diagnosis of actinomycosis may be difficult due to its non-specific symptoms and the fastidious, slow-growing nature of the pathogens, requiring an anaerobic atmosphere for primary isolation. Based on 111 references, the aim of this review is to summarize current advances regarding the clinical features, diagnostics, and therapy of cervicofacial Actinomyces infections and act as a paper for dentistry specialists, other physicians, and clinical microbiologists.