Patient with actinomycosis of the cervicofacial and abdominal area, case report. / Wielopostaciowosc promienicy ­ jednoczesna aktynomikoza obszaru szyjno-twarzowego i brzusznego, opis przypadku.

Actinomycosis is a very rare, infectious disease, which is especially difficult to diagnose due to non-specific symptoms and the ability to emulate neoplasms or inflammatory changes. Due to those facts, it is often misdiagnosed or diagnosed too late to be successfully treated. This article presents the case of 31-year-old Caucasian female with recurrent upper respiratory tract infections and tonsillitis as the potential risk factors of actinomycosis. Upon examination of material collected through the course of tonsillectomy, the patient was diagnosed with actinomycosis of the left palatine tonsil. Despite the introduction of antibiotic therapy, initial progression was noted with the appearance of numerous, hypodense changes in the liver and the spleen, which regressed during further antibiotic treatment. According to our team's knowledge, this is the first described case of a patient with actinomycosis occurring simultaneously in the cervico-facial and abdominal area. The unusual localization and potential dissemination of actinomycosis should be considered in clinical practice.

The role of Actinomyces spp. and related organisms in cervicofacial infections: Pathomechanism, diagnosis and therapeutic aspects.

Members of the Actinomyces genus and Actinomyces-like organisms (ALOs; namely Actinotignum, Arcanobacterium, Schaalia and Varibaculum) are Gram-positive, non-spore-forming rods that are commensal members of the human oral cavity, gastrointestinal tract, female genital tract and skin microbiota. Cervicofacial actinomycosis or "lumpy jaw syndrome" - the chronic, suppurative granulomatous disease caused by Actinomyces spp. And ALOs - is characterized by an initially slow and unspecific disease-presentation, which often mimics other pathologies, followed by the formation of painful abscesses and severe tissue destruction. Actinomycosis has been described as a rare disease, however, reliable epidemiological data are lacking. In addition, there is increasing awareness regarding the role of Actinomyces spp. in the development of osteoradionecrosis and medication-related osteonecrosis of the jaw. The aim of this narrative review is to succinctly summarize the current advances regarding the microbiological, clinical, diagnostic and therapeutic aspects of cervicofacial actinomycosis, in addition to the roles of Actinomyces species and ALOs as members of the oral microbiota and in dental biofilm, in other dental infections (caries, root canal infection, periapical infection, periodontitis) and osteonecrosis of the jaw, in the context of recent taxonomic changes affecting the genus. Our paper aims to be a blueprint for dentists, other physicians, microbiologists and researchers regarding the multifaceted field of cervicofacial actinomycosis.

Cervicofacial Actinomycosis in the Pediatric Population: Presentation and Management.

BACKGROUND: Infection caused by Actinomyces species is a rare cause of head and neck infection in children. This chronic cervicofacial infection can present with localized swelling, abscess formation, sinus drainage and can be complicated by osteomyelitis. METHODS: Presented are 2 pediatric cases of secondary actinomycosis in the context of congenital lesions: 1 patient with a previously excised preauricular sinus and another with a persistent sublingual mass. A comprehensive literature search was conducted for reported cases of pediatric actinomycosis in the cervicofacial region. RESULTS: Both cases presented were successfully treated with a combination of complete surgical excision of the lesions and prolonged antibiotic therapy. Thirty-four pediatric cases of cervicofacial actinomycosis are reviewed, 2 presented herein, and 32 from the published literature. There was equal gender distribution and the median age was 7.5 years. The most common site for infection was the submandibular area. Four (12%) of cases arose in pre-existing congenital lesions. Most patients were treated with penicillin-based antibiotics for a median duration of 6 months following surgical excision or debridement. CONCLUSIONS: Actinomycosis is a rare infection of the cervicofacial region; secondary infections arising from congenital lesions of the head and neck are even more rare. A previously excised pre-auricular sinus and a sublingual dermoid cyst are not previously reported sites of infection. Actinomycosis should be suspected in chronically draining sinuses of the head and neck region and confirmed through anaerobic culture. Osteomyelitis is a potential complication and magnetic resonance (MR) imaging is warranted. Long-term antibiotic therapy with a penicillin-based antibiotic and surgical excision should be considered.

A de-escalated treatment strategy in the management of paediatric cervicofacial actinomycosis.

Actinomycosis is a rare invasive bacterial disease that is characterised by granulomatous inflammation often mistaken as malignancy. Traditionally, this has been managed with prolonged courses of antibiotics with durations up to 6-12 months. Surgical intervention as an adjuvant treatment has been shown to reduce the length of antibiotic treatment significantly to 4 weeks. We report a case of cervicofacial actinomycosis in a 12-year-old girl who was adequately treated with an 11-day course of antibiotics without surgical intervention and shows no signs of recurrence at 6 months post-treatment.

Cervicofacial actinomycosis: a unique diagnostic challenge.

Actinomycosis is a rare, chronic bacterial infection caused by Actinomcyes israelii. This anaerobic filamentous gram-positive bacterium frequently colonizes the human mouth, digestive, and genital tracts. Cervicofacial actinomycosis infections have a proclivity for affecting the upper and lower mandibles and occur in 50% of cases. Most cases present in immunocompetent individuals and almost always involve some degree of pre-existing mucosal trauma through either recent dental procedures or poor dental hygiene. Herein, we present a 54-year-old man diagnosed with cervicofacial actinomyces infection in the absence of periodontal disease or recent dental procedures. The purpose of this testimony is to discuss the pathogenesis and clinical and histologic findings of actinomycosis. In addition, we review diagnostic techniques and the current breadth of treatment options. It is our hope that this manuscript will serve as a guide for physicians of all specialties in accurately recognizing and promptly treating actinomycosis.

[Cervicofacial actinomycosis]. / Zervikofaziale Aktinomykose.

Actinomycosis is an infectious disease caused by gram-positive, facultative anaerobic bacteria, which in most cases manifests itself in the cervicofacial area and often has a dentogenic focus. The clinical presentation ranges from acute abscess to chronically fistulating soft tissue processes. Early diagnosis and an appropriate therapeutic approach including a combination of extensive antibiotic treatment and, if necessary, surgical intervention are critical. This article presents five cases of actinomycete infections, which are intended to illustrate the variety of clinical presentations, the problems on the way to the correct diagnosis and possible therapeutic courses.

Cervicofacial actinomycosis following third molar removal: case-series and review.

Actinomycosis is an opportunistic infection caused by bacteria of the Actinomyces spp., commonly A. israelii. These are non-pathogenic commensals in the mouth, gut, and female genital tract. An infection may arise following trauma or surgery, such as tooth extraction. More than half of cases of actinomycosis occur in the perimandibular area and are termed cervicofacial actinomycosis. Initially, the infection develops as a painful, rapidly progressive swelling. The lesion may then indurate and is often painless while the overlying skin discolors red to purple-blue. Prolonged treatment with antibiotics and surgery are often required for resolution, unless treatment is promptly started. However, diagnosis may be delayed or missed because of difficult bacterial culturing and frequent confusion with malignancy and other infections. This case study describes six patients who developed cervicofacial actinomycosis following third molar extraction. The purpose of this study is to inform clinicians on this stubborn and deceitful disease entity and to highlight the importance of clinical recognition for quick resolution with minimal morbidity.

Cervicofacial actinomycosis of the mandible in a paediatric patient.

Cervicofacial actinomycosis remains a rare pathogenic finding in the paediatric population. Diagnosis is challenging, as findings are often non-specific and Actinomyces species are generally difficult to culture. Treatment is a prolonged course of antibiotics, either intravenous and oral, often combined with a surgical procedure to remove the lesion. This patient had non-specific intermittent left mandibular pain for 8 months that was eventually attributed to an Actinomyces odontolyticus infection in the mandible. Diagnosis required incisional biopsy, and treatment involved 12 months of oral antibiotics.

Bony cystic lesion with associated submandibular lymphadenopathy on a background of breast carcinoma: an unexpected case of cervicofacial actinomycosis.

Actinomycosis is an uncommon, chronic suppurative granulomatous infection and needs to be considered as a differential diagnosis. A 56-year-old woman with a background of type 2 diabetes mellitus and breast carcinoma was referred to the Oral and Maxillofacial Surgery 2-week wait clinic, regarding a tender sublingual mass and firm erythematous swelling in the right submandibular and submental region. This was slowly progressive and had not responded to oral co-amoxiclav. An orthopantomogram showed a well-defined radiolucency and smaller radiolucent lesions throughout the edentulous right body of the mandible. A contrast-enhanced CT confirmed a right submandibular abscess communicating with cavitating lesions. The differentials included osteomyelitis, bony metastases, multiple myeloma or other cystic lesions. The patient underwent incision and drainage of the abscess, alongside biopsies, and intravenous co-amoxiclav was given. Microbiology cultures confirmed the presence of Actinomyces israelii and a diagnosis of cervicofacial actinomycosis with mandibular osteomyelitis. The patient was successfully treated with prolonged antibiotics.

Cervicofacial actinomycosis.

Cervicofacial actinomycosis is an uncommon, chronic, suppurative, and granulomatous bacterial infection. It is often of dental origin and tends to mimic other dental infections, granulomatous disorders, and cancers. The initial diagnostic workup, predicated upon imaging and tissue biopsies, is frequently nonspecific. A definitive diagnosis is usually rendered only after surgical excision and histologic examination of the cervicofacial mass. We propose a classification of three stages: localized infection without sinus involvement, localized infection with sinus involvement, and disseminated infection, to facilitate recognition, diagnosis, and early aggressive treatment. Untreated infection may be life-threatening. Therapy may require long-term antibiotics; however, many cases may also necessitate complete surgical excision.

Pediatric Cervicofacial Actinomycosis: Lessons From a Craniofacial Unit.

Actinomycosis is a rare disease that remains difficult to diagnose and manage. Prompted by 2 recent cases the authors sought evidence-based conclusions about best practice. A systematic review was conducted using standard PRISMA methodology. The study was registered prospectively (PROSPERO: CRD42018115064). Thirty-three children from 23 series are described. The mean age was 8 years (range 3-17). Fifty-five percent were female. Twenty cases involved bone (usually mandible); 13 cases involved cervicofacial soft tissue. Poor dental hygiene and oral trauma were implicated. The median diagnostic delay was 12 weeks (range 1-156 weeks). The median duration of definitive antibiotic therapy was 17 weeks (range 1-130 weeks). Although diagnostic delay did not correlate with number of surgeries, bony involvement was associated with more procedures (P = 0.008, unpaired t test). All (6) cases with residual infection had bony involvement (P = 0.06, Fisher exact test). Neither diagnostic delay nor number of surgeries significantly influenced infection-free outcome which, instead, relies on aggressive surgical debridement and prolonged antibiotic therapy. Mandibular involvement exhibits a higher surgical burden and chronicity in around a third of cases. As dental caries are implicated in mandibular disease, preventative strategies must focus on improving pediatric oral hygiene.

Actinomicosi com a causa d'abscessos laterocervicals recidivants / Actinomicosis como causa de abscesos laterocervicales de repetición / Actinomycosis as a cause of recurrent cervical abscesses

Introducció: l'adenitis cervical aguda és relativament freqüent en pediatria. Davant adenitis o abscessos cervicals de repetició o d'evolució tòrpida, cal descartar malformacions congènites (quist branquial, fístula del si piriforme o quist tiroglòs), infeccions per micobacteris i immunodeficiències. Altres causes més infreqüents són la nocardiosi, l'actinomicosi, la toxoplasmosi i els tumors. Cas clínic: es presenta el cas d'una nena de 7 anys amb antecedents d'abscessos laterocervicals de repetició (cinc episodis des dels 2 anys) que consulta per nou episodi. Prèviament havia requerit drenatge quirúrgic en quatre ocasions (amigdalectomia i marsupialització de l'abscés en un episodi). Els estudis microbiològics havien mostrat creixement de flora orofaríngia, i els estudis d'imatge no havien objectivat malformacions. En l'episodi actual es realitza drenatge i s'aïlla Actinomyces odontolyticus al cultiu anaerobi del material purulent drenat. Completa cinc setmanes d'antibioteràpia endovenosa i sis mesos més amb tractament oral, i presenta una evolució excel•lent. Comentaris: l'actinomicosi és una malaltia infreqüent cau-sada per bacteris del gènere Actinomyces. La forma de presentació més habitual és la d'abscessos cervicals recidivants. L'aïllament del germen no sempre és fàcil perquè requereix condicions específiques per obtenir creixement. La presència de grànuls de sulfur a la histologia pot ajudar al diagnòstic. L'actinomicosi requereix desbridament quirúrgic i/o drenatge i tractament antibiòtic perllongat per tal d'aconseguir la curació definitiva

Introducción. La adenitis cervical aguda es relativamente frecuente en pediatría. Ante adenitis o abscesos cervicales de repetición o de evolución tórpida es necesario descartar malformaciones congénitas (quiste branquial, fístula del seno piriforme o quiste tirogloso), infecciones por micobacterias e inmunodeficiencias. Otras causas más infrecuentes son la nocardiosis, la actinomicosis, la toxoplasmosis y los tumores. Caso clínico. Se presenta el caso de una niña de 7 años con antecedentes de abscesos laterocervicales de repetición (cinco episodios desde los 2 años) que consulta por nuevo episodio. Previamente había requerido drenaje quirúrgico en cuatro ocasiones (amigdalectomía y marsupialización del absceso en un episodio). Los estudios microbiológicos habían mostrado crecimiento de flora orofaríngea y los estudios de imagen no habían objetivado malformaciones. En el episodio actual se realiza drenaje y se aísla Actinomyces odontolyticus en el cultivo anaerobio del material purulento drenado. Completa cinco semanas de antibioterapia endovenosa y seis meses más con tratamiento oral, presentando excelente evolución. Comentarios. La actinomicosis es una enfermedad infrecuente causada por bacterias del género Actinomyces. La forma de presentación más habitual es la de abscesos cervicales recidivantes. El aislamiento del germen no siempre es fácil porque requiere condiciones específicas para obtener crecimiento. La presencia de gránulos de sulfuro en la histología puede ayudar al diagnóstico. La actinomicosis requiere desbridamiento quirúrgico y/o drenaje y tratamiento antibiótico prolongado para conseguir la curación definitiva (AU)

Introduction. Acute cervical adenitis is quite frequent in paediatrics. In the presence of recurrent or refractory adenitis or cervical abscesses it is necessary to rule-out congenital malformations (branchial cleft cyst, pyriform sinus or thyroglossal cyst), mycobacterial infections and immunodeficiencies. Other less common causes are nocardiosis, actinomycosis, and tumours. Case report. A 7-year-old girl with history of repeated cervical abscesses (five episodes since she was 2 years old) returned for a new-onset cervical abscess. Previously she required surgical drainage in four occasions (in one episode tonsillectomy and marsupialization was done). Microbiological studies revealed normal oropharyngeal flora, immunological evaluation was normal, and no congenital malformations were detected on imaging studies. In the current episode an anaerobic culture of the drainage grew Actinomyces odontolyticus. The patient responded well to 5 weeks of intravenous antibiotic therapy and 6 more months of oral treatment, with full resolution. Comments. Actinomycosis is an infrequent disease caused by bacteria from Actinomyces genera. The more usual presentation is repeated cervical abscesses. The isolation of the bacterium can be congènidifficult as it requires specific anaerobic conditions for growth. The presence of sulfur granules in histology can help with the diagnosis. Actinomycosis requires surgical debridement or drainage and extended antibiotic course for definitive treatment and full recovery (AU)

Mandíbula abultada / A lumpy jaw

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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.

Cervicofacial Primary Cutaneous Actinomycosis: Surgical Treatment for Complete Remission of the Disease.

Actinomycosis, an infectious bacterial disease caused by Actinomyces species, is very rare and is characterized by contiguous spreading, subacute to chronic granulomatous inflammation and the formation of multiple abscesses and sinus tracts that may discharge sulfur granules. Actinomycosis that presents on the skin without endogenous origin is called primary cutaneous actinomycosis, and the occurrence and treatment of primary cutaneous actinomycosis is rarely reported. This report describes the treatment of primary cervicofacial actinomycosis with a literature review, and emphasizes the importance of surgical option for complete remission of the disease.

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

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. While oral piercings have not been yet described as a risk factor for oropharyngeal actinomycosis, the mucosal disruption could favor the onset of this disease.

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.