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.

Actinomycosis Presenting as Macroglossia: Case Report and Review of Literature.

Cervicofacial actinomycosis is a common form of Actinomyces infection. However, the latter seldom occurs in the tongue. We present a case of a 66 year-old man with macroglossia caused by actinomycosis of the tongue. Radiographic features were compatible with a chronic inflammatory disease. Biopsies revealed granulomas containing giant cells and Gram positive bacterial clusters consistent with actinomycosis. The patient was treated with a 22 week course of antibiotics. Imaging showed a notable improvement in the extent of the lesions 1 year later. The patient was asymptomatic and in good condition during his second year follow-up. Diagnosis of actinomycosis of the tongue can prove to be challenging because of the non-specific nature of its symptoms, clinical signs, and radiographic features. Isolation of Actinomyces sp. is an added diagnostic hurdle, because of its fastidious nature.

Facial Actinomycosis Mimicking a Cutaneous Tumor.

Actinomycosis is a chronic granulomatous infection that commonly occurs in the cervicofacial region. Although Actinomcyes is an element of the normal oral flora, infections of the facial skin are very rare because of the entirely endogenous habitation of the organism. The authors report a case of facial actinomycosis, which mimicked a cutaneous tumor both clinically and surgically in a 44-year-old woman with chronic renal failure and Hepatitis C viral infection. The majority of cases can be treated with long-term antibiotics. However, a treatment-resistant abscess, a fistula, or postsurgical excision of the mass formation that are infected can be treated with antibiotics as soon as possible, and recurrence of infection is prevented. The treatment should consist of conservative surgery to obtain a firm histological diagnosis and to drain any collections.

Unusual Behavior of a Posttraumatic Scar: Craniofacial Actinomycosis.

Actinomycosis is a chronic suppurative granulomatous infection most commonly involving the cervicofacial region. Clinical diagnosis is usually difficult, and fine-needle aspiration cytology or imaging studies are usually unhelpful in diagnosing actinomycosis. Definitive diagnosis is based on the histopathological examination of a tissue biopsy. The authors report a case of a 32-year-old healthy man who underwent multiple surgeries over a period of 7 years to correct a posttraumatic scar on his forehead with unusual behavior. Final diagnosis was made by tissue biopsy. Scar was excised and penicillin was administered for 1 month postoperatively; after a 12-month follow-up, the wound was fully healed with minimal scarring and no recurrence.

Isolated Actinomycotic Swelling in Right Upper Cervical Region.

Cervicofacial actinomycosis is today a rare disease in our country. Isolated neck swelling due to actinomycosis is extremely rare. A case of 52 year old man with an isolated neck swelling due to actinomycosis without any discharging sinus is reported here.

[Mandibular actinomycosis]. / L'actinomycose mandibulaire.

INTRODUCTION: Actinomycosis is a rare disease. The cervicofacial region is the most frequent localization. A chronic pus discharge, sometimes tumor-like, suggests the diagnosis, which is often confirmed by anatomopathology. The treatment is surgical debridement and antibiotic therapy, frequently long-term. We report three cases of mandibular actinomycosis. CASE REPORTS: A 21-year-old male patient presented with a fistulized swelling of the right jaw. A 48-year-old male patient was referred for alveolar healing delay after avulsion of teeth 32, 33, and 34. A 38-year-old female patient presented with a left mandibular swelling and restricted mouth opening. In the three cases, the diagnosis of actinomycosis was made by histology. The clinical outcome was good following alveolar curettage (and sequestrectomy for 1 patient) and antibiotic therapy. DISCUSSION: Mandibular actinomycosis is caused by Actinomyces israelii. Lesions if untreated may evolve to osteitis and sequestration. Early diagnosis is crucial.

Osteomielitis mandibular por actinomices: Reporte de caso / Mandibular osteomyelitis by actinomyces: Case report

Se reporta el caso de un paciente varón de 27 años con antecedente de exodoncia compleja de la tercera molar mandibular inferior derecha que presentaba una tumefacción circunscrita dolorosa en la región submandibular ipsilateral. En el estudio imaginológico, la radiografía panorámica presentaba un proceso osteolítico periapical e interradicular con un patrón osteogénico circundante por lo que se utilizó como complemento una tomografía cone beam, en donde se evidenció compromiso desde la rama mandibular derecha hasta la sínfisis mandibular. Las lesiones a nivel de tejidos blandos y tejidos duros fueron diagnosticadas y manejadas como una actinomicosis cervicofacial y osteomielitis crónica supurativa respectivamente. El conocimiento de las diferentes infecciones bacterianas, un adecuado análisis clínico y estudio imaginológico nos darán la pauta para la correcta terapéutica de las distintas patologías maxilofaciales.

A Case of a 27-years old male with a history of complex extraction of right mandibular third molar that had a painful circumscribed swelling in the ipsilateral submandibular region. In imaging studies, the ortopantograph showed a periapical and interradicular osteolytic process with a osteogenic pattern surrounding, so we used a Cone beam Tomography as complement where we found commitment from the right ramus to the mandibular symphsis. Damage at soft and hard tissue were diagnosed and managed as a cervicofacial actinomycosis and supurative chronic osteomyelitis respectively. The knowledge of different bacterial infections, appropriate clinical analysis and imaging studies will lead us to the correct therapy of various maxillofacial pathologies.

[Laryngeal and pharyngeal actinomycosis]. / Aktinomykose im Bereich von Pharynx und Larynx.

Cervicofacial actinomycosis is an uncommon infection and in most cases odontogenic in origin. Pharyngeal and/or laryngeal lesions, usually occurring secondary to mucosal trauma, are very rare and may mimic a malignant tumor. In such cases, which represent less than 1% of all cases, the differential diagnosis with upper aerodigestive tract malignancy remains challenging. We report a case of actinomycosis in a 56-year-old male patient who presented with an extensive, centrally necrotic mass in the oropharynx, hypopharynx and larynx region suspected to be a tumor. The lesion was diagnosed 6 months following accidental ingestion of an ear of corn and ultimately proved to be cervicofacial actinomycosis. The clinical and pathological features and current aspects of the diagnosis and treatment of cervicofacial actinomycosis are discussed.

Two unusual presentations of cervicofacial actinomycosis and review of the literature.

Cervicofacial actinomycosis is the most common clinical form of actinomycosis. This bacterial infection is rare. Diagnosis is difficult, often it is definitive only after surgical excision of the cervicofacial mass. Personal experience is reported concerning two cases of cervicoactinomycosis. Diagnosis, in both cases, has been based on histological findings, not on clinical symptoms. A review of the literature shows that mainly males are affected by this condition and, in fact, both patients described here are males. Symptoms of acute infection were absent. Both patients denied any history of oromaxillofacial trauma or recent dental extraction or oral manipulations. Imaging techniques--ultrasonography and computerized tomography--were not effective in making the diagnosis, in either of these patients. Furthermore, fine needle aspiration cytology did not provide a definitive diagnosis. Both patients underwent surgical excision of the mass. Penicillin was the drug of choice in post-operative long-term treatment (one month). In one of the two men, intravenous steroids were administered. As in several reports in the literature, the definitive diagnosis was histological and not clinical.

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.

Actinomycosis of the larynx.

Actinomycosis is a rare chronic granulomatous disease that involves the upper airway and gastrointestinal tract. Approximately 40-55% of actinomycosis comprises the cervicofacial form. It presents a challenging clinical diagnostic dilemma because of variable presentations in the head and neck. Herein, we report a rare case of actinomycosis presenting as a vocal cord nodule in a healthy 21-year-old man who was not immunocompromised and had no other known medical disease.

Cervicofacial actinomycosis: still a difficult differential diagnosis.

Cervicofacial actinomycosis, a rare chronic infectious disease, is, however, an important clinical entity, due to the difficulties involved, still today, in its diagnosis. Following personal experience in a case referred to our Department, and in agreement with reports in the literature, attention is drawn to the presenting clinical manifestations, stressing that these are often confusing since they mimic those of other diseases, Moreover, many pre-operative investigations (radiological scans, incisional biopsy, fine-needle aspiration) are generally nonspecific. Finally, surgical excision of the mass is now the last essential step to make a definitive diagnosis and define the appropriate antibiotic therapy.