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Cervicofacial actinomycosis: Diagnosis and management

Abstract

Cervicofacial actinomycosis is an uncommon but fascinating infection of the head and neck. Most cases are odontogenic in origin and occur predominantly in immunocompetent individuals. Causative microorganisms are generally of low pathogenicity and cause disease only in the setting of antecedent tissue injury. The disease process is characterized by the formation of abscesses, fibrosis and woody induration of tissues, and draining sinuses that discharge "sulfur granules." Cultural isolation of Actinomyces species from clinical specimens, or microscopic visualization of grampositive, non-acid-fast, thin, branching filaments in cytologic aspirates or histopathologic sections are the best methods of diagnosis of cervicofacial actinomycosis. Penicillin is the drug of choice and is usually administered for 2 to 12 months, although short-course treatment may cure uncomplicated infection. Surgical therapy is often indicated for curettage of bone, resection of necrotic tissue, excision of sinus tracts, and drainage of soft tissue abscesses. The prognosis for treated infection is excellent.

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References and Recommended Reading

  1. 1.

    Smego RA Jr, Foglia G: Actinomycosis. Clin Infect Dis 1998, 26:1255–1261.

    PubMed  Google Scholar 

  2. 2.

    Smego RA Jr: Actinomycosis. In Infectious Diseases. Edited by Hoeprich PD, Jordan MC, Ronald AR. New York: Lippincott Co.; 1994:493–497.

    Google Scholar 

  3. 3.

    Lerner PI: The lumpy jaw: cervicofacial actinomycosis. Infect Dis Clin North Am 1988, 2:203–220.

    PubMed  CAS  Google Scholar 

  4. 4.

    Pulverer G, Schutt-Gerowitt H: Human cervicofacial actinomycoses: microbiologic data for 1997 cases. Clin Infect Dis 2003, 37:490–497. The authors of this study evaluate microbiologic and selected clinical data, including age and gender predisposition, derived from 1997 culture-positive cases of human cervicofacial actinomycoses seen from 1972 to 1999. Relevant procedures necessary for reliably diagnosing actinomycosis are discussed, with details of their complex etiology.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Hirshberg A, Tsesis I, Metzger Z, Kaplan I: Periapical actinomycosis: a clinicopathologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003, 96:386–390. This article discusses the incidence (1.8%), clinical features, and outcome of an accidental finding of actinomycotic colonies in periapical lesions submitted for histopathologic examination from 1997 to 2000.

    Article  Google Scholar 

  6. 6.

    Palonta F, Preti G, Vione N, Cavalot AL: Actinomycosis of the masseter muscle: report of a case and review of the literature. J Craniofac Surg 2003, 14:915–918.

    PubMed  Article  Google Scholar 

  7. 7.

    Smego RA Jr: Actinomycosis of the central nervous system. Rev Infect Dis 1987, 9:855–865.

    PubMed  Google Scholar 

  8. 8.

    Belmont MJ, Behar PM, Wax MK: Atypical presentation of actinomycosis. Head Neck 1999, 21:264–268.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Hotchi M, Schwarz J: Characterization of actinomycotic granules by architecture and staining methods. Arch Pathol 1972, 93:392–400.

    PubMed  CAS  Google Scholar 

  10. 10.

    Holmberg K: Diagnostic methods for human actinomycosis. Microbiol Sci 1987, 4:72–78.

    PubMed  CAS  Google Scholar 

  11. 11.

    Happonen RP, Viander M: Comparison of fluorescent antibody technique and conventional staining methods in diagnosis of cervicofacial actinomycosis. J Oral Pathol 1982, 11:417–425.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Pollock PG, Meyers DS, Frable WJ, et al.: Rapid diagnosis of actinomycosis by thin-needle aspiration biopsy. Am J Clin Pathol 1978, 70:27–30.

    PubMed  CAS  Google Scholar 

  13. 13.

    Custal-Teixidor M, Gimbernat JMT, Lopez GG, Rosello MV: Fine-needle aspiration cytology in the diagnosis of cervicofacial actinomycosis: report of 15 cases. Med Oral Patol Oral Cir Bucal 2004, 9:464–470. This is one academic center’s experience with cervicofacial actinomycosis, including its clinical behavior, evolution and treatment, and applicability of a useful, less invasive, diagnostic alternative to tissue biopsy—fine-needle aspiration cytology.

    Google Scholar 

  14. 14.

    Park JK, Lee HK, Ha HK, et al.: Cervicofacial actinomycosis: CT and MR imaging findings in seven patients. Am J Neuroradiol 2003, 24:331–335. This is a radiographic series of seven patients with cervicofacial actinomycosis and the results of their imaging studies of the head and neck.

    PubMed  CAS  Google Scholar 

  15. 15.

    Holmberg K, Nord CE, Dornbusch K: Antimicrobial in vitro susceptibility of Actinomyces israelii and Arachnia propionica. Scand J Infect Dis 1977, 9:40–45.

    PubMed  CAS  Google Scholar 

  16. 16.

    Martin MV: The use of oral amoxycillin for the treatment of actinomycosis. A clinical and in vitro study. Br Dent J 1984, 156:252–254.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Martin MV: Antibiotic treatment of cervicofacial actinomycosis for patients allergic to penicillin: a clinical and in vitro study. Br J Oral Maxillofac Surg 1985, 23:428–434.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Robbins TX, Scott SA: Actinomycosis: the disease and its treatment. Drug Intell Clin Pharm 1981, 15:99–102.

    PubMed  CAS  Google Scholar 

  19. 19.

    Sudhakar S, Ross J: Short-term treatment of actinomycosis: two cases and a review. Clin Infect Dis 2004, 38:444–447. This paper describes cases of esophageal and cervicofacial actinomycosis treated successfully with short-term (< 6 months) antibiotic therapy and reviews the literature, contrasting it with more prolonged treatment needed for neglected, advanced disease and for patients previously receiving interrupted therapy at suboptimal dosages.

    PubMed  Article  Google Scholar 

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Oostman, O., Smego, R.A. Cervicofacial actinomycosis: Diagnosis and management. Curr Infect Dis Rep 7, 170–174 (2005). https://doi.org/10.1007/s11908-005-0030-0

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Keywords

  • Sinus Tract
  • Actinomycosis
  • Nocardiosis
  • Nocardia Species
  • Soft Tissue Abscess