1/5. Atypical presentations of actinomycosis.BACKGROUND: Actinomycotic infections of the cervicofacial region are uncommon. Most major medical centers report approximately one case per year. Presenting clinical manifestations are confusing because they often mimic other disease processes. diagnosis may be difficult due to a general lack of familiarity with the disease and the fastidious nature of the organism in culture. The cervicofacial manifestations of actinomycosis are varied, and a high index of suspicion is required to make an accurate and timely diagnosis. methods: Retrospective chart review with the presentation of four unusual cases of actinomycosis were performed. RESULTS: Two patients were initially seen with dysphagia from a tongue base mass. The third patient was initially seen with a 3-week history of worsening hoarseness and stridor. Examination revealed an ulcerative lesion of the left hemilarynx and pyriform sinus. All three patients were thought to have a neoplastic process. diagnosis was made on histologic examination of a tissue biopsy. The fourth patient was initially seen with a buccal space mass that was draining externally. culture of the purulent drainage revealed actinomyces. In all four cases, symptoms resolved after appropriate antimicrobial therapy. CONCLUSIONS: actinomycosis of the head and neck, although rare, is an important entity to the otolaryngologist. A confusing clinical presentation combined with the fastidious nature of the organism make for a difficult diagnosis. A high index of suspicion is required to make an accurate diagnosis and institute the appropriate antibiotic therapy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/5. Rare lesions of the oral cavity: case report of an actinomycotic lesion limited to the gingiva.actinomycosis is an infectious disease that frequently has chronic granulomatous and suppurative lesions caused by saprophytic actinomyces species. Although cervicofacial actinomycosis is known to be the most common type, intraorally and periodontally types occur rarely in a localized fashion. The present case reports on an adult periodontitis patient with a diffuse and atypic actinomycotic lesion which was limited to the gingiva and had an abscess formation, a large desquamation and subsequent exposure of the alveolar bone in the involved region. diagnosis was based on histopathological examination, the history of the case and clinical nature of the lesion. The patient responded to daily administration of 100 g doxcycycline (first day-bid) for 3 weeks and 0.2% chlorhexidine gluconate irrigation (following tooth brushing) performed with oral hygiene reinforcement and periodontal debridement procedures. Complete improvement of the lesion was observed after 5 weeks. Due to the opportunistic characteristics of the actinomycotic infection, early and adequate differential diagnosis of actinomycosis prior to therapeutic attempts, as well as management steps, are of great importance in the oral cavity to prevent the spread of the disease.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
3/5. Acute cervico-facial actinomycosis.Cervico-facial actinomycosis still occurs occasionally and should be included in the differential diagnosis of infectious processes in the jaws and the oral cavity. The typical actinomycosis-cases are clinically chronic in nature; however actinomycosis may be atypical with subacute or acute clinical manifestations. Among 37 cases of infectious processes in the jaws treated with extraoral incision between 1980 and 1985 in the Department of Oral Surgery, School of Dental medicine, University of Berne, 3 (8%) were diagnosed as acute actinomycosis according to the following procedure. Prior to incision, pus was aspired under aseptic conditions. Presence of gram-positive branched filaments in the microscopically examined pus led to the suspicion of actinomycosis. This diagnosis was confirmed by cultivation of actinomyces israelii using the anaerobic culture method, biochemical characteristics and gas-liquid chromatographic analysis of metabolic products. These 3 actinomycosis-cases were successfully treated by surgical removal of the suspicious foci and by administration of clindamycin per os for 16 days.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
4/5. Pediatric cervicofacial actinomycosis.It is well recognized that cervicofacial actinomycosis is rare in children. We have summarized the cases in the English language literature and reported a recent case from our hospital. In only 10% of clinical situations is actinomycosis the primary diagnosis. Failure to consider actinomycosis in the differential diagnosis of a cervical mass may compromise the ability to make the diagnosis, given the fastidious nature of the most common pathogen, actinomyces israelii. Indeed, the recovery rate of only 30% in some of the earlier studies of actinomycosis may have been in part due to this oversight. The correct diagnosis, however, is imperative because the treatment of actinomycosis is different from that of routine cervical adenitis in that actinomycosis requires high doses of penicillin over a prolonged time, since it is subject to relapse. Our case serves as a reminder to consider actinomycosis as the possible cause of a cervical mass, not only in adults, but in children as well.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
5/5. Cervical actinomycosis causing spinal cord compression and multisegmental root failure: case report and review of the literature.OBJECTIVE AND IMPORTANCE: Epidural invasion and the resulting cord compression are clinical entities not usually associated with actinomycosis, and we found only 11 reported cases of cord compression caused by actinomyces infection in the literature. Only one reported case was described as actinomycosis with epidural granuloma (14, 16), whereas in the other cases, epidural macroabscess (phlegm) formation caused the symptoms. Histopathological demonstration of the inflammatory granulation tissue and gram-positive sulfur-containing filamentous bacteria are important for the diagnosis of actinomycosis, because the clinical and microbiological studies cannot always demonstrate the causative microorganism and primary infection source. CLINICAL PRESENTATION: In this article, a case of actinomyces infection causing cervical cord compression is presented. Precise diagnosis was accomplished using specific histopathological studies of the surgical specimens; such a precise diagnosis cannot always be achieved using preoperative investigations and microbiological studies. The treatment modalities and the patient's outcome are also discussed. CONCLUSION: As shown by hematoxylin and eosin stain, in contrast to the nocardia species, actinomyces filaments histopathologically are basophilic in nature and terminate in eosinophilic clubs as a predictive feature. The clinical and radiological findings closely resemble metastatic tumors and other infectious processes. A differential diagnosis is also emphasized in this article, along with a review of the literature.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |