Diagnosis and treatment of cervicofacial actinomycosis

Abstract

Actinomycosis is an uncommon and frequently misdiagnosed infection of the cervicofacial region that may be acute or indolent. The term ‘‘actinomycosis’’ derives from the Greek aktino (ray) and mykos (fungus). Historically, Langenback may have been the first to describe the disease in humans (1848), although it had been considered to be a sarcoma in cattle 20 years earlier by Leblanc. Bollinger (1870) coined the term ‘‘lumpy jaw’’ in its bovine form, whereas Harz (1877) described the appearance of a ray-like microorganism, which he named Actinomycoses bovis. In 1878, Israel and Ponfick observed and described ‘‘sulfur granules’’ in human disease, and in 1891, Israel and Wolf isolated the anaerobic filamentous organism from humans. In 1898, the organism found in humans was named Actinomycoses israelii, and by the 1940s further research had confirmed that whereas A. bovis was responsible for ‘‘lumpy jaw’’ in cattle, A. israelii was the etiologic agent of human disease [1–3]. Originally considered to be a fungus (mykos) because of its slow growth and filamentous appearance, it is currently generally accepted that Actinomyces are bacteria and are taxonomically classified accordingly as members of the order Actinomycetales and the family Actinomycetacae. Other orders classified as Actinomycetales include Mycobacteriaceae and Nocardiaceae. Evidence that Actinomyces are bacteria include their filaments, which are narrower than the hyphae of fungi, their morphology, including bacillary forms, and their reproduction by typical bacterial fission rather than by budding or by spores. Actinomyces are anaerobic (whereas fungi are aerobic) and lack the nuclear membrane of fungi and yeasts. Actinomyces are destroyed by antibacterial agents such as penicillin and erythromycin but are not affected by antifungal medications, such as amphotericin B (see box 1) [2,3].