Actinomycosis Research Articles

Cervicofacial Actinomycosis: Detection and follow‐up through ultrasound image

AbstractAimTo demonstrate a case of Actinomyces infection in which ultrasound was used as a diagnostic aid tool.Materials and MethodsDescription of a case of cervicofacial actinomycosis in a patient, whose treatment and long‐term evaluation were performed using ultrasound, a crucial tool to ensure accuracy and real‐time images, without exposing the patient to radiation, contributing to the success of treatment.ResultsIn the case of actinomycosis, the ultrasound findings consisted of hyperechoic foci surrounded by hypoechoic areas.ConclusionsUltrasonography plays a broad role in dentistry, being able to assist in diagnosis, guided surgical interventions and post‐treatment monitoring. Furthermore, ultrasound is an accessible and portable examination that can be used at the patient's bedside, especially in critical cases, proving to be a promising tool in clinical management in a hospital environment.

Enigmatic Cer Enigmatic Cervicofacial Actinomy vicofacial Actinomycosis P cosis Post Radiother ost Radiotherapy - A Case Report

Although thought to be uncommon, it is believed that cervicofacial actinomycosis is underreported due to frequent misdiagnosis. It has been called the “most misdiagnosed disease by experienced clinicians”. A wide range of dental procedures or trauma, including tooth eruption, may precipitate actinomycosis by enabling microorganisms to penetrate the deeper tissue layers via an entry point. This infective disease is significant due to its potentially aggressive and locally destructive nature. This case describes a patient diagnosed with cervicofacial actinomycosis. Her history prior to this was significant for proliferative verrucous leukoplakia, and T4aN0M0 (AJCC 7th Edition) squamous cell carcinoma of the right hard palate for which she received surgery and post-operative radiotherapy. The mechanism of actinomycotic infection, its presentation, differential diagnosis, and management is discussed, with review of the relevant literature. This case highlights an unusual case of cervicofacial actinomycosis and demonstrates the complexities in reaching a definitive diagnosis in cases of osteomyelitis and osteoradionecrosis with significant bacterial burden.

Cervicofacial actinomycosis: case report and literature review

Cervicofacial actinomycosis: case report and literature review

18F]FDG PET/CT Findings of Mass-Forming Actinomycosis in an Uncontrolled Diabetic Patient.

We report a case of cervicofacial actinomycosis mimicking malignant sarcoma in a 78-year-old man with diabetes. High lesion uptake and decreased cerebral uptake on [18F]FDG PET/CT provide a potentially important diagnostic clue suggesting infectious disease in a poorly controlled diabetic patient.

Unveiling a common neglected tropical disease: actinomycotic mycetoma.

Unveiling a common neglected tropical disease: actinomycotic mycetoma.

The Great Imitator: Cervicofacial Actinomycosis Masquerading as Cancer Recurrence

The Great Imitator: Cervicofacial Actinomycosis Masquerading as Cancer Recurrence

A Rare Case of Submandibular Actinomycosis

Actinomycosis is caused by actinomyces israelii, a gram positive nonacid fast, anaerobic, commensal bacterium within the oral cavity. Though it is a commensal in oral cavity, it seldom presents as cervicofacial actinomycosis. But there is limited access to literature proving cervicofacial actinomycosis existence so far. We report a case of 35 year old gentleman who presented with painless progressive neck swelling associated with pain while chewing food. On examination, 3.5*2.5 swelling was noted in right submandibular gland area, radiologically a foreign body was detected in the right submandibular gland. Mass was excised in toto and sent for HPE which revealed submandibular gland actinomycosis. Post operatively, patient was managed with long-term broad-spectrum beta lactams and was on regular follow-up. No evidence of recurrence/ fresh complaints noted till date. Although cervicofacial actinomycosis is rare and dangerous with debilitating complications, timely diagnosis and early intervention with broad spectrum antibiotics and surgical excision (if required) shows promising results with complete eradication of disease leaving no residues.

Updated Review on Nocardia Species: 2006-2021.

This review serves as an update to the previous Nocardia review by Brown-Elliott et al. published in 2006 (B. A. Brown-Elliott, J. M. Brown, P. S. Conville, and R. J. Wallace. Jr., Clin Microbiol Rev 19:259-282, 2006, https://doi.org/10.1128/CMR.19.2.259-282.2006). Included is a discussion on the taxonomic expansion of the genus, current identification methods, and the impact of new technology (including matrix-assisted laser desorption ionization-time of flight [MALDI-TOF] and whole genome sequencing) on diagnosis and treatment. Clinical manifestations, the epidemiology, and geographic distribution are briefly discussed. An additional section on actinomycotic mycetoma is added to address this often-neglected disease.

Diagnostic Dilemma with a Case of Primary Bronchopulmonary Actinomycosis Causing Unilateral Destroyed Lung: A Case Report and Literature Review

Among chronic pulmonary infections, pulmonary actinomycosis is a rare one, caused by a gram-positive microaerophilic bacterium called Actinomyces. Aside from cervicofacial or abdominopelvic actinomycosis, pulmonary involvement is rare, and sometimes this type of infection results in a misdiagnosis of pulmonary tuberculosis or carcinoma. Clinical presentation of pulmonary actinomycosis could be acute or subacute, with lobar involvement. However, the disease is most commonly diagnosed at the chronic phase, with patients presenting mild fever, weight loss, and occasional hemoptysis. Here, we described the case of a 30-year-old male patient, presented with a history of respiratory complaints for more than three years and was diagnosed clinically and radiologically as a case of a destroyed left lung. Later on, post-operative tissue diagnosis was confirmed—pulmonary actinomycosis.

A RARE CASE OF CONCURRENT PULMONARY ACTINOMYCOSIS AND ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS IN A PARTICIPANT OF NATIVE AMERICAN SWEAT LODGE CEREMONIES

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pulmonary actinomycosis is a rare manifestation, typically seen in patients with poor oral hygiene at risk for aspiration. Whether underlying pulmonary disease predisposes risk of thoracic infection has not been well elucidated due to the disease rarity. CASE PRESENTATION: A 32-year-old male with childhood asthma was referred to our Interventional Pulmonologist for evaluation of a lung mass incidentally discovered on spine radiograph during back pain workup. He reported 3-month history of dyspnea, nonproductive cough, constitutional symptoms, and scant hemoptysis. The patient had participated in multiple local Native American tribal sweat lodge ceremonies where members sit around hot stones doused with water to produce steam in huts made of sticks covered with animal skins and blankets that have been stored in the woods. CT showed an 8x9 cm RLL finger-like mass extending across the fissure to the RUL with background multifocal bronchiectasis. Bronchoscopy revealed diffuse mucopurulent secretions with a large yellow-black broncholith at the os of the superior segment of RUL enclosing an area of post-obstructive pus and multiple sulfur granules. Antibiotics, voriconazole, and corticosteroids were initiated for presumed ABPA and post-obstructive pneumonia. Serum aspergillus IgE was strongly positive (29.2 kU/L), aspergillus IgG elevated at 91.9 mg/L, total IgE initially 1424 IU/mL and increased to 5291 IU/mL, confirming ABPA. BAL cultures speciated Actinomyces odontolyticus. Maxillofacial CT revealed a right periodontal abscess, suggesting cervicofacial actinomycosis as the potential source of thoracic disease. He was discharged on a prolonged course of ampicillin/sulbactam, subsequently transitioned to amoxicillin, corticosteroids, and voriconazole with significant improvement of respiratory status, imaging, and IgE levels on outpatient follow-up. DISCUSSION: To our knowledge, this is the first case of pulmonary actinomycosis reported in a patient with ABPA. Thoracic involvement typically results from aspiration of orogastric contents, supported by radiographic predilection for peripheral and lower lobes. Our case strengthens the limited body of evidence suggesting underlying respiratory disease as potential risk factor for pulmonary involvement. The presence of sulfur granule broncholithiasis and endobronchial disease involvement adds to the unique presentation, as does the potential link between sweat lodge exposure and ABPA. While lodge-related deaths from heat overexposure, smoke inhalation, dehydration, and improper construction causing suffocation have been reported, this is the first case to our knowledge of a potential link to aspergillus-associated lung disease. CONCLUSIONS: Pulmonary actinomycosis is a rare cause of airway obstruction and may be more prevalent in patients with underlying respiratory disorders such as ABPA, which may arise following sweat lodge exposure. REFERENCE #1: Pulmonary actinomycosis G.F. Mabeza, J. Macfarlane European Respiratory Journal Mar 2003, 21 (3) 545-551; DOI: 10.1183/09031936.03.00089103 REFERENCE #2: Byard, RW; Riches, KJ (September 2005). "Dehydration and heat-related death: sweat lodge syndrome". Am J Forensic Med Pathol. 26 (3): 236–9. REFERENCE #3: Herel, Suzanne (2002-06-27). "2 seeking spiritual enlightenment die in new-age sweat lodge". San Francisco Chronicle. Hearst Communications. Retrieved 2006-09-26. DISCLOSURES: No relevant relationships by Shaheen Lashani, source=Web Response No relevant relationships by Justin Thomas, source=Web Response No relevant relationships by Shawnt Tosonian, source=Web Response

Post COVID-19 invasive mucormycosis and actinomycosis co-infection: a case report

<p>Actinomyces are commensals of human oropharynx and actinomycosis is considered mainly as an endogenous infection that is triggered by a mucosal lesion. Typically, the disease presents as a slowly progressive painless indurated mass evolving into multiple abscesses with draining sinus tracts sometimes expressing a typical yellow exudate with characteristic sulfur granules. The gold standard of diagnosis is histological examination and bacterial culture of the tissue. Most isolates are susceptible to beta lactams and they are the treatment of choice along with surgical management with drainage of abscesses and excision of recalcitrant fibrotic lesions and debridement of necrotic bone tissue. Here we present a case of 37-year-old male patient who has developed severe COVID-19 infection following which he developed invasive mucormycosis followed by actinomycosis. We postulate that the lymphopenia and the use of immunosuppressants used in treatment of COVID-19 lead to mucormycosis and aggressive debridement used as a strategy in treatment of mucormycosis led to colonization of actinomyces leading to cervicofacial actinomycosis.</p>

27826 Cervicofacial actinomycosis: A unique diagnostic challenge in a middle-aged male.

Actinomycosis is a rare bacterial infection caused by the Actinomyces spp, with roughly three new cases per 100,000 people per year. Actinomyces israelii is the pathogenic agent behind approximately 70% of all cervicofacial actinomycosis cases. A history of a recent dental procedure is frequently elicited upon questioning, as trauma is the most crucial predisposing factor to this infection. Our case follows a 54-year-old Hispanic male who presented to our dermatology clinic for evaluation of a nonresolving erythematous plaque of 8-month duration on the left nasolabial fold.

Dermoscopy-An Aid in the Diagnosis of Mycetoma.

A 45-year-old farmer consulted for a gradually increasing swelling over right leg. Examination revealed hard swelling with multiple discharging sinuses over right foot. Many pin-point hypopigmented macules arranged in a schematic pattern were seen, corresponding to the site of administration of indigenous medication [Figure 1]. Dermoscopic examination using DermLite™ DL3-3Gen under contact polarized mode from one of the active sinus revealed small black grains, surrounded by bluish white veil suggestive of deeper fungal colonies [Figure 2a]. White structureless area around the openings corresponding to dermal fibrosis was seen[Figure 2b]. Skin punch biopsy from the lesion demonstrated periodic-acid-schiff positive, pigmented fungal colonies over a background of granulation tissue [Figure 3].Figure 1: Diffuse woody hard swelling over dorsum of right foot with multiple discharging sinusesFigure 2: a. Dermoscopy of the sinus opening shows multiple small black grains. b. The sinuses are surrounded by bluish white veil (Red arrow). Crust surrounding the sinus opening can be seen (Yellow arrow) Structureless pink-white areas related to the underlying fibrosis was seen surrounding to the lesion (Star). (DL3 dermoscope, polarized mode 10x)Figure 3: Histopathology shows pigmented fungal colony comprising of radiating hyphae of eumycetoma, showing splendor hoeppli phenomenon and surrounded by dense neutrophilic infiltrate. (PAS stain, 10x)Mycetoma is a granulomatous infection that can be caused by bacteria (actinomycotic mycetoma) or fungi (eumycotic mycetoma). Grains represent the hallmark of mycetoma and color of grains is often suggestive of the probable causative agent. However, diagnostic facilities are often limited and inaccessible to many patients affected by this neglected tropical disease.[1] Dermoscopy is an easy, quick, and noninvasive tool, which can be helpful in visualizing minute grains and ascertain the type of mycetoma.[1] Black colored granules are highly suggestive of eumycotic mycetoma and its visualization by dermoscopy can help in early institution of definitive treatment. The dermoscopic images can also be stored and transferred electronically and an expert opinion sought through teledermoscopy.[2] Dermoscopy has been explored in the diagnosis of many pigmentary disorders, granulomatous infective diseases like leprosy and sporotrichosis.[34] The current report reinstitutes the importance of dermoscopy in diagnosis of dermatological disorders with clinico-dermoscopic-pathological correlation.[2] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

English

Involvement of the submandibular gland in actinomycotic osteomyelitis in the absence of sinus is rare. Cervicofacial form is characterized by contiguous spread, suppurative osteomyelitic & granulomatous inflammation of the mandible and formation of multiple abscesses and hallmark discharging sinuses draining serosanguinous fluid containing sulphur granules. As the imaging finding of this entity is rarely described, in this case report, a rare case of mandibular actinomycotic osteomyelitis, with a submandibular swelling, but without draining sinus is reported. The imaging findings of cone beam computed tomography (CBCT) & ultrasonography (US) of the case are discussed with a review. In subacute stage, mandibular actinomycosis may show no hallmark sinuses. Sclerotic margins around the lesion may be found on radiograph. Imaging is useful in ruling out clinical diagnostic challenge when it includes involvement of mandible & submandibular region. Cervicofacial actinomycosis commonly occurs as perimandibular infection, rarely as osteomyelitis of the mandible.1 It may present as two distinct morphological patterns; first, "lumpy jaw," and second, simulating an acute pyogenic infection affecting the submandibular area, discharging sinus being a hallmark finding.1 Other variant reported include chronic osteitis, osteolytic lesion, hard nodule on the tongue, lockjaw, periapical, or paradental abscess. Diagnosis of cases presenting in multiple areas in the absence of multiple discharging sinuses is a challenge.2 Usefulness the imaging findings are rarely enumerated. This report is of a twin presentation of a non - sinus forming actinomycotic mandibular osteomyelitis and a submandibular swelling, along with a review of various diagnostic imaging features.

Un mycétome actinomycosique pseudotumoral de la fesse chez l’enfant : une observation

Mycetoma is a rare and neglected tropical disease among children. Extrapodal forms, in particular the buttock, are serious because they expose to visceral extension. We are reporting an observation remarkable for its clinical tumor presentation in a child. An 11-year-old boy was admitted at to the dermatology department for a buttock tumor that has been evolving for 2 years. Physical examination showed a multinodular, polyfistulized, and inflammatory tumor emitting red granules located in the buttocks. Mycological examination isolated Actinomadure pelletieri that confirms the diagnosis of actinomicotic mycetoma. The evolution, after a two-year follow-up, was positive under antibiotic therapy combining cotrimoxazol, clavulanic acid amoxicillin and streptomycin. Our observation is specific by the occurrence of a pseudotumoral actinomycotic buttock mycetoma in a child, the diagnostic delay and the favorable evolution without recurrence after a follow-up of 24-month.

Imaging of disseminated actinomycosis

Imaging of disseminated actinomycosis

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: important considerations on a mimicking disease

La actinomicosis es una enfermedad infecciosa muy infrecuente de tipo crónico y supurativo que afecta al área cervicofacial e el tracto gastrointestinal. El presente trabajo tuvo como objetivo, revisar informaciones importantes en cuanto etiopatogenia, presentación clínica y tratamiento de la actinomicosis cervicofacial. Se puede clasificar de tres maneras a depender del sitio anatómico: cervicofacial (50%), torácica (30%) y abdominal (20%). Presentamos una revisión de la literatura con foco en aspectos importantes de la actinomicosis cervicofacial. Aunque micosis, la enfermedad es causada por bacterias grampositivas del género Actinomyces, siendo que A. israelli es el agente etiológico más frecuente, cuales son microorganismos comensales de la boca. Sin embargo, si la integridad de la mucosa es violada, ellos se tornan patogénicos. La actinomicosis es lentamente progresiva y frecuentemente imita otras condiciones clínicas como malignidades. El tratamiento consiste en terapia antibiótica y puede durar 12 meses en casos más graves. El conocimiento de los profesionales de salud acerca de esa enfermedad es fundamental para promover su prevención, diagnóstico precoz y tratamiento correcto.

Mycetomas in the Endemic Area of Argentina

To describe the different characteristics of mycetoma in the endemic area of Argentina and its etiological agents, using mainly data from Santiago del Estero and Salta provinces. Argentina is not considered an important endemic area, but it possesses a large documented casuistry and many non-published cases of patients. Santiago del Estero presents the greatest quantity of mycetoma cases of the country, mainly by Actinomadura madurae. The First Argentinian Mycetoma Reunion took place in 2016, which was the starting point to train medics and healthcare professionals of the province, which are the first to enter into contact with the patient. The described endemic area has very diverse climatic and ecologic characteristics. This has direct impact in the causal agents of mycetoma. Actinomycotic mycetomas by Nocardia spp. abounds in the zones with greater rain regime and sugar cane cultivation, while in arid or semi-arid zones with low rain regime, A. madurae and fungal mycetomas predominate.

Cervicofacial actinomycosis: a report of 14 patients observed at the Dermatology Unit of the University of Milan, Italy.

Actinomycoses are rare chronic infections often caused by Actinomyces spp. Cervicofacial actinomycosis (CFA) is caused by primary lesions in the oral cavity and subsequent fistulae, and suppurative and granulomatous lesions on the skin of the face. We present the results of a retrospective study on 14 patients with CFA, observed in the period 1984-2019 at the Dermatology Unit of the University of Milan. Physical general and dermatologic examinations, instrumental tests, and histopathologic and bacteriologic examinations were carried out in all patients. In three patients, polymerase chain reaction was also carried out. Six patients showed poor oral hygiene; eight patients had been subjected to previous surgical operations in the oral cavity. Histopathologic examination was superimposable in all patients. In four patients, bacteriologic examinations were positive for A. israelii. In three patients, polymerase chain reaction was positive for A. israelii. X-rays of the bones of the face showed osteolytic lesions in four patients. All patients were successfully treated with benzathine benzylpenicillin followed by amoxicillin or with amoxicillin in monotherapy. In all patients, surgical drainage and debridement of the oral cavity were carried out. CFA is a rare infection caused by primary lesions in the oral cavity and subsequent fistulae, and nodular and ulcerative lesions on the skin of the face. Clinical diagnosis must be confirmed by histopathologic, bacteriologic, and instrumental examinations. Therapy with penicillins is usually very long and must be accompanied by surgical drainage and debridement of the oral cavity.