Intraoral actinomycosis. Report of five cases

Cervicofacial actinomycosis of the mandible in a paediatric patient

Cervicofacial actinomycosis remains a rare pathogenic finding in the paediatric population. Diagnosis is challenging, as findings are often non-specific and Actinomyces species are generally difficult to culture. Treatment is a prolonged course of antibiotics, either intravenous and oral, often combined with a surgical procedure to remove the lesion. This patient had non-specific intermittent left mandibular pain for 8 months that was eventually attributed to an Actinomyces odontolyticus infection in the mandible. Diagnosis required incisional biopsy, and treatment involved 12 months of oral antibiotics.

Actinomyces-associated calcifications in a dentigerous cyst of the mandible

Actinomyces-associated lesions in the jaw, such as radicular cyst and osteomyelitis, have been reported by many authors. The lesions are caused by infection from peripheral sites and can be seen to contain Actinomyces druses on pathologic examination. To our knowledge, no previous reports have described Actinomyces-associated calcification in the jaw, although the lesions in the jaw often include druses. We report here a rare case of Actinomyces-associated calcifications in a dentigerous cyst of the mandible.

[Mandibular actinomycosis]

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.

Actinomycosis osteomyelitis of the jaws: Report of four cases and a review of the literature

Actinomycosis osteomyelitis of the jaw bones, particularly in the maxilla, is an extremely rare disease. This report presents two cases of maxillary and two cases of mandibular actinomycosis osteomyelitis, with the diagnosis particularly based on histological procedures. The highly diversified pathogenicity of the phenomenon and the absence of solid diagnostic criteria are discussed. Laboratory challenges are emphasized, and a comprehensive overview of the entity including treatment alternatives is given along with a review of the relevant literature.

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.

Immunoelectron microscopic study of Actinomyces colony in odontogenic periapical infection

A periapical Actinomyces colony was studied by immunoelectron microscopy with a specific antiserum against Actinomyces israelii. Positive as well as some negative micro-organisms were seen within the colony. Reacting antigens were localized in the cytoplasm and the cell wall of the bacteria, which suggests that more than one antigen is involved in the reactions with the present antiserum. The ultrastructural results confirmed the applicability of the peroxidase method with Actinomyces antiserum in paraffin sections for diagnostic purposes.

Comparison of fluorescent antibody technique and conventional staining methods in diagnosis of cervico-facial actinomycosis

Eight formalin-fixed and paraffin-embedded biopsies with a histopathology suggestive of actinomycosis, were tested with fluorescent antibody technique using antiserum specific against Actinomyces israelii. The method was found effective even in decalcified tissue material. Positive fluorescent staining resulted, not only in the colonies but also in the surrounding cells, suggesting the presence of intracellular Actinomyces antigens. The possibility of retrospective biopsy study is very helpful in cases of prolonged infections. Grocott's stain was found to be most effective conventional method for screening suspected actinomycosis.

Periapical actinomycosis. Report of a case and review of the literature

An analysis of actinomycosis in periapical inflammatory lesions in the English-language literature was carried out. Nineteen cases were found, and an additional case is presented. The most frequent locations for these infections were the maxillary central incisor region and the mandibular first molar region. The average age of the patients was 27.5 years, and a slight male predilection was noted. Formation of draining sinuses, local swelling, and pain were the most common presenting symptoms. Many of the cases were diagnosed following endodontic procedures, suggesting that such procedures might be responsible for introducing the organisms into the periapical tissues or that the organisms might be responsible for some cases of endodontic failure.

Actinomycosis after cyst enucleation

A case report of actinomycosis associated with bony sequestra resulting from a post-operative infection of a dental cyst in a young patient is presented. The need for careful wound debridement as a prophylactic measure is emphasized.

Actinomyces of infected dental root canals

The aim of the present study was to identity Actinomyces occurring in infected dental root canals. Out of twenty-five isolated Actinomyces strains, four were A. israelii, four were A. naeslundii, four were A. odontolyticus, and six were A. viscosus. Seven strains could be identified only as Actinomyces spp. The relative frequency of various species of Actinomyces isolated from root canals was similar to that of carious dentin. The Actinomyces strains were usually part of polymicrobial infections. These infections could usually be eliminated by one or two conventional endodontic treatments. In two cases, however, A. israelii was repeatedly isolated in pure culture from the root canals. These two infections had to be eliminated by means of periapical surgery.

Periapical actinomycosis. An unusual case report

An unusual case of actinomycosis in the oral cavity is reported. The strict anaerobic qualities of Actinomyces israelii make laboratory culturing and growing of this organism difficult. Accordingly, the diagnosis was based on the histopathologic report. Because of the atypical clinical presentation, i.e., lack of any discharging sinus tract on the skin surface, and the histopathologic reports, it was postulated that the actinomycosis was superimposed on an existing granulomatous tissue.

Actinomycosis: masquerader in the head and neck

The diagnosis of cervicofacial actinomycosis is usually not simple, but may be essential for adequate treatment. Cases seen in a Head and Neck Service illustrate some of the many guises under which actinomycosis may be concealed, and a review of recent literature confirms its propensity to be a masquerader. A combination of techniques is necessary to diagnose, and both surgical and medical approaches are needed to treat this often distressingly persistent affliction.

Cervico-facial and intra-oral actinomycosis: a 5-year retrospective study

Actinomycosis is often considered to be a rare disease in the oral region. A retrospective study of the Routine Diagnostic Services in Glasgow Dental Hospital revealed 39 cases in which actinomyces were detected, indicating that this organism is not infrequent in oral infections and may be seen in a variety of lesions.