A case of actinomycosis causing unilateral tonsillar hypertrophy

Clinical parameters predicting tonsillar malignancy

PURPOSE

Tonsillectomy is indicated in unilateral tonsillar enlargement (UTE) to rule out malignancy, which eventually is found in about 1.4% of the patients. The aim of this study was to evaluate the presenting symptoms of patients who underwent tonsillectomy for UTE and identify parameters that are associated with an increased risk for malignancy, for better assessment and refinement of current management protocols.

METHODS

A retrospective chart review of adult patients with UTE who underwent tonsillectomy between 1/1/2006 and 31/12/2016 was conducted.

RESULTS

Forty-one patients with a median age of 53 years were included. There were 20 (49%) females and 21 (51%) males. Sixteen (39%) patients were diagnosed as having tonsillar malignancy. Patients with malignancy were older than those in the benign group (p = 0.001), had a previous malignancy (p = 0.006), and were less likely to present as an incidental finding (p < 0.001). Lymphadenopathy, throat pain, suspicious appearance of tonsillar mucosa, and hard consistency were also found to be statistically significant findings in the malignancy group (p = 0.017, p = 0.001, p = 0.01 and p = 0.018, respectively). Multivariable regression showed age, appearance and adjacent tissue involvement to be independently with malignancy.

CONCLUSIONS

UTE alone, as an incidental finding, should not be regarded as an indication for tonsillectomy, as the risk for malignancy is low and the morbidity is significant. We suggest integrating the above-mentioned clinical parameters in the decision-making process, which were found to be significantly more frequent in the malignant group.

Relation of Actinomyces with Tonsillar Hypertrophy and Antibiotic Use

Objective

This study aimed to investigate the incidence of Actinomyces in tonsillar tissues of patients undergoing tonsillectomy and to determine the association among tonsillar volume, preoperative antibiotic use, and presence of Actinomyces in tonsil tissues.

Methods

In this study, 142 patients who underwent tonsillectomy in last four years were included. Of the total patients, 97 (66.9%) were children and 47 (33.1%) were adults. The patients' age, sex, preoperative antibiotic use, tonsillar volume, and presence of actinomyces in tonsillar tissues were recorded.

Results

Actinomyces was identified in tonsillar tissues of 16 (16.4%) pediatric and 21 (44.6%) adult patients. Of all pediatric patients positive for Actinomyces, 13 were males and three were females whereas of all adult patients positive for actinomyces, 14 were males and seven were females. Tonsillar tissue volumes in both pediatric and adult patients positive for Actinomyces were statistically higher than the Actinomyces negative ones. Antibiotic use was higher and the incidence of Actinomyces was lower in pediatric patients than in adult patients positive for Actinomyces.

Conclusion

Our study results revealed that Actinomyces was prominent in adult patients with tonsillar hypertrophy. In addition, the frequent use of antibiotic decreased the incidence of Actinomyces in tonsillar tissues.

Actinomyces and related organisms in human infections

Actinomyces israelii has long been recognized as a causative agent of actinomycosis. During the past 3 decades, a large number of novel Actinomyces species have been described. Their detection and identification in clinical microbiology laboratories and recognition as pathogens in clinical settings can be challenging. With the introduction of advanced molecular methods, knowledge about their clinical relevance is gradually increasing, and the spectrum of diseases associated with Actinomyces and Actinomyces-like organisms is widening accordingly; for example, Actinomyces meyeri, Actinomyces neuii, and Actinomyces turicensis as well as Actinotignum (formerly Actinobaculum) schaalii are emerging as important causes of specific infections at various body sites. In the present review, we have gathered this information to provide a comprehensive and microbiologically consistent overview of the significance of Actinomyces and some closely related taxa in human infections.

The role of the actinomyces in obstructive tonsillar hypertrophy and recurrent tonsillitis in pediatric population

OBJECTIVE

To determine the prevalence of tonsillar Actinomyces in subjects with recurrent tonsillitis and those with obstructive tonsillar hypertrophy, and to determine the association between the presence of Actinomyces and tonsillar volume, and crypt abscess.

SUBJECTS AND METHODS

A prospective designed cross-sectional study consisted of 90 children subjects who underwent tonsillectomy or adenotonsillectomy for recurrent tonsillitis and obstructive tonsillar hypertrophy. The subjects of recurrent tonsillitis (Group A) and obstructive tonsillar hypertrophy (Group B) were compared to the presence of Actinomyces. The relationship between the presence of Actinomyces and the presence of crypt abscess, and tonsillar volume were also compared.

RESULTS

Actinomyces was found to be significantly more prominent in obstructive tonsillar hypertrophy group (61.5%) compared to recurrent tonsillitis group (26.6%) (p<0.001). Additionally, the mean tonsillar volume was significantly higher in tonsils with Actinomyces than those without (p<0.001). The histopathological study revealed that there was no significant inflammatory response to the existence of Actinomyces.

CONCLUSION

According to the presented study, Actinomyces was seen more prominent in subjects with obstructive tonsillar hypertrophy compared those with recurrent tonsillitis. Furthermore Actinomyces had a pathological influence on tonsil size. This study showed there was a significant relation between Actinomyces and enlargement of tonsillar tissue. However, how causes tonsillar hypertrophy is not understood yet in tonsillar disease.

[Laryngeal and pharyngeal actinomycosis]

Cervicofacial actinomycosis is an uncommon infection and in most cases odontogenic in origin. Pharyngeal and/or laryngeal lesions, usually occurring secondary to mucosal trauma, are very rare and may mimic a malignant tumor. In such cases, which represent less than 1% of all cases, the differential diagnosis with upper aerodigestive tract malignancy remains challenging. We report a case of actinomycosis in a 56-year-old male patient who presented with an extensive, centrally necrotic mass in the oropharynx, hypopharynx and larynx region suspected to be a tumor. The lesion was diagnosed 6 months following accidental ingestion of an ear of corn and ultimately proved to be cervicofacial actinomycosis. The clinical and pathological features and current aspects of the diagnosis and treatment of cervicofacial actinomycosis are discussed.

A case of an unilateral tonsillar hypertrophy caused by actinomycosis

The purpose of this report was to present an unusual case of an unilateral tonsillar hypertophy caused by actinomycosis. It is an infrequent bacterial infection nowadays. Only five such cases have been reported up to now. Diagnosis is difficult, because there are not specific diagnostic procedures. Medical treatment consists of surgical excision of tonsils and postoperative antibiotic therapy.