Cervicofacial Actinomycosis in Children

Abstract

Actinomycosis is caused by Actinomyces spp., which are Gram-positive, non-acidfast, pleomorphic, non-spore-forming rods. They require anaerobic or microaerophilic environments for growth, and demonstrate branching, often appearing as beaded filaments [5,6]. Gram stain shows varying morphology from diphtheria bacillus-like appearance to a mycelial structure. The organisms are members of the Actinomycetales order, Actinomycetaceae family, Actinomyces genus [2]. Mycobacteria and Nocardia are also included in the Actinomycetales order, and histopathological and clinical differential diagnosis with the members of Actinomyces genus is sometimes difficult [1][2][3].Genus Actinomyces and the very closely related genus Nocardia were previously considered fungi [1,2]. The word Actinomyces means "ray-fungus," and the organisms resemble fungi because of their filamentous appearance. However, Actinomyces spp. are typical bacteria due to the structural features and antimicrobial drug susceptibility. They have much narrower filaments than the hyphae of the fungi. While the filaments of Actinomyces are easily fragmented, the tubular hyphae of the molds do not split and exhibit different branching patterns. Reproduction of Actinomyces is by binary fission, while fungi reproduce by spore and bud formation [2][3][4].Actinomyces spp. are natural members of the oropharyngeal, gastrointestinal, and genitourinary system microbiota [1,5,7]. Dental plaques, carious teeth, periodontal pockets, gingival crevices, tonsillar crypts, and saliva are colonized by Actinomyces species [8,9]. In a pediatric study performed on tonsillectomy tissue, Actinomyces colonization was detected at a rate of 12% [10].Twenty-six of the 49 known Actinomyces species have been implicated in human infections [7]. Actinomyces israelii is the most frequent cause of human disease, and Actinomyces gerencseriae, Actinomyces graevenitzii, Actinomyces meyeri, Actinomyces naeslundii, Actinomyces neuii, Actinomyces odontolyticus, Actinomyces radicidentis, Actinomyces radingae, Actinomyces turicensis, and Actinomyces viscosus were reported as the other leading Actinomyces species causing disease in humans [1,2,6,8]. Although A. israelii is the leading cause of actinomycosis, A. odontolyticus and A. naeslundii are the most common colonizing species in the oral cavity of children [11]. While Actinomyces bovis causes the disease known as "lumpy jaw" in cattle, it has been identified only in a single human case due to possible transmission via a lamb bite [12]. A study conducted in Germany found that A. israelii (42.0%) and A. gerencseriae (26.7%) were the most common species in 1997 culture-positive cases of human cervicofacial actinomycoses [13].Actinomyces spp. are co-pathogens, and require other bacteria to multiply, explaining why they are commonly found in tissues harboring other aerobic and/or anaerobic species. Thus, Actinomyces species are frequently isolated from clinical specimens together with other bacteria of the polymicrobial microbiota. They synergistically inh...

A rare case of actinomycosis in routine fnac of the face in a tertiary care center in Central India

“…2 Cervicofacial swellings are the most common manifestation of actinomycosis accounting for 50-70% the of reported cases. 11 The incidence of the disease is greater in males along with the mean age group of 40 to 50 years. 4 This is in line with our case as the site is the root of the nose of a 38-year-old male.…”