Pediatric Cervicofacial Actinomycosis: An Unusual Cause of Head and Neck Masses

Abstract

Cervicofacial actinomycosis is an unusual cause of head and neck masses in children. This low prevalence of disease in children inevitably leads to delay in clinical recognition and often requires invasive intervention for diagnosis and curative therapy. We present an illustrative case and review cases of cervicofacial actinomycosis in the pediatric literature with particular attention to clinical presentation, course, and outcome.

Actinomyces and Related Organisms in Human Infections

“…In cases of cervicofacial actinomycosis, except for a recent report of concomitants representing the genera Capnocytophaga, Prevotella, Enterococcus, and Streptococcus, only a few, poorly defined bacterial taxa have been identified (66). Among 14 thoracic actinomycosis cases involving children, Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum were the most commonly detected organisms, being detected in 9 and 5 cases, respectively (95).…”

“…Data on pediatric cases include data from 10 case reports of cervicofacial actinomycosis, 8 of which reported the presence of concomitant organisms (66), and 14 case reports of thoracic actinomycosis, with all specimens being positive for concomitants (95). In cases of cervicofacial actinomycosis, except for a recent report of concomitants representing the genera Capnocytophaga, Prevotella, Enterococcus, and Streptococcus, only a few, poorly defined bacterial taxa have been identified (66).…”

Asymptomatic subcutaneous cervical mass due to Actinomyces odontolyticus infection in a pyriform sinus fistula

“…Actinomyces is a Gram‐positive facultative anaerobe and an endogenous flora of the oral cavity . Actinomyces infection, particularly cervicofacial actinomycosis, is rare in children . On the basis of a previous review of 17 pediatric cervicofacial actinomycosis cases, clinical features include disease development at any age in children, a higher frequency in girls, and an association with pain and fever .…”

“…Actinomyces infection, particularly cervicofacial actinomycosis, is rare in children . On the basis of a previous review of 17 pediatric cervicofacial actinomycosis cases, clinical features include disease development at any age in children, a higher frequency in girls, and an association with pain and fever . Clinical diagnosis is reached on histopathological confirmation of typical sulfur granules, positive culture, and/or isolation of Actinomyces species .…”

“…On the basis of a previous review of 17 pediatric cervicofacial actinomycosis cases, clinical features include disease development at any age in children, a higher frequency in girls, and an association with pain and fever . Clinical diagnosis is reached on histopathological confirmation of typical sulfur granules, positive culture, and/or isolation of Actinomyces species . Although the most predominant organism was A. israelii , only one patient reported A. odontolyticus infection as the cause .…”