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Cervicofacial actinomycosis in children
1Department of Otolaryngology, Henry Ford Hospital, Detroit, MI 48202.
Abstract:
Actinomycotic infections, once common in humans and cattle, are now rare causes of disease in man. This general group of organisms belongs taxonomically between the true bacteria and the fungi; however, the organisms behave clinically like true anaerobes. The organism, although phagocytized by the host cells, is not killed. Therefore, it is defined as a facultative intracellular parasite of the host. The protean manifestations of actinomycotic infections often mimic infectious processes, such as osteomyelitis or granulomatous disease, as well as neoplasia. It is therefore important for the surgeon to include actinomycosis in the differential diagnosis of cervicofacial masses in children as well as in adults. Being an anaerobe, the organism is difficult to culture and the diagnosis must be considered at the time of biopsy of a cervicofacial mass or when culturing a sinus tract. A case of a 12-year-old girl seen at Children's Hospital of Los Angeles prompted the review of our experience with this disease. In this child, actinomycosis presented as an expansile mass in the mandible. From 1956 to 1986, five children were treated for cervicofacial actinomycosis. Detailed case analysis, pathophysiology, clinical characteristics, and current treatment recommendations are presented.
Insights
Actinomycosis, a rare infection caused by anaerobic bacteria, presents diverse symptoms mimicking other diseases. Early diagnosis through biopsy is crucial for effective treatment of these facultative intracellular parasites.
Area of Science:
- Microbiology
- Infectious Diseases
Background:
- Actinomycotic infections, historically common, are now rare in humans.
- The causative organisms are taxonomically positioned between bacteria and fungi, exhibiting anaerobic behavior.
- These organisms are facultative intracellular parasites, evading host cell destruction.
Observation:
- Actinomycosis presents with varied clinical manifestations, often resembling osteomyelitis, granulomatous disease, or neoplasia.
- Cervicofacial masses in both children and adults necessitate considering actinomycosis in differential diagnoses.
- Diagnosis can be challenging due to the organism's anaerobic nature and difficulty in culturing, often requiring biopsy or sinus tract culture.
Findings:
- A review of five pediatric cases of cervicofacial actinomycosis treated between 1956 and 1986 is presented.
- One case involved a 12-year-old girl with an expansile mandibular mass due to actinomycosis.
- The study details the pathophysiology, clinical characteristics, and treatment of cervicofacial actinomycosis.
Implications:
- Highlights the importance of including actinomycosis in the differential diagnosis of cervicofacial masses.
- Emphasizes the diagnostic challenges and the need for timely consideration during biopsy or culture.
- Provides insights into the management of this rare but potentially serious infection.