[Cervicofacial actinomycosis: report of a case]

Actinomycotic infection involving the head and neck is not commonly diagnosed and is often a diagnostic enigma to the otolaryngologist. The reasons for this are due to the infrequency of this disease itself, the current general lack of familiarity with this disease and the pronounced sensitivity of actinomyces organisms to most of the common antibiotics in current use. The case reported here is fairly typical of cervicofacial actinomycosis. A 26-year-old man suffering from trismus and a noncharacteristic mass over the right parotidomasseteric region for one month after a lower molar tooth was extracted presented at our hospital. There were many yellowish gritty "sulfur granules" found within the pus when surgical drainage was made. Immediate Gram stain examination of these granules showed numerous filamentous Gram-positive bacilli, some of which showed true branching. Bacterial culture grew only an anaerobic organism which was identified as Actinomyces israelii by biochemical tests. This patient improved after further treatment with intensive intravenous penicillin injections for ten days and prolonged oral tetracycline treatment for two months. We suggest that increased alertness of clinicians and microbiologists to the presence of anaerobic organisms as the cause of cervicofacial infections could result in an earlier and more frequent diagnosis of actinomycosis.