Pediatric Cervicofacial Actinomycosis: Lessons From a Craniofacial Unit.

Area of Science:

• Medical Microbiology
• Pediatric Infectious Diseases
• Systematic Reviews

Background:

• Actinomycosis is a rare bacterial infection, often challenging to diagnose and treat, particularly in pediatric populations.
• Recent cases prompted a review to establish evidence-based best practices for managing pediatric actinomycosis.

Purpose of the Study:

• To systematically review and synthesize evidence on the diagnosis, management, and outcomes of actinomycosis in children.
• To identify factors influencing treatment success and disease chronicity in pediatric cases.

Main Methods:

• A systematic review adhering to PRISMA methodology was conducted.
• Data were extracted from 23 case series, describing 33 pediatric patients.
• Statistical analyses were performed to assess correlations between variables like diagnostic delay, bony involvement, and surgical burden.

Main Results:

• The study included 33 children (mean age 8 years; 55% female), with 20 cases involving bone (primarily mandible) and 13 involving cervicofacial soft tissue.
• Median diagnostic delay was 12 weeks, and median antibiotic therapy duration was 17 weeks.
• Bony involvement correlated with a higher number of surgical procedures and a trend towards residual infection; neither diagnostic delay nor surgery number impacted infection-free outcomes.

Conclusions:

• Effective management of pediatric actinomycosis hinges on aggressive surgical debridement and extended antibiotic courses, not solely on reducing diagnostic delays or surgical interventions.
• Mandibular actinomycosis presents a significant surgical challenge and potential for chronicity, underscoring the need for preventative strategies focused on pediatric oral hygiene.