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Cervicofacial Actinomycosis in the Pediatric Population: Presentation and Management
Karan Gandhi1, Benjamin D van der Woerd1,2, M Elise Graham1,2,3
1Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Background:
Infection caused by Actinomyces species is a rare cause of head and neck infection in children. This chronic cervicofacial infection can present with localized swelling, abscess formation, sinus drainage and can be complicated by osteomyelitis.
Methods:
Presented are 2 pediatric cases of secondary actinomycosis in the context of congenital lesions: 1 patient with a previously excised preauricular sinus and another with a persistent sublingual mass. A comprehensive literature search was conducted for reported cases of pediatric actinomycosis in the cervicofacial region.
Results:
Both cases presented were successfully treated with a combination of complete surgical excision of the lesions and prolonged antibiotic therapy. Thirty-four pediatric cases of cervicofacial actinomycosis are reviewed, 2 presented herein, and 32 from the published literature. There was equal gender distribution and the median age was 7.5 years. The most common site for infection was the submandibular area. Four (12%) of cases arose in pre-existing congenital lesions. Most patients were treated with penicillin-based antibiotics for a median duration of 6 months following surgical excision or debridement.
Conclusions:
Actinomycosis is a rare infection of the cervicofacial region; secondary infections arising from congenital lesions of the head and neck are even more rare. A previously excised pre-auricular sinus and a sublingual dermoid cyst are not previously reported sites of infection. Actinomycosis should be suspected in chronically draining sinuses of the head and neck region and confirmed through anaerobic culture. Osteomyelitis is a potential complication and magnetic resonance (MR) imaging is warranted. Long-term antibiotic therapy with a penicillin-based antibiotic and surgical excision should be considered.
Insights
Actinomycosis is a rare head and neck infection in children, often stemming from congenital lesions. Successful treatment involves surgery and long-term antibiotics, particularly for chronic sinus infections.
Area of Science:
- Pediatric infectious diseases
- Head and neck surgery
- Microbiology
Background:
- Actinomycosis is an uncommon cause of pediatric head and neck infections.
- Cervicofacial actinomycosis can manifest as swelling, abscesses, and sinus drainage, potentially leading to osteomyelitis.
Observation:
- Two pediatric cases of secondary actinomycosis associated with congenital lesions (preauricular sinus, sublingual mass) are presented.
- A literature review identified 32 additional pediatric cases of cervicofacial actinomycosis.
Findings:
- The median age of affected children was 7.5 years, with equal gender distribution.
- The submandibular area was the most frequent infection site (12% arose from congenital lesions).
- Treatment involved surgical excision and prolonged (median 6 months) penicillin-based antibiotic therapy.
Implications:
- Secondary actinomycosis from congenital head and neck lesions is rare, with preauricular sinus and sublingual dermoid cysts being novel reported sites.
- Suspect actinomycosis in chronic head and neck sinus drainage, confirm with anaerobic culture.
- Consider osteomyelitis and use MRI; long-term antibiotics and surgery are recommended treatments.
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