Introduction:
Actinomycosis is a chronic infectious disease with worldwide distribution caused by microaerophilic and anaerobic bacteria in the oral cavity. Actinomycosis is often difficult to diagnose as the condition can mimic numerous noninfectious and infectious diseases. It is usually caused by the bacterium called Actinomyces Israelii. This is the organism found in the throat and nose, but they do not cause any disease in normal conditions. Because of its usual location in the nose and throat, this condition affects the face and neck.
What Is Cervicofacial Actinomycosis?
In cervicofacial actinomycosis is the most common form of rare disease. The common site involved includes the cheek, parotid gland, submandibular space, nasal cavity, tongue, teeth, gingival and oral space. The occurrence is slightly high in males. It is an endogenous infection, and it is not transmitted from person to person; it usually occurs in immunocompetent persons but can occur in individuals with diminished host defense.
What Causes Cervicofacial Actinomycosis?
Individuals who are immunocompetent are more likely to get this condition. Poor dentition, recent dental manipulation, otitis, and chronic tonsillitis are important factors for these infections. Immunosuppression and debilitating factors like steroid therapy, pregnancy, diabetes, or cancer are predisposing factors. External trauma can also lead to actinomycosis in the head and neck region. Young people are more susceptible, and men are more affected than women. It is mainly caused by bacterial infection of the actinomyces family.
What Are the Signs and Symptoms of Cervicofacial Actinomycosis?
In cervicofacial actinomycosis, most of the mouth is infected; this can cause a “lumpy jaw.”
A hard lump is felt in the jaw; it is typically painful. This can result in a painful skin abscess that initially appears as a reddish bruise at the site. Cervicofacial actinomycosis can cause a muscle spasm in the jaw known as a “locked jaw.” In this condition, the mouth fails to open in a normal way.
Other symptoms of cervicofacial actinomycosis are:
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Lumps on face and neck.
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Weight loss.
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Chest pain.
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Excess sinus drainage.
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Draining sores on the skin.
What Are the Risk Factors of Cervicofacial Actinomycosis?
The risk factors of Cervicofacial actinomycosis are:
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Damaged immune system from medication or other illnesses.
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Negligence of dental hygiene and care after a trauma or oral surgery to the mouth or jaw.
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Any recent history of oral abscess should be diagnosed and treated immediately; negligence in such cases can lead to cervicofacial actinomycosis.
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Women who use intrauterine devices for birth control are more likely at higher risk of getting cervicofacial actinomycosis.
How Is the Diagnosis Done for Cervicofacial Actinomycosis?
The diagnosis of cervicofacial actinomycosis is done in the following ways:
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Blood Test: Complete blood count is done; anemia and mild leukocytosis are common.
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Erythrocyte Sedimentation Rate- ESR and C-reactive levels are often high.
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Culture Test: Clinical specimens taken to identify typical organisms from sulfur granules are necessary for a definitive diagnosis in many cases.
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PCR Test: Polymerase chain reaction is done to develop more accurate and rapid identification.
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Chest Radiography: A x-ray can reveal a poorly defined mass or cavitary lesions, or pneumonitis. Hilar adenopathy is uncommon.
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CT Scan (Computed Tomography Scan): Usually reveals infiltrative mass with focal areas of decreased attenuation.
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CT Scan With FNAC (Fine needle aspiration cytology): CT scan with guided fine needle aspiration is usually performed for a successful diagnosis.
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Biopsy: Biopsy is done to obtain clinical material for diagnosis.
What Is the Treatment for Cervicofacial Actinomycosis?
Antibiotics:
Especially antibiotics like penicillin for the main cornerstone for treating cervicofacial actinomyces. The organisms causing the condition are susceptible to b lactam antibiotics.
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Initial treatment starts with high-dose penicillin therapy along with wide surgical excision of the infected tissue and then long-continued penicillin therapy of two to five million IU per 12-18 months after excision.
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Long-term antibiotic therapy eradicates signs and activity of the diseases and precludes reactivation.
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Another approach is three to six weeks of oral antibiotic therapy along with surgical drainage is curative for cervicofacial actinomycosis.
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In advanced cases where the individuals do not respond to the penicillin therapy, alternative therapy with sulfa drugs like Sulfamethoxazole. In cases with unresponsiveness to antibiotic therapy and aggressive lesions involving the orbital region, the antibiotic Bactrim is recommended.
Surgery:
Surgical therapy is often indicated for the resection of necrotic tissue, curettage of bone, excision of a sinus tract, and drainage of the abscess. The surgical approach, excision, remains a fundamental therapy for soft tissue tumors. It is at least a resolutive approach in cases of unresponsiveness to antimicrobial therapy.
What Steps Can Be Taken to Prevent Cervicofacial Actinomycosis?
There are no specific measures to be taken to prevent actinomycosis. Maintenance of good personal or dental hygiene, and in particular, maintaining oral hygiene, and removal of dental plaque, reduces the density and incidence of colonization and low-grade periodontal infection with actinomyces species.
What Is the Differential Diagnosis of Cervicofacial Actinomycosis?
The differential diagnosis of cervicofacial actinomycosis are:
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Osteomyelitis: A condition that causes inflammation of bone that results from infection, generally in the arm, spine, and legs.
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Carcinoma: It is a type of cancer that starts in cells of the tissue lining organs and the cells that make up the skin, like kidneys and liver. In this condition, the proliferation of abnormal cells occurs without control.
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Abscess: It is a confined sac or pocket of pus that collects over the organs, tissues, or spaces inside the body. It can be painful and lead to severe infections.
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Tuberculosis: It is a potentially serious condition caused by infectious bacteria and mainly affects the lungs.
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Fungal Disease: Any infection or disease that is caused by fungus is a fungal disease.
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Congenital Anomalies: Medical conditions that are inherited before birth.
Conclusion:
Cervicofacial actinomycosis is a unique polymicrobial infection of endogenous origin that displays diseased conditions ranging from acute suppurative lesions to a chronic fibrotic process that leads to malignancy. An appropriate diagnosis has a significant impact on the diagnosis of cervicofacial actinomycosis, a great masquerade of the neck and head disease. A bacteria’s negative culture test does not exclude the diagnosis of the disease. Though surgery plays an important role in the diagnosis and treatment, recurrence following surgery alone is common and in wide excision of the lesion in morbidity.
