- Abdu A Sharkawy, MD, FRCPC
Abdu A Sharkawy, MD, FRCPC
- Assistant Clinical Professor of Medicine
- Division of Infectious Diseases
- University of Toronto
- Anthony W Chow, MD, FRCPC, FACP
Anthony W Chow, MD, FRCPC, FACP
- Professor Emeritus of Medicine
- University of British Columbia
Cervicofacial actinomycosis is a chronic disease characterized by abscess formation, draining sinus tracts, fistulae, and tissue fibrosis. It can mimic a number of other conditions, particularly malignancy and granulomatous disease, and should be included in the differential diagnosis of any soft tissue swelling in the head and neck. Cervicofacial involvement is the most common manifestation of actinomycosis, accounting for 50 percent of all cases, while central nervous system, thoracic, abdominal, and pelvic actinomycosis occur less frequently [1,2].
Cervicofacial actinomycosis will be reviewed here. Ileocecal actinomycosis and actinomycosis related to intrauterine devices are discussed separately. (See "Abdominal actinomycosis" and "Intrauterine contraception: Devices, candidates, and selection".)
Cervicofacial actinomycosis is caused by branching gram-positive bacteria belonging to the order Actinomycetales, family Actinomycetaceae, genus Actinomyces . Of note, both Mycobacteria and Nocardia species also belong to the same order, and infections caused by these microbes may at times be difficult to distinguish from Actinomyces . Actinomycosis was originally described in 1878 by Israel  and later by Wolfe , who isolated the causative organism and defined its anaerobic nature .
Actinomyces are non-spore-forming, strict or facultative anaerobes with a variable cellular morphology, ranging from diphtheroidal to coccoid filaments (picture 1). They are normal constituents of the oral flora within gingival crevices and tonsillar crypts and are particularly prevalent in periodontal pockets, dental plaques, and on carious teeth . (See "Deep neck space infections".)
Distinguishing features from fungi — The name actinomycosis literally translates as "ray fungus" and reflects its filamentous, fungal-like characteristic appearance in infected tissues. However, Actinomyces are true bacteria with filaments much narrower than fungal hyphae. While actinomycotic filaments readily fragment into bacillary forms, tubular hyphae of molds never fragment and exhibit distinct branching patterns. Another distinguishing feature between actinomyces and fungi is the method of reproduction, which occurs by binary fission in Actinomyces and not by spore formation or budding as in fungi .
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- Distinguishing features from fungi
- Growth characteristics
- Infecting species
- Coinfecting organisms
- Sulfur granules
- Predisposing conditions
- CLINICAL MANIFESTATIONS
- Pitfalls in the diagnosis
- Definitive diagnosis
- - Culture
- - Histology
- - Monoclonal antibody staining
- - Molecular techniques
- SUMMARY AND RECOMMENDATIONS