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Background Actinomycoses are rare chronic infections often caused by Actinomyces spp. Cervicofacial actinomycosis (CFA) is caused by primary lesions in the oral cavity and subsequent fistulae, and suppurative and granulomatous lesions on the skin of the face. Methods We present the results of a retrospective study on 14 patients with CFA, observed in the period 1984-2019 at the Dermatology Unit of the University of Milan. Physical general and dermatologic examinations, instrumental tests, and histopathologic and bacteriologic examinations were carried out in all patients. In three patients, polymerase chain reaction was also carried out. Results Six patients showed poor oral hygiene; eight patients had been subjected to previous surgical operations in the oral cavity. Histopathologic examination was superimposable in all patients. In four patients, bacteriologic examinations were positive for A. israelii. In three patients, polymerase chain reaction was positive for A. israelii. X-rays of the bones of the face showed osteolytic lesions in four patients. All patients were successfully treated with benzathine benzylpenicillin followed by amoxicillin or with amoxicillin in monotherapy. In all patients, surgical drainage and debridement of the oral cavity were carried out. Conclusion CFA is a rare infection caused by primary lesions in the oral cavity and subsequent fistulae, and nodular and ulcerative lesions on the skin of the face. Clinical diagnosis must be confirmed by histopathologic, bacteriologic, and instrumental examinations. Therapy with penicillins is usually very long and must be accompanied by surgical drainage and debridement of the oral cavity.

Members of the Actinomyces genus are saprophytic components of the normal microbiota of humans. Actinomyces spp.infections are considered to be rare, with cervicofacial infections (frequently called as ‘lumpy jaw syndrome’) describedas the most prevalent type in the clinical practice. Actinomycoses may resemble other pathologies, such as solid tumorsor other infectious processes. These infections are characterized by a slowly progressing infection, with non-specificsymptoms. The clinical diagnosis of actinomycosis may be difficult and it requires a plethora of clinical, microbiologicaland histopathological examination methods. The aim of this review is to summarize current advances on the clinical features,diagnostics and therapy of cervicofacial Actinomyces infections for dental specialists.

Members of the Actinomyces genus are non-spore-forming, anaerobic, and aerotolerant Gram-positive bacteria that are abundantly found in the oropharynx. They are the causative agents of actinomycosis, a slowly progressing (indolent) infection with non-specific symptoms in its initial phase, and a clinical course of extensive tissue destruction if left untreated. Actinomycoses are considered to be rare; however, reliable epidemiological data on their prevalence is lacking. Herein, we describe two representative and contrasting cases of cervicofacial actinomycosis, where the affected patients had distinctively different backgrounds and medical histories. Identification of the relevant isolates was carried out using matrix-assisted laser desorption/ionization mass spectrometry; antimicrobial susceptibility was performed using E-tests. Cervicofacial actinomycoses are the most frequent form of the disease; isolation and identification of these microorganisms from relevant clinical samples (with or without histological examination) is the gold standard for diagnosis. The therapy of these infections includes surgical debridement and antibiotic therapy, mainly with a penicillin-derivative or clindamycin.

Actinomycoses, a rare bacteriological illness whichis primarily involved in cervico-facial infections in susceptible populations. Thoracic, abdominal, pulmonary and cardiac involvement are also reported but are exceedingly rare in incidence. So, high degree of suspicion is required for early detection and treatment.We confirmed 2 cases of Actinomycosis, in the period of January, 2014 to July, 2015 with variable presentation and different outcome.J MEDICINE January 2017; 18 (1) : 47-51

Actinomycosis and nocardiosis are uncommon pulmonary infections with distinct morphologic features. Both infections most commonly present as chronic, debilitating illnesses with radiographic manifestations simulating lung cancer or tuberculosis. Immunocompromised hosts, however, may develop fulminant disease resembling acute bacterial pneumonia. The purpose of this review is primarily to review the clinical features, diagnosis, and management of actinomycosis and nocardiosis.Treatment of actinomycosis is usually simple, requiring long-term, high-dose intravenous penicillin. Short-course chemotherapy, however, has recently been reported to be successful. Pulmonary nocardiosis is an important cause of opportunistic infection in immunosuppressed patients, and the incidence of this infection is increasing. The sulfonamides are still first-line agents in the management of nocardiosis, but resistance is most common among N. farcinica and N. otitidiscaviarum isolates. Carbapenems should be used as an alternative treatment for severely ill patients. Broth microdilution, E-test (AB Biodisk, Solna, Sweden) and BACTEC (Becton Dickinson, Sparks, Maryland, USA) radiometric method may be more useful in the routine clinical laboratory for antimicrobial testing of aerobic actinomycetes.The practical distinction between the two diseases is in the matter of therapy. Diagnosis depends on a high degree of suspicion so as to alert the microbiology and pathology laboratories to employ special methods to identify the organisms. Early recognition and prompt treatment usually results in complete cure.

Mycetomas are chronic, subcutaneous infections characterized by a clinical triad of chronic induration, draining sinuses, and discharge of granules. The granules are composed of colonies of either actinomycotic bacteria or eumycotic fungi. The infection develops after traumatic inoculation with contaminated soil and progresses to adjacent tissues or bone. The foot, hand, and lower-leg regions are the most commonly affected areas. Treatment can be difficult and includes surgical debridement with prolonged antibiotic or antifungal treatment. Mycetomas are primarily found in tropical and subtropical areas of the world and are relatively rare in the United States. A case of indigenously obtained actinomycoses that was successfully treated with surgical resection and long-term antibiotic therapy is presented. This case is unique because of the rarity of contracting this type of infection in the United States. Mycetomas have been reported in southern states, but there are no reported cases of obtaining this pathogen in Michigan. This case stresses the need for clinical suspicion of this rare dermatosis, especially considering the increase in immigration to the United States.

Actinomycosis is an uncommon disease caused by actinomycoses, which is a normal flora in the human mucosal membrane. It is difficult to diagnose pre- and intra-operatively and requires long-term use of antibiotics even after surgery. Especially, abdominal actinomycosis is frequently misdiagnosed as a tumor, diverticulitis, chronic inflammatory disease, or other infectious disease preoperatively. Thus, we report the case of a 21-yr-old male patient who was thought to have acute appendicitis and who underwent a cecal wedge resection, including the appendix, with the assistance of laparoscopy for appendiceal actinomycosis.

A case of pulmonary actinomycosis due to Actinomyces naeslundi in a 20-year-old woman is described. She is the first patient in whom this agent has been shown to be pathogenic for man. The resulting empyema responded to therapy but decortication was required.