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Actinomycosis is an uncommon, chronic, bacterial infection that induces both suppurative and granulomatous inflammation [1]. The diagnosis of actinomycosis is challenging because the infection is rare, insidious, chronic, has nonspecific symptoms and imitates more common conditions such as malignancy and TB. This article reviews the diagnostic pitfalls of actinomycosis.
Localized swelling with suppuration, abscess formation, tissue fibrosis and draining sinuses characterize actinomycosis [1,2]. Actinomycosis generally spreads through contiguous extension and forms draining sinuses that produces 'sulfur granules.'These are characteristic but not pathognomonic to actinomycosis. The most common infections are of the oral and cervicofacial regions [2,3]; but any location in the body can be affected [1-4]. Other regions that are often affected are the thoracic region, abdominal-pelvic region and the CNS. Musculoskeletal and disseminated disease can also be rarely seen.
Actinomyces species are agents of low pathogenicity that require disruption of the mucosal barrier to cause disease. Infections of the oral and cervicofacial areas usually are associated with dental infections (i.e., caries and extractions, infection in erupting secondary teeth, gingivitis and gingival trauma), chronic head and neck infections (i.e., tonsillitis, otitis and mastoiditis) and systemic conditions that evolve reduced immunity (i.e., diabetes mellitus, immunosuppression, malnutrition, local tissue damage caused by surgery, neoplastic disease, or irradiation, steroid use and human immunodeficiency viral infections) [5,6]. Lung infections usually happen after oropharyngeal or gastrointestinal secretions aspiration [6,7]. Gastrointestinal infection generally occur after mucosal breach, following surgery, diverticulitis, appendicitis, trauma or foreign bodies [7,8]. The presence of intrauterine contraceptive devices was linked with the development of female genital tract actinomycotic infection [9,10].
Actinomyces species infection is often polymicrobial evolving other bacterial species. These organisms may be copathogens and assist in the infection spread through host defenses inhibition and reduction of local oxygen tension. After Actinomyces species is locally established, it disseminates to surrounding tissues in a progressive manner that ignores tissue planes, producing a chronic, indurated, suppurative infection that is frequently associated with draining sinuses and fibrosis, mostly in infections of the pelvic and abdominal regions [1]. Prior to suppuration the infection can be confused with a neoplasm because the fibrotic walls of the mass are 'wooden'in nature. Hematogenous spread can be fulminant, but is rare [2].
Cervicofacial infection evolves as a chronic or subacute painless or painful...