Cervicofacial Actinomycosis

Cervicofacial Actinomycosis

Write a short note on cervicofacial actinomycosis.
Answer:

Cervicofacial actinomycosis is a chronic granulomatous suppurative and fibrosing disease caused by anaerobic or microaerophilic, Gram-positive, non-acid fast, branched filamentous bacteria.

Cervicofacial actinomycosis Pathogenesis

The infection enters from the tonsils, carious teeth, periodontal disease or trauma following tooth extraction. A firm swelling develops in the lower jaw.

There is the presence of initial acute inflammation followed by a chronic indolent phase. The lesion appears as single Or multiple induration.

Cervicofacial actinomycosis Clinical Features

• Commonly seen in adult males.
• The submandibular region is commonly infected.
• Trismus is the common feature that is present.

Cervicofacial actinomycosis

Cervicofacial actinomycosis Laboratory Diagnosis

• Biopsy: Biopsy from the lesional tissue is taken and is assessed microscopically. On microscopic examination, the following features are seen:
  • There is the presence of a granuloma with central suppuration.
  • There is a formation of an abscess in the center of the lesion and at the periphery are seen chronic inflammatory cells, giant cells, and fibroblasts.
  • The center of each abscess contains a bacterial colony ‘sulfur granule’ characterized by radiating filaments with hyaline, eosinophilic, club-like representatives of secreted immunoglobulins.

Actinomycosis oral cavity

• Microscopy: Pus from the lesion is collected. Pus is withdrawn with a capillary pipette. Granules may also be obtained by applying gauze pads over the discharging sinuses. The granules are white or yellowish and range in size from minute specks to about 5 mm. They are examined microscopically under a coverslip. They are crushed between the slides and stained by Gram stain and examined. The granules are bacterial colonies that are found to consist of dense networkofthinGram-positive filaments surrounded by a peripheral zone of swollen radiating club-shaped structures presenting a sun ray appearance. Clubs are Gram-negative, acid-fast, and are of host origin.
• Staining: By Gomori’s methenamine silver stain the organism stain positively.
• Culture: Sulphur granules or pus-containing actinomycetes are washed and inoculated into thioglycollate liquid medium or streaked on brain-heart infusion agar and incubated anaerobically at 37 °C. In thioglycollate, A bovis produces general turbidity whereas A. israelii grows as fluff balls at the bottom of the tube.