[Oral and cervicofacial actinomycosis. Presentation of five cases].

BACKGROUND: Actinomycosis is a suppurative and granulomatous chronic infectious disease caused by Actinomyces sp. and most commonly affecting the cervicofacial area. AIM: To study the clinical characteristics of patients with actinomycosis, with regard to clinical history, presentation, method of diagnosis, treatment and follow up. PATIENTS AND METHODS: A retrospective review was performed on all cases of microbiologically or histologically proven oral or cervicofacial actinomycosis.
RESULTS: Five patients were studied, 2 men and 3 women, 25-69 years old. Four patients had a history of surgical procedures and/or dental manipulations. Three patients showed the classic presentation of a lump and fistulization, and two patients presented intra-oral lesions. Four patients were diagnosed by cultures positive to A. israelii on microbiologic study and the remaining patient by cytologic detection of a sulfur granule. The first patient received the classic initial regimen of iv penicillin and 3 were treated with third-generation cephalosporins, continuing with oral amoxicillin during 12 months. Patient no.2 required a second surgical procedure. Patient no. 5, who had an exclusively oral process, received a short course of amoxicillin. There were no relapses during follow-up.
CONCLUSION: Actinomycosis is an uncommon disease. Establishment of the definite diagnosis requires a high index of suspicion and good clinical-microbiological collaboration. The classic course of iv penicillin and oral amoxicillin during 6-12 months is effective. For the acute phase treatment, iv penicillin can be replaced by third-generation cephalosporins.