[Oral and cervicofacial actinomycosis. Presentation of five cases]

Actinomycosis is a suppurative and granulomatous chronic infectious disease caused by Actinomyces sp. and most commonly affecting the cervicofacial area.To study the clinical characteristics of patients with actinomycosis, with regard to clinical history, presentation, method of diagnosis, treatment and follow up.A retrospective review was performed on all cases of microbiologically or histologically proven oral or cervicofacial actinomycosis.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.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.